Do residents/med students take meds to stay awake?

[pianola]

I can count the number of times I've stayed up 36+ hours on both hands.

What on earth do med students in clinical rotations and/or residents do to stay awake?

I know there have been articles about abusing Adderall/Ritalin/[insert drug of choice] -- anyone care to wager a guess as to whether a majority of students use drugs of some sort or whether it's just a few?

---

Members don't see this ad.

 

[MILK07]

I would guess it's a lot of caffeine. Also, usually when they are up, they are really busy, which would keep the adrenaline going. I think maybe your body just gets used to it after awhile and you learn to stay awake for long periods of time or just take 20 minute naps to tide you over.

 

[MaryLennox]

i do think a lot of people use those drugs and do so lightly. it seems like they are easy to get. when i was struggling and studying for my phys 2 exam someone offered me some adderall but i said no- i've heard enough to know that it really does work, and i don't want to set a precedent for myself where I need to have it in order to succeed. it seems like it would be addictive. what happens if you are so used to using it, and then all of a sudden something happens where you cant get it? do you start falling asleep and failing tests? i dont know.

so for now i just try to stick with getting as much sleep as i can when i can, and drinking a lot of coffee when i need to focus. although coffee helped me a lot more for some things (chem🙂) than others (physics.🙁)

 

[richse]

I know that Modafinil http://en.wikipedia.org/wiki/Modafinil is being prescribed for people who work night shifts and it is used by soldiers to stay alert with very little sleep. I'm not sure about doctors using it, but given that it supposedly has less side effects (shaking, elevated heart rate) than caffeine I would imagine it could be beneficial over downing an extra large coffee.

 

[Catalystik]

What on earth do med students in clinical rotations and/or residents do to stay awake?

I got through residency with only adrenaline to keep me going during bad call nights and the following work day. If anyone else was using more than coffee to stay alert, they were discrete enough to keep it to themselves.

 

[CCLCMer]

I can count the number of times I've stayed up 36+ hours on both hands.

What on earth do med students in clinical rotations and/or residents do to stay awake?

I know there have been articles about abusing Adderall/Ritalin/[insert drug of choice] -- anyone care to wager a guess as to whether a majority of students use drugs of some sort or whether it's just a few?

I don't think it's the majority. Haven't you ever pulled an all-nighter before? You don't really crash until the following afternoon. Plus after a while, you just get used to functioning while being tired. And you also start nodding off whenever you're not actively doing anything. I've even dozed standing up before, and I've heard stories about people falling asleep while retracting during a surgery. That's my next rotation, so I'll let you know how easy it is to do that. But mainly what I do is try to keep myself moving. I don't think drugs are a very good solution in the long term, because eventually you get used to them, too, and they don't work as well any more.

 

[pianola]

Haven't you ever pulled an all-nighter before?

I guess so. But I only have about 3% of my normal brain function after the full 24 hours and I'm not even sure I could fathom what 36 hours is like 😳.

30 minute naps can make things easier on me if I have to stay awake for long periods of time -- but it sounds like these rotations are 36 hours/no breaks ==> Full Steam Ahead!

Good luck in surgery rotation!!😀

 

[MilkmanAl]

There are several med students who get Provigil from the pharmacy I worked at. One of them even has his dad write the script for him...

 

[nonesuchgirl]

I guess so. But I only have about 3% of my normal brain function after the full 24 hours and I'm not even sure I could fathom what 36 hours is like 😳.

30 minute naps can make things easier on me if I have to stay awake for long periods of time -- but it sounds like these rotations are 36 hours/no breaks ==> Full Steam Ahead!

Good luck in surgery rotation!!😀

If you're having an awful night, they can be.

Otherwise, you've usually got a bit of downtime.

 

[betheltim]

I'm not sure if I'll ever be able to wrap my head around how those in charge of residents and those in clinical rotations see this type of thing as a good idea, haha...

But I guess if it's worked for this long, it won't change, huh...

 

[pianola]

I'm not sure if I'll ever be able to wrap my head around how those in charge of residents and those in clinical rotations see this type of thing as a good idea, haha...

👍 When we become physicians we're just going to have to remember that sentiment...that's my take on things anyway.

 

[betheltim]

👍 When we become physicians we're just going to have to remember that sentiment...that's my take on things anyway.

Yeah. I mean, I don't care about the residents and the people doing clinical rotations... I would be more worried about the patients and those directly or indirectly affected by those working with these everything-deprived students... Hmm...

 

[beachblonde]

There are several med students who get Provigil from the pharmacy I worked at. One of them even has his dad write the script for him...

