Pilots aren't allowed to do it. Truck drivers can't either. But it seems medical residents, at least in Ontario, are permitted, and even sometimes required to work twenty-four hours in a row.
A resident in Quebec took his schedule to the courts, arguing that working that long violated his charter rights. He won. Now other provinces are re-examining their policies.
Dr. Jonathan DellaVedova is a 4th pediatrics resident at McMaster University. He is also president of PAIRO, the Professional Association of Internes and Residents of Ontario.
He spoke about that gruelling schedule with CBC Ottawa's Robyn Bresnahan. Here's a transcript of the interview. You can also listen to the interview on this page.
Robyn Bresnahan: I understand you're actually about to start a 24 hour shift. How do you feel about that?
JD: We do know from the medical literature that the 24 hour shift is a challenge for residents and can risk patient safety in some ways. Certainly, I’m in pediatrics and my eight-year-old patients can tell you that a 24-hour shift defies common sense and that a performance towards the end of a 24-hour shift probably isn’t optimal. We know that diagnostic errors, medication errors, needle stick injuries and car accidents on the way home are all more common with 24-hour shifts.
RB: You’re about to go work this 24-hour shift. I assume it’s not the first time you’ve done this?
JD: No, it’s been several years of residency that I’ve been doing 24-hour shifts but on the bright side there are dozens of residency programs in Ontario, including my own, that are experimenting with ways to eliminate the 24-hour shift altogether. Some call it Night Float and some call it Role Call because you don’t see daylight for weeks at a time. But there have been quite a few pockets of success which we think are great for residents, greats for the hospitals and ultimately beneficial to patients.
RB: When you work a 24-hour shift, you go into it…you’ve had how much sleep?
JD: We try to be as well rested as we can before the start of a 24-hour shift.
RB: How many hours did you get before you’re starting this shift?
JD: Six or seven, which is pretty good in the residency world.
RB: How do you feel at the start of the shift compared to how you feel at the end of it?
JD: The start of the shift is no problem. I personally start to feel a dip in the evening around 7:00 or 8:00, right after dinner and then you just have to draw on all your resources, grab some caffeine or a Red Bull and keep going. Some shifts aren’t as busy and we can steal an hour of sleep here or there but some shifts are just busy all the way through.
RB: This just sounds wrong, right from the start. You’re saying you grab a Red Bull. You’re a doctor, they’ve done studies and that stuff is terrible for you.
JD: Unfortunately, in the residency universe, we’re a little challenged at taking care of ourselves sometimes. We’re eager to learn and serve the public but we want to do so in a way that’s safe for patients and safe for ourselves.
RB: Are you doing any kind of major surgeries at all during your shifts?
JD: There are no surgeries, per say, in pediatrics but many of my colleagues are performing operations overnight. Regardless of what specialty we’re in, we’re making critical life and death decisions, we’re prescribing medications all throughout the shift.
RB: Once you become a doctor, do doctors have to perform 24-hour shifts?
JD: Yes, it’s very common for independently licensed physicians to also be working 24-hour shifts.
RB: What do you think of that?
JD: In Ontario the approach we’ve taken is to look at this issue more broadly because it’s very complex. We’re looking at the issue as fatigue management. We’ll never be able to eliminate the need for healthcare at night. We like to think of the topic more broadly and include our senior colleagues when we talk about duty hours.
RB: What would you propose as a solution instead of working 24-hour shifts?
JD: In Ontario we haven’t come out advocating for a hard cap on hours like they have recently in Quebec. We’ve been looking at these pockets of success where residents and programs have some up with solutions on their own to eliminate the 24-hours shift. We want to get these models out there so that people can benefit from sharing best practices and perhaps apply them a little bit more broadly.
RB: What would be the ideal working situation for a medical resident, in your view?
JD: There’s no unifying solution that comes to us from the literature. What we need to do is look at situations that have been working. This discussion has been going on for many years and the rest of the world is way ahead of us with strict duty hour limits in the U.K. , Europe, Australia and New Zealand. Obviously 24-hour shifts defy logic but, depending on where you are in Ontario, the solution might be different. We’re in favour of allowing individual programs to have all of the information they need around the pitfalls of 24-hour shifts and come up with their own solutions.
RB: Doctor, thank you very much.
JD: Thanks for having me, Robyn.
Dr. Jonathan DellaVedova is president of PAIRO, the Professional Association of Internes and Residents of Ontario and a 4th pediatrics resident at McMaster University.