if you want to be a surgeon, you also only do 80 hours right?

[SLUser11]

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let me remind the surgeons out there that the founding father of the American surgical residency, William S. Halsted, was a cocaine addict. does anyone not find insanity in prepetuating the legacy of someone who required COCAINE to keep his work hours?

Well, Halsted was responsible for creating the modern residency system for all specialties, not just surgery......

Besides, he pioneered the concept of the "house officer" in 1897, which is after he was supposedly reformed from his cocaine habit and working at Johns Hopkins. At that point, he was focusing mostly on morphine abuse, which I doubt is beneficial for working long hours....

 

[Hurricane]

You know, I reject the premise that we need to limit work hours to protect the patients. Maybe limiting the hours protects patients and maybe it doesn't. There is certainly a lot more potential for "handoff errors" today as opposed to in the old days simply because there is more handing off.

In that other sleep deprivation thread that links to the NPR story, they interview this sleep medicine guy from harvard who talked about a study he has coming out soon that shows that interns working 24 hour shifts had 4X more errors, including diagnostic errors, than those who worked 16 hrs then handed off the patients. Thus refuting the "it's best for the patient to have one single sleep-deprived doctor with a reaction time comperable to that of someone legally intoxiated for 30 hours straight because they get to know the patient better" argument.

Besides, he pioneered the concept of the "house officer" in 1897, which is after he was supposedly reformed from his cocaine habit and working at Johns Hopkins. At that point, he was focusing mostly on morphine abuse, which I doubt is beneficial for working long hours....

Well, yeah, by the time he was bigwiggy enough to establish the residency system, he didn't need to work like a resident himself. But he based the system on what he considered feasable for a young human being to be able to tolerate, which must have been colored by his experience with chronic psychostimulant use.

What really annoys me is that most of the work hours "reform" is centered around trying to adapt the ACGME restrictions to this archaic 100 year old system instead of trying to come up with new ways to do things. And ignoring the studies on the effects of sleep deprivation one minute then touting how "evidence based" it is the next. But I guess EBM is only applicable to patients who need to be stuck into a hypertension alogorithm, not physicians themselves...

But on a happy note, I just admitted my last patient on my last night of in house medicine call! Ever. The rest of my psych call is all home call after this. And they say psych residents are crazy. Maybe so, but one could argue that signing up for Q4 call x 3 years is crazier 🙂

 

[Tired]

The long hours are all about making you used to the demands so that you will be a better doctor. It teaches you a mentality that will help you be a better partner/doctor. Say you had to stay 4-5hours late, or got a call for an emergency at 3am? Who would make a big deal about cutting into "their time"? Someone who went through a residency were 100+hrs was not uncommon or someone who had an easy residency of 40hrs/week. It's about building expectations of becoming a better doctor so you get the job done, even if it goes beyond the time when your day was supposed to be over

Regardless of this point of view, it is worth noting that the 80-hour work week was instituted due to demands by the public, not residents and interns. In case anyone has forgotten why New York instituted its 80-hour work week in 1989:

http://www.medicalalumni.org/bulletin/fall_2003/lead2.html

"The effort to reform resident working hours has its roots in the state of New York, which implemented an 80-hour-per-week limit in 1989. The state law—the first and only one of its kind—was prompted by the death of an 18-year-old girl who was initially hospitalized with flu symptoms. Her family claimed that negligent residents, working without enough sleep, prescribed improper medication. A grand jury investigation found no criminal fault on the part of the doctors, but the panel expressed concerns about resident working hours and supervision.

Contending that resident working hours were unsafe for patients and inhumane for doctors, advocates for reform lobbied for nationwide limits. The effort gained momentum with the formation of the Committee of Interns and Residents, a union of 11,000 medical residents, and the support of the American Medical Student Association, a national organization representing over 30,000 physicians in training. In 2001, the consumer advocacy group Public Citizen joined the fight and petitioned the federal government to impose restrictions on resident work hours. In 2002, the ACGME voted to approve the New York regulations and promised to impose sanctions on programs that failed to comply.

Citing sleep deprivation studies, advocates for work hour limits have long argued that exhausted residents are more likely to make medical mistakes that could endanger the lives of their patients. An informal survey published in the Journal of the American Medical Association in 1988 found that six out of seven surgical residents had fallen asleep at the wheel while driving to and from work. Researchers at Wayne State University surveyed 700 emergency medicine residents about their driving experiences, and found that 17 percent had been involved in crashes. A study in the journal Nature determined that residents who had been awake for 24 hours had the hand-eye coordination of someone with a blood alcohol level of .10 (above the legal limit for driving in most states)."

I don't mind being told how "lazy" residents and students have become since we "only" do 80-hours a week. I do mind when they portray it as some kind of conspiracy, iniated by trainees, to get out of doing work.

