Overworked Doctors on CNN

[DoctaJay]

http://www.cnn.com/HEALTH/

And click the link below on that page that says, " Young docs' long hours raise hard questions"

I saw it this morning CNN. It doesn't surprise me, but many (83%) residents still have to lie about their hours in order to comply with the 80 hour work week. I think that is stupid. Either they need to enforce it, or let it go. One of the attendings brought up a interesting point. She said that if we reduce the hours even more, patients will be left with doctors that are willing to clock out when their shift is not, not stay over to make sure they get healthy. Anyway, its something interesting.

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[njbmd]

http://www.cnn.com/HEALTH/

And click the link below on that page that says, " Young docs' long hours raise hard questions"

I saw it this morning CNN. It doesn't surprise me, but many (83%) residents still have to lie about their hours in order to comply with the 80 hour work week. I think that is stupid. Either they need to enforce it, or let it go. One of the attendings brought up a interesting point. She said that if we reduce the hours even more, patients will be left with doctors that are willing to clock out when their shift is not, not stay over to make sure they get healthy. Anyway, its something interesting.

We are still in the adjustment period of the shorter work hours for residents. For some attendings and professors, there is plenty of resentment concerning these hours. I have observed professors calling residents "lazy" and "hiding behind the 80-hour work week to get out of work" which, is not the case. There is the mentality that if they were driven to the edge of sanity because of lack of sleep, then they are better physicians than those of us who are training today.

The truth is somewhere in the middle. You don't need to hang out in the hospital and on the wards for hundreds of hours straight to learn what you need to be a good physician. You DO need to be able to take care of patients at all hours of the day and night. You DO need to follow the rules when it comes to residency hours and be wary of any programs that encourage you NOT to follow the rules.

I did General Surgery internship under the old unlimited system and it wasn't that bad. I was responsible for less patients and I always knew them better. Under today's system, you have to learn how to "sign-out" well. The attendings have to get used to the idea that when they enter the hospital at 8pm to round, there will not be resident to round with them and be at their beakon call. (Hard for some to get used to).

My program director loves to come in at 10pm and make rounds. He will give me a call and relate anything that needs to be done or update me on something that he finds. I love to round with him and would rather round with him than sleep but he is in and out and usually doesn't call.

You have to tailor your education within the rules of the Residency Review Committee and ACGME (if you are allopathic). This means that you do loads of reading at home and that you become very efficient at work so you can get as much experience crammed into your working hours. The alternative is to increase the length of residency which, most people are not in favor of.

One thing for sure, you DO NOT have to stay up 36 hours straight to learn medicine and you don't have to be so tired that you are in danger of killing yourself when you drive home (this happened to one of our residents under the old system). The best programs adapted to the new rules and are constantly changing to provide the best education to their residents.

njbmd

 

[mshheaddoc]

Also njbmd,

Aren't there certain specialities that have some exceptions still or was there a time limit on that?

I know many institutions are scrambling to meet the hours requirements but this is also a transition period (as it states in various articles - this topic has quite a few articles in the past day or two published). There has been headway but it won't happen overnight. Now there could be "staffing" issues if there aren't enough residents to cover shifts and I wonder if the overworked programs are seeing the results of that. Now you need more residents to cover the shifts from before, but for that you need more money.

 

[8744]

...One of the attendings brought up a interesting point. She said that if we reduce the hours even more, patients will be left with doctors that are willing to clock out when their shift is not, not stay over to make sure they get healthy. Anyway, its something interesting...

Well then she can drag her happy ass in early and leave late. You know, only one percent of physician encounters take place at academic teaching hospitals. In the rest of the world, doctors don't live at the hospital.

 

[DoctaJay]

Thanks for all the comments. In the end I believe that it will boil down to money. with residents working less hours, and residency programs not increasing in size along with them resisting incresing residency length, other health professions will have to pick up the slack. I predict more PAs, NP, etc., coming in and having a hayday with the extra money that will be offered to them for the extra time. Or I guess hospitals could just give more work to them without upping their pay.

 

[southerndoc]

Just last night a former resident, now attending at my hospital told me that she thought the 80-hour rules hurt resident education. She and I got into an argument about it, and I basically told her that she is ignoring the evidence of the effects of sleep deprivation. It's much like ignoring the evidence for early goal directed therapy or glucose control in ICU patients.

Patients are at risk from sleepy doctors. I know today when I was post-call, I accidentally entered orders on the wrong patient in my stupor. Total time awake: 28 hours straight and counting.

 

[fang]

Just last night a former resident, now attending at my hospital told me that she thought the 80-hour rules hurt resident education. She and I got into an argument about it, and I basically told her that she is ignoring the evidence of the effects of sleep deprivation. It's much like ignoring the evidence for early goal directed therapy or glucose control in ICU patients.

Patients are at risk from sleepy doctors. I know today when I was post-call, I accidentally entered orders on the wrong patient in my stupor. Total time awake: 28 hours straight and counting.

But aren't patients also at risk from poor continuity of care and crappy sign-outs?

I'm a student, and I agree with njbmd that you don't have to work 100 hours a week to learn to be a good doctor. However, I hope we're not headed into a situation where medicine is shift work.

 

[njbmd]

But aren't patients also at risk from poor continuity of care and crappy sign-outs?

I'm a student, and I agree with njbmd that you don't have to work 100 hours a week to learn to be a good doctor. However, I hope we're not headed into a situation where medicine is shift work.

Like it or not, medicine IS shift work and you can be subject to punching a time-clock to log your hours too. Some residency programs have done this for documentation that they are meeting the 80-hour work week.

It is incumbent upon you as the signing out doc, not to give a "crappy" sign-out. Just because you are leaving for the day, doesn't mean that you give poor care to your patients by performing a poor sign-out. These are your patients and sign-out is part of that care.

It is the responsibility of the doc receiving the sign-out NOT to receive a poor sign out. These are YOUR patients for the on-call period and you need a good sign-out to take proper care of your patients. "I got a bad sign-out" is NOT an excuse for poor patient care. Demand an adequate sign -out for your patients. I do not allow anyone to give me a poor sign-out. If they have a difficult time with this, I can refer them to the program director for further study and clarification.

The senior residents at my program did a great job with orientation when the new "terns" came in. They know what to expect and they have stepped up to the plate well. Some people need a bit of coaching but so did I when I was an intern and my seniors were a great help.

With the 80-hour work week, it is our responsibility as physicans to give our patients the best care that we can. It doesn't take any more time to do a good sign-out than to do a poor one. Professionalism is one of the grading points in residency. You can watch your grade drop if you are less than professional.

To the person who made a comment about 88-hours: Some programs petitioned the RRC to be allowed 88 hours per week for some rotations. This can be done and is perfectly under the rules of ACGME and the RRC.

njbmd

 

[Miami_med]

What I'm worrie about is that if the 80 hour week doesn't come into compliance, we'll have the *****s in congress getting involved. Then we might see rules like those in Europe (48 hours a week coming in the UK). That is ridiculously light. I used to do hard labor in warehouse shipping for more hours than that (48, not 80). It turns a professional doctor into a clock watching automiton. If the workload is made too light, medicine will start to turn away some of the overachievers. That would not be good for the future of some of the more complex specialties.