A few weeks back, I was having dinner with some friends/colleagues. One guy (a resident in a New York
hospital emergency room) I've known for a while looked simply exhausted. So, I asked him if he was feeling ok. He responded by saying (I'm paraphrasing), "No I'm not sick. It's pretty typical. I've worked 30 hours straight, with just one break in between. I really need to get out of here and just crash."
Everyone knows that doctors-in-training work extra long shifts and are often sleep deprived. So, I asked him the next logical question, "Can you think straight and actually be productive under these circumstances?" His answer definitely caught the attention of our entire table and made us think about how backwards this system is. It was something like, "I'm good until about hour 24 or 25. Then, I begin to question my own judgment on some patient diagnosis. But, sometimes the toughest part is just to read and correctly process the medical charts of each patient."
Yikes!
Clearly, my friend's experience isn't a singular one because US News & World Report just came out with a thorough study which proves that doctors-in-training across the country are far too tired to effectively do their jobs. Conducted by a panel within the Institute of Medicine, the report suggests that those regulations created five years ago which capped the amount of hours young MDs can work in one week (to 80) simply isn't working. Instead, they now recommend that anyone working a 30-hour shift requires a five-hour break for sleep after 16 straight hours of work.
The panel went on to make other recommendations including far more supervision of these young doctors by experienced supervisors and a better overlap of schedules during shift changes (making sure that the patient hand offs aren’t fumbled).
Even with these recommendations, this system is a disaster waiting to happen each and every day (actually, I'm sure those disasters do happen). The reality is that those who go through a 24-30 hour period with limited sleep (like these doctors experience) are sleep deprived. They experience fatigue and this fogs their brain. Studies have shown that most people actually fall asleep at the wheel (when driving) and others have a greatly increased risk of being in a traffic accident.
Think about this type of brain fatigue as a doctor needs to prescribe the right medicine for a life or death injury, or when he is taking part/assist in a surgery where the most delicate touch means everything. Would you want to be the patient in this situation?
This is a system that has been built (like a rock) over time. The quandary is that these residents cut their teeth by spending so much time working in hospitals, learning every aspect of their specialty. And, the economics work for hospitals because they can have fewer doctors, spending more time on many more patients. But, this is the only profession that operates (no pun intended) this way. And, the safety aspects (never mind the quality of living issue) simply don’t work.
We have some 100,000 doctors who are fresh out of medical school now. It's time to toughen up these standards even more. Doctors should follow the advice they might offer their own patients who are over worked, exhausted and stressed out: Take it easy and go get a good night's sleep.
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