Wednesday September 16, 2009
Telling Tales About Sleep Deprivation
We've gotten an avalanche of emails and blog postings in reaction to our episode last Saturday on sleep deprivation among resident physicians. But if you think the problem of sleep deprivation ends with residency, you're dreaming in High Def!
Here's what Dr. Marcelo Lannes, an anesthesiologist and critical care specialist at McGill University in Montreal wrote us:
"Interesting your talk on medical residents and work load. I was chief resident quite a few years ago and remember having to defend residents against abuse, such as refusing post call days and vacations. What I could not imagine however, is that I would work even longer hours as an attending physician. I have worked in anesthesia in a community hospital where I had to do one in two 24-hour calls for a month. This hospital had obstetrics and trauma services, so nights were very busy. There was no post-call day. My personal record was 42 hours straight at work.
In my current job I have between 12 and 15 calls a month... As a resident, I could not take more than 7 calls per month, I had the next day free to recover and I was not allowed to work more than two weekend days in a month (one Saturday and one Sunday). Now, it happens that I am working three weeks in a row in the ICU. Last July I worked 24 days without a break, because of staff vacations. I wish we also had mechanisms in place to prevent this kind of overwork without this affecting our income."
And Dr. Stanley Stolar, yet another anesthesiologist, had this to say:
"Dear Dr. Goldman, Congratulations on an excellent and informative program. I am an Anesthesiologist who has been on the academic staff of teaching hospitals in the United States and in Canada for the past 40 years. Unfortunately, there are two conflicting problems at play: increased work hours increase the likelihood of errors, but decreased work hours increase the frequency of patient handoffs, which are also associated with significant increases in errors. The concern is for those physicians who have trained under the new restricted hours but then go out into private practice where there are no limits and strong incentives to overwork. "
As an emergency doc, patient handovers are something I know a great deal about. In terms of patient safety, passing a patient from one MD to another is inherently high risk. I've personally seen and been party to a number of problems over the years that are caused by crucial clinical information NOT being passed from one MD to the next. There's no question that if you want shorter work hours for resident and attending physicians, there is a price to pay in more frequent handovers. We'll do a story on that later this season.
In the meantime, the chat I had on the show with Dr. Mike Wansbrough about the drug we both take to keep us awake and alert during and after those long night shifts has caused quite a stir. We thought we'd post a longer version of the interview (we're always so squeezed for time in the show!) for your interest:
Previous Comments (3)
I think that so long as healthcare is single payer doctors will be payed less then the united States which has a free healthcare system and as a result there will always be doctor shortages. The first step is to allow for private clinics and hospitals which are allowed to charge their patients for care, this will encourage competition and innovative ways to treat more patients.
Another solution is to end the CMA monopoly on doctors. Dr. Michael F. Cannon of the Cato institute and author of Healthy Competition argues that we should license facilities rather than personnel. Economist Milton Friedman was also a strong opponent of the AMA licensing in the States. If nothing else allowing for less trained doctors, allowing nurses to perform simple surgeries, allowing for midwives, chiropractors, and others to play a role in healthcare would take up slack and allow the best surgeons perform complex surgeries working shorter days then and doing the best job possible.Brett Knoss, September 18, 2009 11:33 PM
It's not only MD's that have to deal with the effects of sleep deprivation. Many health care professionals have to work overtime and be on call for emergencies, especially in smaller facilities. There have been times I've been out for calls two or three nights in a row and end up exhausted and sick for a week after. Thankfully that doesn't happen often. My biggest concern in those situations is my own health. If I'm sick I'm no good to anyone.Dan Adams, September 21, 2009 2:43 PM
Your show on sleepy residents focused on the pressures that compel them to work long hours.
Interestingly, at the end of the show, your solutions included relieving residents of "scut work" such as filling out forms and blood draws. Overwork wasn't listed among the reasons residents felt compelled to postpone going home -but rather, concern over patients, the desire to learn and the threat of a negative evaluation. Is it not important for residents to master tasks such as blood draws, which they are required to perform during codes? And the time spent filling out forms not a problem across health care fields? Doctors, nurses, social workers, PT and OTs are all plagued by endless paperwork. Calling blood draws and filling forms "scut work" is also insulting to the healthcare workers whose job it is to perform these tasks. What does that say for your ability to work respectfully and collaboratively with other healthcare professionals? As a nursing student, I enjoy your show and often agree with your viewpoints, but find your use disrespectful language to describe the work of other health care professionals tiresome. It just reinforces old, unflattering stereotypes.