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I hope that the actual medical field starts taking note of this. My wife still has to work 24 hour shifts with no sleep, performing emergency surgeries no matt
by HEmanZ 1y ago
I hope that the actual medical field starts taking note of this.
My wife still has to work 24 hour shifts with no sleep, performing emergency surgeries no matter how long it has been since she slept. During residency only a few years ago she and her co-residents were almost weekly required to do 36 hour shifts (on top of their regular 16 hours per day, 5 day per week schedule) and once even a 48 hour shift when the hospital was short staffed.
Of course I’m sure they won’t. No one cares if doctors are over worked.
- lordnacho 1y agoI've never understood those long shifts. Unless a shift just means you are there but sleeping, what is the reason for allowing it? We don't let truck drivers do 24h shifts, why do doctors the world over seem to do this?
- munificent 1y agoMy understanding is that the research shows that the harm to patient care from information loss during doctor shift turnover is worse than the harm from fatigued doctors. Yes, a tired doctor sucks. But a tired doctor who already has the patient's state loaded into their head may still be better than doctor who is completely fresh in both senses. It's a hard problem.
- harperlee 1y agoThat only works if the mean stay in the hospital (or at least the critical care period) is several hours but also way below 24h…
- Timon3 1y agoLonger shifts mean fewer shift turnovers for any patients that stay a sufficient amount of time, especially if longer than 24h. The world doesn't run on boolean logic. A solution can improve an issue without solving it completely.
- Fire-Dragon-DoL 1y agoWhat about the harm to the doctor themselves+the harm to the patient? Would the sum of both be worse?
- arjvik 1y agoOne signed up knowing the risk (not defending, I also think its insane, just devils advocate)
- thaumasiotes 1y ago> My understanding is that the research shows that the harm to patient care from information loss during doctor shift turnover is worse than the harm from fatigued doctors. This would not appear to apply to emergency surgeries. They aren't done by doctors who are familiar with the patient anyway. (Neither are non-emergency surgeries. Surgeries are done by doctors who do that kind of surgery. Familiarity with the patient is useful in deciding what surgery should be done, but not in doing the surgery.)
- renewiltord 1y agoThe European Working Time Directive has requirements for rest, etc. Either Europeans have much better hand-off procedures, they don't know how to comply with the rules they make, or they're fucking idiots who are going to kill people due to information loss during shift turnover. It was proposed decades ago. I wonder what compliance is like in Germany, etc.
- K0HAX 1y agoInstead of 1 doctor covering a 24 hour shift, why not pair them and overlap? 12:00am - 6:00am: Doctor 1 and Doctor 4 are doing everything together. 6:00am - 12:00pm: Doctor 1 and Doctor 2 are doing everything together. 12:00pm - 6:00pm: Doctor 2 and Doctor 3 are doing everything together. 6:00pm - 12:00am: Doctor 3 and Doctor 4 are doing everything together. This way, all 4 doctors only do 12 hour shifts, and the patient's state is maintained continuously through all 24 hours.
- ineedaj0b 1y agoDoctors do not get along and that’s too many Drs. Each patient often has multiple speciality Drs visiting them and reviewing their case up to 3 or 4 sometimes already. Imagine being on consult and trying to figure out which guy on a team of 4 you should talk to about such and such.
- someguyiguess 1y agoIf engineers ran the world
- lostlogin 1y agoThat’s a lot of handovers.
- deleted 1y ago[deleted]
- munificent 1y agoHere's an anecdote that might help answer. When my wife was pregnant with our first doctor, she started hemorrhaging spontaneously ten weeks before her due date. We rushed to the ER. 1. Shortly after, a doctor A came in, asked some questions, looked at the chart, and told us she was having the baby tonight. Holy shit our life is about to get crazy and we're going to be parents 2+ months early! He leaves. 2. Several hours later doctor B comes in. We ask about delivery. "Oh, no. You're not going to have the baby now. But you will have to be on bed rest until the due date." Jesus, my wife is going to have to quit her job. 4. Even more hours later, now the next morning, doctor C arrives. "OK, you're free to go home. No bed rest needed. Just let us know if anything else happens." My general experience with doctors is that you get as many unique opinions as there are doctors in the room. This is not an indictment of the profession. Human bodies are insanely complex, there is way more variation between them than most people realize, and doctors are operating under very very limited time and information. Having overlapping doctors would likely cause even more patient confusion and increase the risk conflicting treatments. Also, it would obviously double the cost of care. (My wife and baby were fine. Partial abruption. Very scary and my daughter was born five weeks early, but no other significant problems.)
- arcticfox 1y ago> Yes, a tired doctor sucks. But a tired doctor who already has the patient's state loaded into their head may still be better than doctor who is completely fresh in both senses. AI fixes this. Imagine the boot time of loading a patient's state from dozens of labs and files vs. a summary that gets you to exactly what they're going to end up remembering anyways. And if a doctor finds something interesting that the AI doesn't flag, they should be flagging it in the chart for the next doctor anyways.