 

[8744]

In that other sleep deprivation thread that links to the NPR story, they interview this sleep medicine guy from harvard who talked about a study he has coming out soon that shows that interns working 24 hour shifts had 4X more errors, including diagnostic errors, than those who worked 16 hrs then handed off the patients. Thus refuting the "it's best for the patient to have one single sleep-deprived doctor with a reaction time comperable to that of someone legally intoxiated for 30 hours straight because they get to know the patient better" argument.



Well, yeah, by the time he was bigwiggy enough to establish the residency system, he didn't need to work like a resident himself. But he based the system on what he considered feasable for a young human being to be able to tolerate, which must have been colored by his experience with chronic psychostimulant use.

What really annoys me is that most of the work hours "reform" is centered around trying to adapt the ACGME restrictions to this archaic 100 year old system instead of trying to come up with new ways to do things. And ignoring the studies on the effects of sleep deprivation one minute then touting how "evidence based" it is the next. But I guess EBM is only applicable to patients who need to be stuck into a hypertension alogorithm, not physicians themselves...

But on a happy note, I just admitted my last patient on my last night of in house medicine call! Ever. The rest of my psych call is all home call after this. And they say psych residents are crazy. Maybe so, but one could argue that signing up for Q4 call x 3 years is crazier 🙂

Personally, seeing that I ended up doing an extra year anyways, I wopuld rather do an extra year on a three year residency with minimal call and decent hours than the system we have today.

 

[lilnoelle]

. Hell, even in Marine Corps boot camp they never interfered with our sleep and I got a solid eight every night. (And I mean solid. I was out before the lights went out and probably didn't stir until revellie.) .

Really? My husband acted like he never got more than 6 hours of sleep during bootcamp and usually it was more like 4 hours. I'll have to ask him again.

 

[earthworm]

Regardless of this point of view, it is worth noting that the 80-hour work week was instituted due to demands by the public, not residents and interns. In case anyone has forgotten why New York instituted its 80-hour work week in 1989:

http://www.medicalalumni.org/bulletin/fall_2003/lead2.html

"The effort to reform resident working hours has its roots in the state of New York, which implemented an 80-hour-per-week limit in 1989. The state law—the first and only one of its kind—was prompted by the death of an 18-year-old girl who was initially hospitalized with flu symptoms. Her family claimed that negligent residents, working without enough sleep, prescribed improper medication. A grand jury investigation found no criminal fault on the part of the doctors, but the panel expressed concerns about resident working hours and supervision.

Contending that resident working hours were unsafe for patients and inhumane for doctors, advocates for reform lobbied for nationwide limits. The effort gained momentum with the formation of the Committee of Interns and Residents, a union of 11,000 medical residents, and the support of the American Medical Student Association, a national organization representing over 30,000 physicians in training. In 2001, the consumer advocacy group Public Citizen joined the fight and petitioned the federal government to impose restrictions on resident work hours. In 2002, the ACGME voted to approve the New York regulations and promised to impose sanctions on programs that failed to comply.

Citing sleep deprivation studies, advocates for work hour limits have long argued that exhausted residents are more likely to make medical mistakes that could endanger the lives of their patients. An informal survey published in the Journal of the American Medical Association in 1988 found that six out of seven surgical residents had fallen asleep at the wheel while driving to and from work. Researchers at Wayne State University surveyed 700 emergency medicine residents about their driving experiences, and found that 17 percent had been involved in crashes. A study in the journal Nature determined that residents who had been awake for 24 hours had the hand-eye coordination of someone with a blood alcohol level of .10 (above the legal limit for driving in most states)."

I don't mind being told how "lazy" residents and students have become since we "only" do 80-hours a week. I do mind when they portray it as some kind of conspiracy, iniated by trainees, to get out of doing work.

Great post! How can people not acknowledge how much sleep effects their mind? We punish people for DUI's but driving or performing surgery while sleep deprived is ok? Would you want your kid riding in the passenger seat after you're 36 hour sleepless call? You're training takes precedence over keeping yourself and others safe? Dr's are smart, but when it comes to commen sense it's as if they suddenly become ******ed.

 

[Hurricane]

Great post! How can people not acknowledge how much sleep effects their mind? We punish people for DUI's but driving or performing surgery while sleep deprived is ok? Would you want your kid riding in the passenger seat after you're 36 hour sleepless call? You're training takes precedence over keeping yourself and others safe? Dr's are smart, but when it comes to commen sense it's as if they suddenly become ******ed.

Heh, maybe you could use that next time some jackass attending rounds for hours and hours and makes it impossible for you to get home within the 30 hours, or some micromanaging sr resident keeps piling on the scut well after noon - "hey, how about I take your kids for a nice driving tour of the local interstate highway system after I get outta here this afternoon?"