Attention lapses due to sleep deprivation due to flushing fluid from brain

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.

I'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?

I 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

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.

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.

That only works if the mean stay in the hospital (or at least the critical care period) is several hours but also way below 24h…

What about the harm to the doctor themselves+the harm to the patient? Would the sum of both be worse?

One signed up knowing the risk

(not defending, I also think its insane, just devils advocate)

Longer 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.

Who said she was forced, and why the personal attack?

> 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

This 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.

I 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.

If 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..

> 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.)

The 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.

The 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.

Instead 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.

> 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.

her 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)

Doctors 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.

In 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.

If engineers ran the world

A surgeon is going to make more than an SWE. Also, surgeons are famously unhappy with anyone questioning any of their decisions.

It's not so much "forced", as "given an offer they can't refuse".

That’s a lot of handovers.

> 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.

It’s an interesting paradox.

Imagine doing your best to help someone and they die as a direct result.

Then you get to go to work and deal with the next case.

Or the patient has life changing, negative outcomes. Damn, that bad. Next case.

Living in that mental state takes a pretty unusual character type. We can expect some extreme behaviour.

It’s also interesting watching the change over time. The trainee versus consultant, or the surgeon as they near retirement.

I’m not a surgeon or a doctor and so I see a small part of their world but see some of the perks (they get everything) and some of the downsides, and there are a lot.

Here 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.

GP's wife isn't being forced into this profession and they are making a lot of money from it. Do we need to offer sympathy for all people with difficult working conditions regardless of the remuneration?

This stupid hazing ritual is only happening because of the AMA, which is doing it for really stupid "because we had to" logic.

Were these continual shifts? I thought that doctor's on shift like this were given sleep rooms to sleep when they aren't needed.

Here'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.)

Jesus 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?

Many industries have solved this issue already. Use a pilot/copilot model. First doctor drives, second one mostly observes and makes sure the first one doesn’t make mistakes.

The answer is there’s already a doctor shortage, and the US simply does not have the capacity to effectively 2x the doctor-patient ratio.

Doctors are also unlikely to want a 50% pay cut in exchange for shorter hours. They aren’t directly exposed to the risk caused by fatigue since they will have malpractice insurance. Therefore the safer method of care would be simply too expensive, and doctors wouldn’t see an upside.

Part of the shortage is a result of artificially constrained supply as there aren’t enough med school seats to keep up with demand.

Maybe doctors are divas and they tend to not communicate very well with others

I 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.

The doctor shortage is entirely caused by intentionally limiting how many doctors are admitted to med school every year

Then you'd need to pay more doctors, and it would be much harder for the hospital to make a lot of money!

Current 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!

Yeah 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.

It 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.

If charting was sufficient, doctor (and nurse!) handover wouldn't be a problem.