- deleted 1y ago[deleted]
- solsane 1y agoIn my experience, AI summarization is a pretty lame application. I don’t really need a block of potentially wrong, rephrased text. I’ve got a feeling that the same applies to healthcare.
- munificent 1y agoJesus Christ you have to be fucking kidding me. Your solution to information loss during doctor handover is to insert a brainless hallucinating program with zero responsibility into the middle?
- toast0 11mo agoIf charting was sufficient, doctor (and nurse!) handover wouldn't be a problem.
- amluto 1y agoI have never, in my entire life, ever personally encountered a situation in which a doctor paid enough attention to anyone over a period of time exceeding two hours that I could possibly believe that keeping the doctor on shift for a long time had the slightest benefit. I’m sure cases exist. But I’d be rather surprised if they’re common.
- deleted 1y ago[deleted]
- deleted 1y ago[deleted]
- cma 1y agoThe AMA works to prevent importing doctors from other countries, largely to maintain wages, but we don't have enough doctors. Doctors boards and AGME (partly governed by AMA, but there is some amount of public representation) control residency admissions and board certification. We don't necessarily want low admissions standards, but there is a lot potential conflict of interest in constraining supply. Some states, I think I read Florida recently, have started pushing back to allow in foreign doctors.
- magicalhippo 1y agoHere in Norway the doctor's association have worked hard against it, and talking to a relative which became a doctor some years ago, it's primarly because they want to keep the extra premium pay they get from the "uncomfortable hours" as it's called here.
- random3 1y agoI think both doctors and patients would want a different system for both doctors and patients. Having seen a poor performing medical system, and comparing it with the US medical system, all I can say it's that the US one doesn't seem designed to optimize health and well being of patients and, based on reading several articles representing doctors opinions, neither doctors'. I do think it's maximially optimized to extract revenue. That can sometimes be good (e.g. good access to healthcare) but often times it's not great. Given healthcare, along with education should be a national priority, both should be heavily "configured" to serve peoples' goals first and any financial goal should be secondary (although arguably useful). I suspect the current shareholder structures from hedge funds are (intentionally or not) driving things in the wrong direction wrt to public health goals. This is article from a few days ago is also interesting https://news.ycombinator.com/item?id=45680695 https://news.ycombinator.com/item?id=45680695
- jdthedisciple 1y ago[flagged]
- cestith 1y agoWho said she was forced, and why the personal attack?
- jdthedisciple 1y ago> still has to work 24 hour shifts with no sleep Reads like being more or less forced to me, it doesn't to you? > and why the personal attack? Not at all my intention! It's a genuine question, which I would ask myself too were I in OP's shoes
- cestith 1y agoI doubt her spouse makes her be a doctor. Most people who go through premed and medical school are pretty dedicated and driven on their own. This is a corporate vs labor issue, and likely not a domestic issue. I’m sure he dislikes it greatly, too.
- HPsquared 1y agoIt's not so much "forced", as "given an offer they can't refuse".
- switchbak 1y agoThis is the nature of the medical system in North America, and some other advanced nations. Also, you're not just being blunt, you're being both ignorant and arrogant.
- jdthedisciple 1y agoIf OP feels the same way, I offer my heartfelt apologies. I don't think what I said would come across this negatively in person though, but okay..
- ineedaj0b 1y agoher at her worst is better than 90% of people at their best. if you get through and into a good med school -match into surgery- you are Peak in a way very few are. I don’t see this changing unless they reduce the requirements for med school; if they let anyone in who wants in and force that group to work 30hr shifts - you’ll get enough bad outcomes the system will change. There was a study, I believe on nurses and shift durations. The study found the nurses were happier with shorter shifts - but the patients did worse. Patients come first. I could see a group of Doctors loudly proclaiming love for Donald Trump (and mentioning very much how great he is) and pleading the case for a change and something happening. He is an interesting president. I would be interested in hearing a european drs perspective, I heard they work shorter shifts (but no EU dr I met has confirmed, it’s like meeting a unicorn)
- lostlogin 1y ago> her at her worst is better than 90% of people at their best. A fraction of a fraction of a percentage of people are good at surgery. If I need someone cutting me, I’d prefer someone good, and that they were rested.
- whamlastxmas 1y agoThis stupid hazing ritual is only happening because of the AMA, which is doing it for really stupid "because we had to" logic.
- bmitc 1y agoWere these continual shifts? I thought that doctor's on shift like this were given sleep rooms to sleep when they aren't needed.
- evulhotdog 1y agoYeah they usually do have a dedicated sleeping space for their service. The thing is, they only sleep if there’s enough downtime. Depending on your service, size of the program, and of course who your patient population is, it could be a lot, or none at all.
- evulhotdog 1y agoCurrent ACGME rules allow a max of 30 consecutive hours, so not as bad but still not great for someone you would hope to have fine motor skills to save a life!
- tomaskafka 11mo agoIt is well estabilished that after 24 hours without sleep, the mental capabilities are similar to being lightly drunk. 36 hours is considerably more drunk. If you were driving a truck in EU, you would have several mandatory 8h stops by then.