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

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?

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.

> 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.

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

That’s a lot of handovers.

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.

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!

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