That stuff is way expensive, but it works wonders for people with OSA, shift-work disorders, etc. It costs, retail, like $300/month.

In the book Intern, the author (a physician) wrote about telling another resident he was terrified that he would fall asleep, or sleep through, some of his shifts. The resident asked if he had ever slept through a final exam (his answer being no) and said that intern year is like having a final exam every day. Hence, the adrenaline and perhaps some pure terror keep you going.

 

[Raryn]

Studies have shown that limiting the Resident work week to 80 hours and shifts to a maximum of 30-36 hours in a row has shown no decrease in mistakes due to fatigue. I.E. Residents were working at the same level at hour 42 before that they're working at hour 30 now...

If theres no benefit to lowering the limits this much, no one really has any incentive to lower them more.

 

[betheltim]

Studies have shown that limiting the Resident work week to 80 hours and shifts to a maximum of 30-36 hours in a row has shown no decrease in mistakes due to fatigue. I.E. Residents were working at the same level at hour 42 before that they're working at hour 30 now...

If theres no benefit to lowering the limits this much, no one really has any incentive to lower them more.

Interesting... Do you know where I can find information on that/those studies?

 

[Raryn]

Interesting... Do you know where I can find information on that/those studies?

http://jama.ama-assn.org/cgi/content/abstract/298/9/975 is the quick one to find. Looking through the citations/articles that cite it gives you more, but its a good start.

 

[MilkmanAl]

That study only references mortality rates. The simpler, more commonplace fatigue-related issues like working inefficiently and forgetfulness are going to be tough to measure.

Isn't the fact that people are researching how fatigue during a "normal" work schedule affects residents an indication that they're pretty clearly overworked?

 

[betheltim]

That study only references mortality rates. The simpler, more commonplace fatigue-related issues like working inefficiently and forgetfulness are going to be tough to measure.

Isn't the fact that people are researching how fatigue during a "normal" work schedule affects residents an indication that they're pretty clearly overworked?

Yeah, mortality rates of Medicare patients.

I'm not saying it isn't important or legitimate, but only measuring mortality rates and that of only Medicare patients is kind of fuzzy. But anyway, I still stand by my first post when I say that I'll never be able to wrap my head around the fact that people think it's the safest or best way to teach someone... But, then again, I'm not a resident, not a teacher, or in any position similar to residents, so I can't say what they experience. It's just always made me scratch my head to an extent.

EDIT: Am I wrong, or does one of the abstracts listed as citing the given abstract actually show a "significant" decrease in mortality among medical patients in Virginia teaching hospitals post-reform?

I'm also curious about how or if they measured hours worked by residents; by timecards, survey, supervisor, etc.

 

[Raryn]

That study only references mortality rates. The simpler, more commonplace fatigue-related issues like working inefficiently and forgetfulness are going to be tough to measure.

Isn't the fact that people are researching how fatigue during a "normal" work schedule affects residents an indication that they're pretty clearly overworked?

http://jama.ama-assn.org/cgi/content/extract/298/9/1055 seems to be another one. I don't have full text access to JAMA though, so I can't vouch for methods. Many people have told me that theres been no noticeable benefit overall though.

 

[scarletgirl777]

Yeah, mortality rates of Medicare patients.

I'm not saying it isn't important or legitimate, but only measuring mortality rates and that of only Medicare patients is kind of fuzzy. But anyway, I still stand by my first post when I say that I'll never be able to wrap my head around the fact that people think it's the safest or best way to teach someone... But, then again, I'm not a resident, not a teacher, or in any position similar to residents, so I can't say what they experience. It's just always made me scratch my head to an extent.

EDIT: Am I wrong, or does one of the abstracts listed as citing the given abstract actually show a "significant" decrease in mortality among medical patients in Virginia teaching hospitals post-reform?

I'm also curious about how or if they measured hours worked by residents; by timecards, survey, supervisor, etc.

How they measured hours worked is very important, since in some places there is a culture of having residents work more than 80 hours, even if it is the law, and asking supervisors for hours worked is not going to give you an accurate number.

 

[Nanon]

That stuff is way expensive, but it works wonders for people with OSA, shift-work disorders, etc. It costs, retail, like $300/month.

In the book Intern, the author (a physician) wrote about telling another resident he was terrified that he would fall asleep, or sleep through, some of his shifts. The resident asked if he had ever slept through a final exam (his answer being no) and said that intern year is like having a final exam every day. Hence, the adrenaline and perhaps some pure terror keep you going.

I've never slept through a final, but I did fall asleep during a midterm once...

I didn't sleep more than 4 hours at a time during the last 4 months of my pregnancy, and then for the first 6 months of my kid's life. I think most parents go through this, too. You'll be amazed at what you can push your body to do when you're up against it. My husband and I joke about it all the time. We thought we were type A's until we had a baby. We now realize that we were total slackers.

 

[Nanon]

BTW - I'm working 80 hours this week. And yet, still finding time to post here... 😉

 

[MilkmanAl]

http://jama.ama-assn.org/cgi/content/extract/298/9/1055 seems to be another one. I don't have full text access to JAMA though, so I can't vouch for methods. Many people have told me that theres been no noticeable benefit overall though.

That study actually indicates that there have been some observable benefits in patient care due to reducing hours, but the authors seem hesitant to draw any conclusions.

 

[pianola]

I've never slept through a final, but I did fall asleep during a midterm once...

I didn't sleep more than 4 hours at a time during the last 4 months of my pregnancy, and then for the first 6 months of my kid's life. I think most parents go through this, too. You'll be amazed at what you can push your body to do when you're up against it. My husband and I joke about it all the time. We thought we were type A's until we had a baby. We now realize that we were total slackers.

Geez. I was wondering the same thing about motherhood only a couple of months back.

I agree about the adrenaline factor + movement, beachblond and others. Maybe residents can recoup some sleep time during vacations (are there any?) Even a 3-4 day vacation every month and a half or so would probably help a bit.

Well, we'll see. I know I'm going to need psychological support from friends and family to get through 36-hour shifts on any sort of regular basis.

 

[Raryn]

Geez. I was wondering the same thing about motherhood only a couple of months back.

I agree about the adrenaline factor + movement, beachblond and others. Maybe residents can recoup some sleep time during vacations (are there any?) Even a 3-4 day vacation every month and a half or so would probably help a bit.

Well, we'll see. I know I'm going to need psychological support from friends and family to get through 36-hour shifts on any sort of regular basis.

I think they're required to have at least 2 days in a row off every two weeks or some such. The 80 hour a week restrictions had some caveats like that. (I think another was after a 30 hour shift you get at least a full day off to recuperate, but don't quote me on that)

 

[betheltim]

How they measured hours worked is very important, since in some places there is a culture of having residents work more than 80 hours, even if it is the law, and asking supervisors for hours worked is not going to give you an accurate number.

My thoughts exactly. 😉

 

[Retsage]

Studies have shown that limiting the Resident work week to 80 hours and shifts to a maximum of 30-36 hours in a row has shown no decrease in mistakes due to fatigue. I.E. Residents were working at the same level at hour 42 before that they're working at hour 30 now...

If theres no benefit to lowering the limits this much, no one really has any incentive to lower them more.

How about for the health of your workers? The second that you start thinking your own health is only important in relations to your patient's health, you are lost.

 

[45408]

I understand the concerns about hours of those who have not entered the medical field yet. But before you start getting too worked up and self-righteous about health, family, etc, just keep this in mind: Physicians have always worked ridiculously long hours especially in training, and yet most still seem to be reasonably happy, mentally healthy, with kids who love them, and plenty of outside interests. That ought to tell you something.

And a couple of divorces to boot!


Having now been on the wards, I can definitely appreciate the attempts to cut down on transferring care too often, but just because things have been done a certain way for a long time doesn't make it any more valid.

 

[nonesuchgirl]

Yes, just because something has been done a certain way for a long time, it doesn't automatically make it valid. However, if you have multiple generations of reasonably happy physicians who have provided world-class medical care and advanced the cause of health science, one would be inclined to think said system is working pretty well.

Is the new system working any better in the opinion of people who are actually in it? I'd honestly be surprised if less hours of training and the upsurge in paperwork was producing better surgeons, but TPTB tell me it is. 😏

 

[JacobSilge]

Every generation wants to re-invent the wheel, but the truth is that the system of long training hours has been around for over 100 years in one form or another. The whole reason that residents are referred to as "House Officers" is because back in the day they actually lived in the hospital 24/7 for a year or more while learning their craft. The current system of 80hrs/wk is a dramatic decrease in what was done even just 5-10 years ago; many of my surgical staff describe 120+ hrs every week, with 1-2 days off. Even accounting for historical embellishment, there's no question we are working fewer hours now than the last generation of medical trainees.

Then again, this doesn't take into account the increasing complexity of care and the increased patient throughput due to DRGs. In the past patients had hospital stays of weeks for simple surgeries and the like. So, it wasn't really the same system for over 100 years, more like the last 20 years. I'd say that the residents of the late 80's and 90's got hosed by having the # of patients of today and the hours of their counterparts in the 60's, when you might have been in the hospital for 120 hours a week but getting 3 hours of uninterrupted sleep wasn't impossible.

 

[nonesuchgirl]

Then again, this doesn't take into account the increasing complexity of care and the increased patient throughput due to DRGs. In the past patients had hospital stays of weeks for simple surgeries and the like. So, it wasn't really the same system for over 100 years, more like the last 20 years. I'd say that the residents of the late 80's and 90's got hosed by having the # of patients of today and the hours of their counterparts in the 60's, when you might have been in the hospital for 120 hours a week but getting 3 hours of uninterrupted sleep wasn't impossible.

Agreed, except for "drg" since IDK what that stands for.

Or maybe I do and I can't remember. 😕

 

[pianola]

Agreed, except for "drg" since IDK what that stands for.

Or maybe I do and I can't remember. 😕

http://en.wikipedia.org/wiki/Diagnosis-related_group

And, good point to Jacob --> I think I could physically keep myself awake 36 hours; that's not such a big deal, most people can do that! But keeping myself at 100% or even 75% after 30 hours to care for 20 patients is asking a lot.

30 hours is definitely better than 36, though 🙂

 

[Law2Doc]

The current rules are:

1) No more than 80hrs/wk averaged over a 4wk period

2) No more than 30hrs on duty in a row

3) At least one full 24hrs off each week averaged over a 4wk period

4) At least 10hrs off between work days

I would also point out that from what I've seen it's not uncommon for the newer folks to show up earlier than they "sign in" because they need a bit more time to get up to speed on their patients, and also not uncommon for folks to "sign out" but not leave immediately, so the reported hours by the hospital are going to under-reflect the hours its residents may be on the grounds. Also I don't think most places are as rigorous about the 30 hours in a row as they are about the 80 hour work week. It's pretty rare for everyone to be out the door before noon post-call, although many folks start their day before 6am the day before.

And for those reading on here, bear in mind that these rules don't apply to med students, so if a resident wants you to preround before they come in and finish up some stuff after they leave, they theoretically are allowed to do this. It happens rarely, but not never, and you don't have a law protecting you.

As for the original question, no; few residents use meds to keep them going. I'd take the wager that a puny minority are using that kind of stuff. It isn't widespread, notwithstanding the handful of threads that seem to pop up on pre-allo defending the stuff. When you are on call every 3rd or 4th night, that is an awful lot of meds you'd have to take and so it's not like you could even do it sparingly. Bad idea to get on that track, and I kind of doubt anyone would give you a prescription for such meds in the dosages you'd need. You hear about a few physicians a year getting caught taking illegal stuff, and have to shake your head about what a foolish way to end one's career. Most of the residents I know get through their shifts with lots of coffee and junk food. Go into any team room first thing in the morning and it's a mess of take-out leftovers, empty doughnut boxes and cups from Starbucks. That plus the adrenaline rush you get when a couple of patients are circling the drain at once are what keeps you up.

 

[HurricaneKatt]

i do think a lot of people use those drugs and do so lightly. it seems like they are easy to get. when i was struggling and studying for my phys 2 exam someone offered me some adderall but i said no- i've heard enough to know that it really does work, and i don't want to set a precedent for myself where I need to have it in order to succeed. it seems like it would be addictive. what happens if you are so used to using it, and then all of a sudden something happens where you cant get it? do you start falling asleep and failing tests? i dont know.

so for now i just try to stick with getting as much sleep as i can when i can, and drinking a lot of coffee when i need to focus. although coffee helped me a lot more for some things (chem🙂) than others (physics.🙁)

I'm pretty sure it is. I have an aunt who is addicted. She claims that all of her kids (she has eight) are ADD or ADHD so that she can get adderall and ridilin. 🙄 She flipped a switch when my grandma was helping her clean out cabinets and threw away an entire thing of expired drugs. 😱 She's always cracked out on something or other...somedays I swear she does speed....it's all just prescription drugs though.
I just drink caffine to help me stay awake. On the flip side, I do take NyQuill to make me fall asleep sometimes though.

 

[nonesuchgirl]

I just drink caffine to help me stay awake. On the flip side, I do take NyQuill to make me fall asleep sometimes though.

Caffeine doesn't work for me. 🙁 I use benedryl.

