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LOL - the previous generation didn't have the 80 hour limit and did not do anything to change it.
Fatal errors more likely on 24-hour call
- Thread starter humuhumu
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LOL - the previous generation didn't have the 80 hour limit and did not do anything to change it.
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Maybe some of your buddies in the legal and political professions will give us a hand with this (whether we want their help or not)....😀
I bet a lot of people would have given the 80 hour rule "no chance" a while back as well. Sometimes these situations turn out better than one can guess.
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The 80 hour rule is not greeted with love by many other than residents (and I've actually known residents who get annoyed at it at times when they were forced to miss out on interesting procedures because they hit their cap). Sentiments like need for staffing, continuity of care, and the simple fact that if you aren't there to see procedures/interesting cases, you are missing out on learning experiences, abound. Plus older docs simply have no sympathy for the youngsters who whine about hours that are already substantially lower than back in their day; many surgeons you will meet will honestly be able to tell you that their week was regularly over 100 hrs.. Once you have done your 80 hour/wk residency you will have no patience for the next generations protests either. Thus I find it unlikely that you (or anyone on here) are going to push for further changes when you get to the leadership level, long after your residency ends.
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One big change that is happening to medicine is that women are an increasing fraction of MD's and might even be a majority of physicians at some point in the future. Maybe we will be growing our children in test tubes and sending them to boarding schools for education by then, but if motherhood is similar to the way it is today, female attendings are not going to want to work 100 hours on a regular basis and they will change the system with job shares or whatever. That could change the culture of medicine and residency as we know it. This has already happened to some extent in some branches of engineering and in pharmacy. I'm not sure about law; maybe that's a counterexample as to why women will not change the massive number of hours worked. There are already some early changes taking place along these lines in medicine with pediatrics job shares, moms working a few shifts in the ER, etc. Let's see if they continue.
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Am I the only one here who has ever gotten to the point where you are so overwhelmed you're like, "Ah, what the heck...is that the best you can do??? Bring it on!!!"? I always sort of figured that was the attitude that would end up getting me through residency.
Anyway, I totally agree that a change is in order, but I seriously doubt anything will happen 'til some people die. And I don't mean patients, I mean doctors...No, this isn't any form of threat or conspiracy theory. I just think that the old school doctors aren't ever going to allow us to change it because as was mentioned before they're going to say, "I had to do it, now you do. It's just the way it always has been and always should be."
Anyway, I totally agree that a change is in order, but I seriously doubt anything will happen 'til some people die. And I don't mean patients, I mean doctors...No, this isn't any form of threat or conspiracy theory. I just think that the old school doctors aren't ever going to allow us to change it because as was mentioned before they're going to say, "I had to do it, now you do. It's just the way it always has been and always should be."
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But once they pass on WE will be the old school doctors and will be equally apathetic about the plight of the residents working under us. Thus I doubt any dctors dying off will matter.
FWIW medicine does not have the monopoly on hard work. Plenty of professions routinely push their underlings past the 80 hour mark. Big lawfirms and I banks certainly have been known to. Someone has to do the grunt work, and it's the best way to learn a ton in a relatively compressed period of time.
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How about this compromise? keep the 80 hrs, but any shift greater than 20 hours should automatically include a mandatory 5 hour sleep break(accomodation provided by hospital). This sleep break should count as part of the 80 hours.
BTW, I just emailed this to ACGME, I am sure they deleted it on receipt.
BTW, I just emailed this to ACGME, I am sure they deleted it on receipt.
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Dare to dream. LOL😀
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Well since they probably won't go the easy way, how about these radical options?
1) Form a national resident doctors' association which will consistently challenge work conditions and compensation. Stage walkouts consistently.
2) Incite consumer rights groups to request records of medical errors commited in hospitals by sleepless doctors.
3) Mount publicity campaigns to inform the public that they should watch out for sleepless doctors, who are no different from drunk people.
etc
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Are you trying to drive people out of the profession and/or cause it to lose respect among the public? Look, I know the end result is the best possible patient care, but don't use that as an excuse to turn medicine into camp cupcake.
