The Downside of Requiring Young Doctors to Get More Sleep

[Maxwell Edison]

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I don't know if this has been posted already, my cursory search said no:

http://www.slate.com/id/2206367/

 

[BeardedRunner]

I think that if I stay single, I'll be able to get enough sleep.

 

[armybound]

increase number while decreasing amount required from each

of course that leads to decrease physician pay, but happier lives. I'm sure some people would be able to handle living on a little bit less with their sanity intact.

 

[Bradstein]

They mention that ortho residents who have half the time they did in the "traditional" structure didn't know how to tie sutures and such. Isn't this actually an indictment of the current system? Why do surgeons the first half of their time in the OR observing, and only then begin to learn to do it for themselves?

 

[armybound]

They mention that ortho residents who have half the time they did in the "traditional" structure didn't know how to tie sutures and such. Isn't this actually an indictment of the current system? Why do surgeons the first half of their time in the OR observing, and only then begin to learn to do it for themselves?

It's definitely a testimony to the wasted time/inefficiency of the system.

 

[Bradstein]

It's definitely a testimony to the wasted time/inefficiency of the system.

Thanks. Sometimes I wonder if I'm crazy when I spot arguments which are illogical. Is this inefficiency related to the liability issues surrounding medicine? As in, no one will let someone fresh from their internship work on a patient, instead they let them watch for two years before they make their first cut cause somehow that makes them more qualified? Because, using that argument, some of the people on this very forum are "qualified" to start cutting people, given the amount of hours they've been in the OR...

 

[armybound]

I'm sure they just find something else they could be doing (paperwork), which frees up the more senior residents. The amount of BS paperwork in the system means that physicians in training have to waste a ton of time with meaningless stuff, which gets pawned off on the lowest guy on the totem pole.

 

[NTF]

It's definitely a testimony to the wasted time/inefficiency of the system.

I agree that creating a systematic, efficient, and streamlined pedagogy seems in order. My impression of the teaching going on in residencies is one where the residents and clinical instructors are left to their own devises without much guidance. Sort of a sink or swim, trial by fire, learn by osmosis setting.

I've always wondered whether it's the most effective and efficient way to train doctors. Sometimes the rationale for the current system can appear to be the maintenance of a cheap source of labor for hospitals.

 

[Maxwell Edison]

The thing that caught me most about this article was that a popular argument from the people on the "con" side was "if we cut the hours, doctors won't be as well trained."

Well, this has an obvious fix; make residencies longer. If you're doing X years at 80 hours a week, then you could do X+1 at 60. But somehow I don't see that happening anytime soon...people do a lot of chomping at the bit already.

 

[Trismegistus4]

I've always wondered whether it's the most effective and efficient way to train doctors. Sometimes the rationale for the current system can appear to be the maintenance of a cheap source of labor for hospitals.

Here's something everyone needs to know: the residency system originated out of an educational philosophy that to become a competent doctor, you needed to see patients through the entire course of their illness from start to finish. That's why residents used to actually live in the hospital (that's why they're called residents). The idea was that you'd care for and treat a patient, uninterrupted, from their intial presentation with a cough and diagnosis of pneumonia, through their discharge, and that only by doing so repeatedly did you have the kind of knowledge and experience that makes one a doctor.

Obviously, even the switch from living in the hospital to every-other-night call represents a major step away from this educational philosophy, but the latter still provides a lot more exposure than a system that requires you to go home after 30 hours.

You can agree or disagree with the educational philosophy, and yes, things are different from the olden days when you typically got more sleep while on call, but it was never about cheap labor or, as cuturally left-wing medical students who hate everything old, white, and male like to think, hazing.

 

[armybound]

The thing that caught me most about this article was that a popular argument from the people on the "con" side was "if we cut the hours, doctors won't be as well trained."

Well, this has an obvious fix; make residencies longer. If you're doing X years at 80 hours a week, then you could do X+1 at 60. But somehow I don't see that happening anytime soon...people do a lot of chomping at the bit already.

there's no need to make residencies longer.. make residency hours better spent.

 

[NTF]

Here's something everyone needs to know: the residency system originated out of an educational philosophy that to become a competent doctor, you needed to see patients through the entire course of their illness from start to finish. That's why residents used to actually live in the hospital (that's why they're called residents). The idea was that you'd care for and treat a patient, uninterrupted, from their intial presentation with a cough and diagnosis of pneumonia, through their discharge, and that only by doing so repeatedly did you have the kind of knowledge and experience that makes one a doctor.

Obviously, even the switch from living in the hospital to every-other-night call represents a major step away from this educational philosophy, but the latter still provides a lot more exposure than a system that requires you to go home after 30 hours.

You can agree or disagree with the educational philosophy, and yes, things are different from the olden days when you typically got more sleep while on call, but it was never about cheap labor or, as cuturally left-wing medical students who hate everything old, white, and male like to think, hazing.

I appreciate the point about the educational philosophy of seeing a patient from admission to discharge. Believe me, I understand that these are just pre-med musings and speculation about what I've seen from working in a hospital for the last year and a half.

I could have done w/o the political potshot. You don't have to have a political orientation to wonder and question about whether things are done effectively, efficiently, or to wonder about the rationale for certain ways of doing things.

 

[diosa428]

They mention that ortho residents who have half the time they did in the "traditional" structure didn't know how to tie sutures and such. Isn't this actually an indictment of the current system? Why do surgeons the first half of their time in the OR observing, and only then begin to learn to do it for themselves?

Most surgeons don't spend half their time in the OR observing... although I'm sure this varies by institution... interns rarely go into the OR at all. The purpose of a surgical intern year is to learn how to manage surgical patients, so interns are usually on the floor all day, answering pages, writing orders, etc. You can't be a surgeon if you can't manage the medical aspects of your patients' care. When surgeons are in the OR (intern, resident, fellow, etc) they do do parts of the procedure, but you can't just go from never handling surgical equipment to doing an entire operation. They do the parts of the surgery that are appropriate for their skill level. Sure, the amount you get to do often depends upon who your attending is, but I've never seen a resident sit there and watch a surgery and not do parts of it. Usually they're assisting, and by assisting you generally have to do things.

 

[Trismegistus4]

I could have done w/o the political potshot. You don't have to have a political orientation to wonder and question about whether things are done effectively, efficiently, or to wonder about the rationale for certain ways of doing things.

I'm not talking about people who wonder about the rationale, I'm talking specifically about people who are pretty sure the rationale is hazing. And it's something I've observed. The more likely a student is to think that everything that 1) they think bad and 2) was done in the past, was deliberately engineered by people who exploited unearned positions of power in order to oppress others, the more likely he is to assume that the purpose of residency training is hazing.