Wednesday, September 16, 2009 | Categories: Dr. Brian's Blog |
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: