In my experience at the end of a 30 hour shift you are aware you are tired, and thus far more likely to be double checking things, and plus you know the patients on your service the best you will know them, since you've been keeping them alive all night. Both of those things can often make you less dangerous than when you first show up.
This sounds like the drunk who thinks they're still ok to drive because they drive extra carefully when they're wasted.
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I'm glad that at least a few people agree that long hours = decreased performance. I agree that we don't know how long is "long," and that there are plenty of other problems with figuring out how to shorten hours. I never meant for my "8h x 3 shifts" thing to be such a point of contention...it was just a suggestion. I don't think 12x2 is unreasonable either. There are many other equally valid possibilities including the current rules, which think are actually pretty good, when used correctly.
I know of one program who have residents work from, like, 8am-2pm, then leave from 2pm-10pm, then come back for 10pm-8am call. We all know they are following the letter of the law, but not the spirit. No one is sleeping during that 2pm-10pm period, so their interns are still up for >24h.
There are many programs who aren't abusing their residents. On the interview trail, I found tons of programs whose medicine months were averaging in the 60h/week range, instead of the 80h/week range. We need to look at how those places are succeeding and making that work, instead of just pretending that we are super-human and infallible.
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Please bear with me a second here, but I do feel a little shafted when you all say that I'm not "ultimately responsible" for my patients. I understand that someone else bears "final responsibility," but I take my job very seriously and never just showed up on a service to watch residents treat patients. In fact, on many of MY rotations, there were no residents and I had a lot more responsibility than most of you were probably used to as medical students.
I had a patient once who had some problems with diabetic feet, in addition to numerous other medical problems. One day, my attending and I were examining a particularly nasty ulcer. During the process, we both examined his feet. A few hours later, he started thrombosing everywhere. He was on Heparin. He had developed HIT. Further exam revealed petechiae between his toes. We both missed it. He died a few hours later.
Now, I understand that my attending was "The One" responsible for that patient, but it was still MY miss. I could've caught that. To me, it will forever be MY miss, not his. I would add that he was on his 5th 12h (plus change) shift in a row and was a bit haggard, but I won't.
By the same token, MY saves are MY saves. I saw a patient presenting with anxiety and depression, who also had a history of a weird heart arrhythmia, muscle aches, joint problems, and a nice tan. His hemochromatosis had been missed by no less than 5 attendings (FM, Cards, GI, Rheum, Psych) and lord knows how many residents. I caught it. My save.
To say that a med student isn't responsible for their patients does us a disservice.
I guess my perspective is a little different since I rotated in so many non-teaching hospitals, and many of the teaching hospitals that I did rotate at had reasonable schedule (and I sought them out for that reason). I've certainly done long shifts, but I probably didn't have the same experience many of you did. I know most med students at the MD school near me didn't actually get to do any surgery on their surgery rotation. They just watched from a stool. I was taking things out and sewing things up.
I've also tended to have more patients on my census than residents are saying they take care of in residency. I did an IM rotation where I was personally responsible for 12-15 patients each day, with no resident or "team," and my attending (who is on CRACK) barely read my notes and saw the patients in about 1-2 minutes each, with only the most cursory of exams. Those were MY patients. I was scared to death he would miss something important. Only one of them died, of Herpes Encephalitis, and that was due to all of us missing his Herpes lesion and attributing his AMS to his EtOH use. So again, please don't assume that I only took care of 2-3 patients per day like some med students that I've talked to. That was not MY experience.
confused