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I certainly hope your right, but if physician families start shipping the kids off to boarding school just so they can bring in the extra dough, I'll quit this profession right here and now. "no amount of success can compensate for failure in the home". i'd rather work at best buy and have a happy family that bring in $500K+ a year and have my children and wife hate me.
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No, I am suggesting we expose the dangers that our fellow citizens are facing. It's our civic duty.
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I don't buy into that macho stuff anymore. Medicine is just a job. It's cooler than most jobs and more rewarding but it's still just a job. There is no reward for staying awake all night twice a week. You are just tired and it probably ruins your health if you do it long enough.
In regards to this thread, I don't give a rat's ass about how being sleep deprived effects patient care. You could produce a hundred studies showing that it's safe to take care of patients while be sleep-deprived. You could also convince me that it's safe to see patients after being awake for thirty hours but I don't care. The question to me is why we should be expected to ever not get a godd night's (or day's) sleep for any job on a routine basis.
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Agreed, but your leaders don't give a rats ass about your walfare either, hence that leaves the problem with no solution unless something adverse happens.That is why I believe consumer rights groups need to be informed about this situation. Hell, if they can harass Walmart for trivial stuff, I am sure they will be more than happy to hear about consumer fatalities caused by hospital policies.
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dutchman: There must already be organizations concerned with this. I would suspect that many teaching hospitals have organizations that deal with this (perhaps even informal ones).
Here is one that I found that appears to be related to the patient safety aspect (although more generally concerned with healthcare quality overall): http://www.ahqa.org/pub/quality/161_685_2441.cfm They seem to be most closely tied with Medicare, and, while that certainly doesn't involve everyone, it's probably a start. You could join their organization and it provides a way to report errors and near-misses if your teaching institution does not have good system for this.
Here is the site that lists their local organizations by state. http://www.ahqa.org/pub/connections/162_694_2450.cfm I'm not sure if anyone has experience with this organization or others like it that concern themselves with patient safety in a way that could result in improvements in patient safety as it pertains to medical education. I'm still years away from residency.
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Doctors have not cultivated the same ability to organize and are not as comfortable with public speaking as members of other professions (i.e., lawyers). These are the same reasons that we don't have real malpractice reform in many states.
Until we can organize and speak out, our patients may well suffer for it.
Until we can organize and speak out, our patients may well suffer for it.
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On the Sleep loss and performance issue: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=16335329
http://jama.ama-assn.org/cgi/reprint/287/8/955.pdf (shows how sleep deprivation after 21-24 hours can be equivalent to alcohol impairment -- they have a nice figure -- and how this directly puts patients at risk.)
As far as not "organizing and speaking out"; it may not have much to do with ability to communicate. (See the article below -- I'm not sure if that is an outlier or not). You may wish to find someplace where you can practice medicine ethically and with patient safety in mind.
It may be very difficult to work outside "the system" and its norms as the article below explains. I have no way of knowing if this is a unique situation or not. Something tells me that there are penalties for those who are "disruptive" in certain situations related to patient safety. In my previous experience in other industries, I have learned to work within "the system" as much as possible and to maximize positive changes; in a few cases, this meant to find other opportunities where I could serve and make a positive difference. It is important to assess a difficult (political) situation and make sure that if you are going to make powerful people mad that you understand the consequences and are prepared to endure them (difficult as that may be). I think it is important to go to bat for patients, even if the cost is high. However, I would not suggest being reckless or careless in "organizing and speaking out."
http://www.post-gazette.com/pg/03299/234499.stm
turn on doctors
First of a series
Sunday, October 26, 2003
By Steve Twedt, Post-Gazette Staff Writer
America's physicians, sworn to protect their patients from harm, increasingly face a surprising obstacle -- their own hospitals.
In medical centers as small as Centre Community Hospital in State College and as prestigious as Yale and Cornell, doctors who step forward to warn of unsafe conditions or a colleague's poor work say they have been targeted by hospital administrators or boards.
