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In many ways, I feel like medical culture is very old-fashioned. Truck drivers aren't allowed to drive if they haven't gotten any sleep, but your doctor in the

by Crake 13y ago

In many ways, I feel like medical culture is very old-fashioned. Truck drivers aren't allowed to drive if they haven't gotten any sleep, but your doctor in the ER making the decisions that will either keep you alive or let you die will almost always insist that 36 hour shifts are essential. There's a lot of ego involved, as can be seen in the way that that same physician will usually support limitations on truck drivers but will readily believe in their own inability to make mistakes--even in the face of scientific research showing otherwise.

idiot900 13y ago
At my hospital, residents take 24-hour calls. The trouble with shorter calls (say, 12 hours) is increasing the number of transfers of care. With 25 patients on a service, spending even five minutes on each means each "shift change" would take two hours. So you spend closer to one minute on each, and at that point it's easy to miss important details. We are skeptical of the "scientific research" because we've all seen errors made because of poor signout that were not happening before work hours were so restricted. For the record, attending ER shifts at my hospital are closer to 8 hours, and residents do 12 hours.
- Crake 13y ago
  I'm familiar with the transfer argument, but frankly find it a little alarming. Doctors are supposed to be very smart, but they're apparently unable to write down some sort of bullet point list or short paragraph about the state of a patient for the next person coming in? Good programmers document their code. The equivalent goes for doctors, too. It doesn't seem like you care much about it ("scientific research"), but IMO it's much more likely to put programs in place to help doctors learn basic literacy/documentation skills than to subvert the basic biological truth that staying up for as long as most medical students/residents/etc are forced to do puts them in a state equivalent to drunk driving. (http://archives.cnn.com/2000/HEALTH/09/20/sleep.deprivation/ http://archives.cnn.com/2000/HEALTH/09/20/sleep.deprivation/) I do NOT want someone crashing my health into a ditch because they were too tired to miss something important. Also if you don't have enough doctors? Maybe you should start training more of them, instead of artificially limiting supply. (Residency placement slots are a whole other issue, of course, but still not something that should stymie a first world country so.) I've had way too much experience with rude, sleepy, and grumpy residents who bungled my medical care in the last two years of frequent ER and inpatient stays to have much trust in the profession as a whole. I mean, if you're going to charge me $50,000 for your crappy medical care, could you at least not snap at me? Or forget me in an observatory room for over 12 hours waiting for a scan? They "lost" me in the system somehow until a nurse wondered why I'd been sitting there so long, called radiology, and left the room to bitch them out about forgetting me. Since the doctors couldn't be bothered to tell me what they were checking for, I only found out 13 or so hours later that the scan was to rule out a carotid artery dissection. I was in extreme pain the whole time, which they did nothing to even try to alleviate. Incredible lack of empathy. I'm glad to hear that your hospital has gone to at least trying to adhere to reasonable shift limits; it's a sign that at least some people in some hospital systems have decided that policies leading to killing or crippling patients is something that should be prevented, not encouraged. It's certainly not something I've seen in the major medical systems in my state. :(
  - idiot900 13y ago
    > Good programmers document their code. The equivalent goes for doctors, too. The information is there; there is simply too much of it to go over with the next person in the limited time available. I understand your point about commenting code - I meticulously document all my own code. > Also if you don't have enough doctors? Maybe you should start training more of them The training itself requires a huge amount of time and exposure to a large variety of situations. There are only so many opportunities for learning, and only so many hospitals which both can provide an appropriately varied case load, have attendings willing to teach, and can afford it. I'm sorry to hear you had a bad experience. I don't shout at my patients, or leave them for 12 hours without any information. > policies leading to killing or crippling patients is something that should be prevented It's not clear to those of us actually doing the work that this is actually true, when we examine our own personal experience.

by Crake 13y ago

idiot900 13y ago

At my hospital, residents take 24-hour calls. The trouble with shorter calls (say, 12 hours) is increasing the number of transfers of care. With 25 patients on a service, spending even five minutes on each means each "shift change" would take two hours. So you spend closer to one minute on each, and at that point it's easy to miss important details. We are skeptical of the "scientific research" because we've all seen errors made because of poor signout that were not happening before work hours were so restricted. For the record, attending ER shifts at my hospital are closer to 8 hours, and residents do 12 hours.

Crake 13y ago
I'm familiar with the transfer argument, but frankly find it a little alarming. Doctors are supposed to be very smart, but they're apparently unable to write down some sort of bullet point list or short paragraph about the state of a patient for the next person coming in? Good programmers document their code. The equivalent goes for doctors, too. It doesn't seem like you care much about it ("scientific research"), but IMO it's much more likely to put programs in place to help doctors learn basic literacy/documentation skills than to subvert the basic biological truth that staying up for as long as most medical students/residents/etc are forced to do puts them in a state equivalent to drunk driving. (http://archives.cnn.com/2000/HEALTH/09/20/sleep.deprivation/ http://archives.cnn.com/2000/HEALTH/09/20/sleep.deprivation/) I do NOT want someone crashing my health into a ditch because they were too tired to miss something important. Also if you don't have enough doctors? Maybe you should start training more of them, instead of artificially limiting supply. (Residency placement slots are a whole other issue, of course, but still not something that should stymie a first world country so.) I've had way too much experience with rude, sleepy, and grumpy residents who bungled my medical care in the last two years of frequent ER and inpatient stays to have much trust in the profession as a whole. I mean, if you're going to charge me $50,000 for your crappy medical care, could you at least not snap at me? Or forget me in an observatory room for over 12 hours waiting for a scan? They "lost" me in the system somehow until a nurse wondered why I'd been sitting there so long, called radiology, and left the room to bitch them out about forgetting me. Since the doctors couldn't be bothered to tell me what they were checking for, I only found out 13 or so hours later that the scan was to rule out a carotid artery dissection. I was in extreme pain the whole time, which they did nothing to even try to alleviate. Incredible lack of empathy. I'm glad to hear that your hospital has gone to at least trying to adhere to reasonable shift limits; it's a sign that at least some people in some hospital systems have decided that policies leading to killing or crippling patients is something that should be prevented, not encouraged. It's certainly not something I've seen in the major medical systems in my state. :(
- idiot900 13y ago
  > Good programmers document their code. The equivalent goes for doctors, too. The information is there; there is simply too much of it to go over with the next person in the limited time available. I understand your point about commenting code - I meticulously document all my own code. > Also if you don't have enough doctors? Maybe you should start training more of them The training itself requires a huge amount of time and exposure to a large variety of situations. There are only so many opportunities for learning, and only so many hospitals which both can provide an appropriately varied case load, have attendings willing to teach, and can afford it. I'm sorry to hear you had a bad experience. I don't shout at my patients, or leave them for 12 hours without any information. > policies leading to killing or crippling patients is something that should be prevented It's not clear to those of us actually doing the work that this is actually true, when we examine our own personal experience.