 

[betheltim]

This whole discussion kind of makes me excited to get into it... Does that make me a masochist of some sort? 😉

I mean, I already have 12 hour days at school, and although it's obviously nowhere near the intensity of anything related to medical education, I like being really busy with classes, extracurricular stuff, studying, and the occasional break to watch the Twins or Wild. It's a good thing I like being this busy, I guess...

 

[45408]

Yes, just because something has been done a certain way for a long time, it doesn't automatically make it valid. However, if you have multiple generations of reasonably happy physicians who have provided world-class medical care and advanced the cause of health science, one would be inclined to think said system is working pretty well.

Seriously though, did they do anywhere near this much paperwork 30-40 years ago? Or did they have a lot more time for patient care?

 

[nonesuchgirl]

Seriously though, did they do anywhere near this much paperwork 30-40 years ago? Or did they have a lot more time for patient care?

They didn't.

Of course, back in their day, they had to walk 15 miles uphill in a blizzard both ways. 🙄

 

[patchadams35]

I can count the number of times I've stayed up 36+ hours on both hands.

What on earth do med students in clinical rotations and/or residents do to stay awake?

I know there have been articles about abusing Adderall/Ritalin/[insert drug of choice] -- anyone care to wager a guess as to whether a majority of students use drugs of some sort or whether it's just a few?

op is most certainly a troll.

 

[nonesuchgirl]

op is most certainly a troll.

IDK. Sounds more like she wants an okay to use drugs.

 

[patchadams35]

IDK. Sounds more like she wants an okay to use drugs.

Yeah.... ithink you're right...I like you

 

[nonesuchgirl]

Yeah.... ithink you're right...I like you

All the boys say that.

 

[patchadams35]

All the boys say that.

yeah and all the girls say im pretty fly for a white guy.

 

[pianola]

op is most certainly a troll.

IDK. Sounds more like she wants an okay to use drugs.

. Caught me red-handed. How silly of me to waste 1,000+ posts en route to trollhood. And yeah, I'm clearly a user and an abuser. Gotta watch out for those...uh...vanilla lattes? They'll get you every time. 👍

EDIT: Just to clarify, I was very genuinely interested in how people managed to stay up for long periods of time during intense work periods. I imagine that it would certainly be a legitimate difficulty in med school and beyond, that's all.

 

[patchadams35]

. Caught me red-handed. How silly of me to waste 1,000+ posts en route to trollhood. And yeah, I'm clearly a user and an abuser. Gotta watch out for those...uh...vanilla lattes? They'll get you every time. 👍

well how is this thread any more relevant than my virginity thread??

 

[pianola]

well how is this thread any more relevant than my virginity thread??

Later!

 

[Raryn]

well how is this thread any more relevant than my virginity thread??

Has to be near the record for quickest banned troll...

 

[Raryn]

. Caught me red-handed. How silly of me to waste 1,000+ posts en route to trollhood. And yeah, I'm clearly a user and an abuser. Gotta watch out for those...uh...vanilla lattes? They'll get you every time. 👍

EDIT: Just to clarify, I was very genuinely interested in how people managed to stay up for long periods of time during intense work periods. I imagine that it would certainly be a legitimate difficulty in med school and beyond, that's all.

Personally, I think this topic is perfectly legitimate. At least compared to the "virginity thread" that got booted to all students within an hour.

 

[nonesuchgirl]

Has to be near the record for quickest banned troll...

We've had at least 2 on 4 or less. I think we did a few in 1, actually.

 

[Raryn]

We've had at least 2 on 4 or less. I think we did a few in 1, actually.

There was only about an hour between his beginning and end though...

I think this is a pretty legitimate worry. I am an avid meat eater, but at my work place, a vegetarian told me that once he switched from red meat to vegetarian (non-vegan), he had less need to sleep at night.

Now, I LOVE red meat. I used to loathe vegetarians, because they were being unnatural (humans = omnivores =/= cows), but considering how I need at least 8-9 hours of sleep a night to work at optimal, the thought of becoming vegetarian came to mind.

I never take coffee or drugs, though. I don't like reliance on substances. I'm sure some people will take meds to stay awake, but i doubt they'll share it. If you really are worried about staying awake, i'm sure there are some natural ways to accomplish this without compromising yourself and relying on drugs.

And yes, all meats contain tryptophan, which can make you sleepy. The effect is truly negligible though, and most of the time the sleepiness effect (i.e. like on thanksgiving) is caused by eating meals that are too large, not from eating meat.

Personally, I will never be a vegetarian. I might cut down on my meat consumption, and really probably should, but I love the stuff too much to ever come close to giving it up. Period.