Asymmetrical Information

My rule was "if you are phyiscally incapable of pushing the car you own to the side of the road in an emergency, you shouldnt drive it"

and 'if you can't change a tire, you cant drive a car".

Doesn't this really just illustrate that we should all use public transportation and kill off cars? No doctor training at a hospital in Manhattan ever had this problem.

And all you red staters say we New Yorkers are good for nothing. At least our doctors don't go around killing people with their cars. They use subways. In a word: duh.

The above comment has to be a joke.

Shorter NY Times: hazing is stupid.

That ER show's been saying it for years before they jumped the shark.

Of course my comment was a joke.

Hell, if it's O.K. for someone who hasn't slept in over 30 hours to perform an emergency tracheaotomy, why not open employees-only cocktail lounges in all the trauma centers? On the other hand, why should docs and nurses have all the fun? Quaffing hooch would make the waiting times more bearable for the patients as well!

Doctors think they are superman. A few years ago, there was a lawsuit when a very tired young doctor made a serious mistake in treatment - a lawsuit aimed at the hospital that arranged his hours, not at the doctor. Senior doctors from the AMA and medical schools all lined up to testify that a doctor should be able to perform well after 48 hours without sleep. But I'm sure my doctor would tell me that it was a terrible idea for me to miss that much sleep - quite aside from driving or performing any other dangerous or mentally intense task. But it's all right for their profession.

When MD's worked alone on the frontier, it was necessary for them to be supermen sometimes. When cholera hit several isolated farms at once, the doc just had to keep riding around between them until his patients recovered or died - and then he might get weeks of no work to rest up. But to carry that over to routinely scheduling 30 hour shifts in an urban hospital is ridiculous. Also, in frontier days the doc's job wasn't all that complicated, because he didn't have that many effective treatment options to choose from (and that's assuming he didn't subscribe to such idiocies as bleeding every patient). Most of the patients who recovered would have eventually recovered anyhow. Now we expect the medical student to practically memorize the encyclopedia, the doctor to keep up with maybe a thousand pages of new information a year, and the doctor to immediately recall all the relevant information under stress - and mistakes kill people who could have been saved.

I don't think it's cuz doctors think they're superhuman (how many senior doctors pull 30-hour shifts?). My impression is that this turned into a rite of passage for young doctors and med students. Or, as I said, hazing.

The medical profession has been called on this before, but traditions are tough to change, even when lives are at stake.

Doctors, in general, do not choose to work 30 -hour shifts. They are required to work 30-hour shifts by their residency program, by the hospital that employs them.

I don't know anything that the doctors can do about it. Do you have any suggestions, Jane? Should the doctors just quit?

The solution is simple. Distribute the workload more evenly between junior doctors and senior doctors. I presume doctors do have a say in this part of hospital policy, no?

Long hours worked by medical residents are just a symptom of the anything-for-a-buck mentality of residency programs, coupled with the desperation of deeply in debt interns and residents. My internship program not only worked us like dogs, but allegedly committed $22.5M worth of billing fraud on our behalf. My residency program forbad me from telling people the risks of procedures, lest they not have those procedures, even while the feds were breathing down the hospital's neck for decieving patients. More details are listed here. Read the more recent posts for a story of alleged healthcare fraud.

fling93:

Senior doctors often have extra responsiblities which keep them from taking on the longest shifts. In some departments, the senior doctors do work 30-hour shifts, too.

It seems to be a structural, or at least a management problem throughout the hospital business.

I have a cousin and college buddy who became doctors ten and twenty years ago. I asked them about the long residency shifts at the time, and they both said that it was so that the young doctors could follow individual cases over a longer constant period to observe the progression of various conditions.

Of course, this could just be a made-up reason the older hands tell the new guys because that's what they were told when they were young. On the other hand, I'm alive today because a doctor remembered something he'd seen on one of these long residency shifts. (I have a rare enzyme deficiency that put me on life support once, and one of the doctors remembered seeing a similar case in his residency and thought to order the right diagnostic test -- but there's no guarantee he wouldn't have seen the same thing on a shorter shift.)

I suspect that there is a shortage of doctors in this country; that if the AMA and various governmental agencies, along with the education industry, did not work towards restricting supply (deliberately or not), there would be far more doctors to spread around the workload. I don't hear of pilots or dentists having to work 30 hours straight in order to meet demand.

Matthew Goggins: Senior doctors often have extra responsiblities which keep them from taking on the longest shifts. In some departments, the senior doctors do work 30-hour shifts, too.

Are you saying that, on average, senior doctors work the same number of hours as junior doctors?

I've asked otherwise sensible people who are doctors or residents about this and they say things like "doctors need to be able to work under pressure" to justify the 30-36 hour shifts. When I call them on the effects of a lack of sleep, they get sheepish, but continue to mutter the above like some kind of incantation or mantra.

But then they also defend the Match and the collusion by medical schools on residency programs as being necessary for a variety of reasons, many of which are based on 1800's or early 1900's society.

Bolie IV

Older doctors work just as many hours per week, they just have the freedom to schedule it in a sane manner. E.g., after my wife had gall bladder surgery, the surgeon (who was nearing retirement age) checked up on her at 9 PM and was back to check again before 7AM. But he hadn't stayed at the hospital in between! And IIRC, he also had a time in the afternoon when he wasn't available unless you could convince his secretary that it was an immediate life-and-death matter. Nap time, obviously.

The effects of sleep deprivation are mildest in young adults, but I very, very much doubt that any doctor would approve of a pilot of any age climbing back into the cockpit after being up for 30 hours. But they've got no problem with requiring a resident of the same age to make life and death decisions when just as tired.

And finally, I agree that there must be collusion to limit the supply of doctors. Overly-tired doctors are one bad effect of this. A far more serious problem from a patient's point of view is doctors that have no time to listen to the patient or to fully explain their diagnosis and treatment, and maybe not even to review the record and think about the case. When I was in the Air Force, I had to go to the clinic six or eight times within 3 months with severe cold or flu symptoms. Three months before I could get someone to look back through the record and realize that this wasn't yet another cold. Then it took less than three weeks of the right treatment to wipe out the mononucleosis germs.

I don't think this can blamed entirely on an anything-for-a-buck mentality. We have exactly the same issues in Canada in our public system. I knew one med student who did a three-week internship at a small-town hospital and never had a chance to leave the building. He essentially worked straight through and grabbed snatches of sleep whenever he had a few spare hours. I'm not sure what excuses he was given to justify the long hours, but he made it quite clear he wasn't buying them.

In case you haven't seen it, Alex Tabarrok at Marginal Revolution posted on this too.

At least our doctors don't go around killing people with their cars. They use subways. In a word: duh.>>>

yes living and dying in NYC is the best...
but the exhausted doctors get to operate anyway!!

I think people are missing the key point: Doctors may be twice as likely to get into an auto accident, but it appears that they are driving home less than half as frequently. Thus, this reduces the total number of accidents into which they will get. This sounds like a good thing for society and, incidentally, the young docs themselves.

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