Dr. Tom Kirby, a surgeon, stands in his home that is now in foreclosure after he was suspended from University Hospitals in Cleveland. Kirby has not operated on a patient in nearly 18 months while he fights charges of being "disruptive and abusive." View larger image. (John Beale, Post-Gazette)
The Series
Also in Day One
Dispute over treatment of heart patients derails career
Doctors who spoke out
About the team
Audio Clips: Steve Twedt talks about the series
Day Two
When right can be wrong
A negative data bank listing isn't easy to erase
Rules of fair play don't always apply
Doctors who spoke out
Day Three
Centre County hospital critics soon unwanted
Doctors pay for reporting suspicions
Doctors who spoke out
Day Four
Doctor says whistleblowers need more protection
Law gives hospital panels wide powers over doctors
Doctors who spoke out
--------------------------------------------------------------------------------
Instead of receiving praise or even support for trying to improve care, they're disciplined or dismissed for being "disruptive" or for violating patient confidentiality. Frequently, the hospital turns the tables on the whistleblowers and accuses them of poor care. They also threaten internal investigations that could result in listing the complaining doctors in the National Practitioner Data Bank, which can make finding a similar position at another hospital all but impossible.
Not even whistleblower laws, designed to give legal protection to those trying to report wrongdoing, safeguard the doctors in many cases. And all too often, state and federal agencies and national accrediting groups do little to protect these physicians or make sure patient care problems are corrected.
...
"While it's unknown exactly how often physicians are targeted for patient advocacy, a 1998 survey of 448 emergency physicians across the United States found that 23 percent had either lost a job, or were threatened with it, after they'd raised quality-of-care concerns. Ed Kabala, a lawyer with the Downtown law firm Fox Rothschild, which represents physicians, said he had noticed a recent increase locally in physicians being accused of disruptive conduct."
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I have no problem working within the system and am merely offering some explanations as to why we might not be as successful in combating these problems as we might want.
Physicians have not historically been great at lobbying for laws and political change. Lobbying does take skill and communication in a different context than what physicians are used to-- there will have to be huge numbers of press articles to start a public grass roots campaign to make the difference.
Doctors are not trained to negotiate like other professions are. It is a different paradigm.
Physicians have not historically been great at lobbying for laws and political change. Lobbying does take skill and communication in a different context than what physicians are used to-- there will have to be huge numbers of press articles to start a public grass roots campaign to make the difference.
Doctors are not trained to negotiate like other professions are. It is a different paradigm.
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Yes, true. That's why it's nice to see some ex-lawyers joining the medical profession. Perhaps they can make some needed improvements in this respect.
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We can try. 🙂
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I still think most of us will still go ahead and just:
4) suck it up, muddle through our residency like our predecessors did (albeit with 80 hour ceilings now) and hope we learn a lot and don't kill too many people. And then the second we finish residency, we no longer will give a darn about the plight of residents -- not our problem anymore.
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Amen. I don't pretend to have the answer to this problem, but I do think it's sad that hospitals can't get by without residents making less than minimum wage.
As for the idea of hiring more PAs, I think it could be a start. After all, as a MSIII, I spend a lot of my time filling out discharge paperwork, writing scripts, telling the patient not to lift anything heavy, etc. I don't mind doing these things for free, but if there isn't a student there, someone still has to do these things. How does it harm the patient to have a PA do this, compared to a med student? We probably would have a similar level of knowledge about the patient, and a PA certainly couldn't do a worse job of filling out this paperwork (I just BS my way through).
One thing that irritates me is when attendings complain about the wussy residents who are so spoiled by the 80 hour workweek. I realize their training was more difficult, but was it that much better? Do you learn so much more in a 100 hour week versus an 80 hour week that we are shortchanging our current residents?
And I am totally not surprised that the head of the ACGME made such a statement. After all, the 80 hour week is practically cush! How dare we complain!
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I think it's undeniable that you will see and do many more procedures if you are there many more hours. You learn by seeing and doing. So yes, I can buy the notion that in a harder residency you will learn more. May be bad news for the patients you work on while you are exhausted, but probably benefits the subsequent patients you see down the road in your practice, when you do a procedure on them that you "can do in your sleep" (and actually have).
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That does not mean they were learning better.
http://exn.ca/Templates/Story.asp?ID=2000030753
"Scientists from Harvard Medical School are giving us one more reason to get a good night's rest. According to their research, people who get at least six but preferably eight hours of sleep a night are better able to learn. Specifically, after getting the requisite hours of sleep, people can improve the new skills they have just learned."
