Thursday, December 04, 2008

From The L.A. Times

Usually we pick our post topics off the New York Times, but here's a couple stories from the LA Times that caught my eye today:

Report urges more sleep for medical residents

The National Institute of Medicine has officially encouraged medical training programs to place 16 hour limits on the length of shifts that doctors in training can work. The report produced by NIM also recommends that any resident required to work longer than a sixteen hour shift be required to take a five hour nap before continuing.

So now the biological functions of physicians are being regulated by accrediting bodies and other professional organizations. Imagine the stress: "Sleep, gosh darn it! Sleep or we'll lose our accreditation!"

I totally agree that doctors need a decent amount of sleep in order to be any good to their patients, themselves and their families. I just think it's weird that hospitals have to be forced to acknowledge the biological needs of their doctors.

Another interesting story in the LA Times is a three part series entitled Through Prison Glass. It's a story about a woman, who also happens to be an attorney, who met and married a prison inmate while he was incarcerated in Pelican Bay. Pelican Bay is California's control unit prison (also known as a SuperMax facility). The prisoner in this story is alleged to be a leader of the Aryan Brotherhood and is in SuperMax for a murder conspiracy and other crimes committed inside prison walls.

I think it's an interesting story because I'm always curious about the psychology of women who marry convicted criminals whom they've never even known outside prison. You can read the second part of the series here.


Dinah said...

I'm too tired to read this...

Anonymous said...

Now I wait with baited breathe for the same requirement to be laid down for 1st year teachers. I am an intern teacher plus am taking 19 credit hours in my teaching credential program, plus there are additional special case studies required by the State of CA which have to be submitted via computer by midnight on specific dates. NOBODY cares about anyone else's deadlines so the State case study was due the day after the weekend I was required to attend a teacher's convention 50 miles away, which coincided for a big term project the next day which coincided with evaluative assessments of my teaching (lesson plans and work for kids needs to be prepared). I have had MANY 3 hour nights and still there are not enough hours in the day. Luckily last night was the end of the semester so now I just teach until Christmas.

Anonymous said...

Are you serious about those hours? UK and Australia did away with those last century.
Psychs here in Oz work a standard 8 hour shift then on call til about 9pm. Then the night shift doc takes over and they rotate weekly. They cover a fair area too and do the regional intake.

You wouldn't get those hours unless you went to a remote rural area and you were the only medic. And even then 6 weeks cover to avoid burnout is a phone call away.

Anonymous said...

What's the attraction of serial killers, murderers and other thugs? Totally clueless.

Midwife with a Knife said...

Hm.. resident (and fellow! ) work hours are sort of one of my pet peeves. While people need to be treated humanely, a set "cap" of 80 hours doesn't make much sense, and when it was invented by Dr. Bertrand Bell, was actually rather arbitrary.

Now while it's true that as a fellow, I'm in a rather abusive program (long story which may be posted a few months from now. ;) ), my excessive (and inappropriate by ABOG standards) work hours are less painful than the residents' for several reasons:

1) Most of the time, I'm not dealing with something unfamiliar. I've seen hundreds of preeclamptics/diabetcs/diabetic preeclamptics by now, and it's no longer stressful for me. Sure, once in a while, someone really sick rolls in, and that stresses me out a bit, but mostly I know what I'm doing and I feel comfortable with it.

2) Although I am frequently taken advantage of by my own attendings, I am not treated like crap by nurses, ancillary staff, consultants, etc. I also am not called for every minor crises (just most of them! ). This also makes my work less stressful than my residents.

Because of this, I will assume that as an attending, things will be even better. So, comparing attendings' work hours to residents' work hours is not a great comparison, I think.

The other thing that irks me about this discussion is that it ignores a couple of factors.

Handoffs are inevitable because everybody has to go home. I can't just stay at the hospital until all of my patients get better rather than hand them off. So, we might as well learn to be good at them.

The other problem I have with decreasing the current requirements is that we really have limited data. There is data in ob/gyn residents to suggest that numbers of procedures aren't affected by the work hours rules, and that shifts and changes in practice are a bigger influence. However, since so many programs are noncompliant with the current rules (and residents lie all the time on their reported work hours), maybe we'd be better off enforcing the rules we've made while tracking some sort of data about them.

Also, if someone has time to lie down for 4-5 hours, you have at least 1 too many people on call at the hospital!

(Sorry for the long comment, I'm on call and waiting to do a c-section with the residents! :))

Fat Doctor said...

I agree with MWAK.

Yes, I trained before work hour rules, but I have professional experience (as both an asst professor during work hour rules era and as a hospitalist when nobody cares how long I've been awake) that gives me some insight.

I spent a lot of time begging/forcing residents to go home when I was teaching. Major pain in the butt for all involved, and probably didn't help patients a whole lot to not be able to see their doc in clinic that day. Now that I'm a hospitalist, there are occasions when I am up in the middle of the night so fatigued I want to die, but the training did allows me to think like a doctor still. I hope.

You can't protect people once they are out of residency. That's my point. Better to know how to pace yourself and keep focused.

That being said, I hope that if I'm a patient my doctor has had a lot of sleep the night before.

Anonymous said...

I think the point is for residents to take a break, if you sleep great, if you dont you still get a brain break. And I cannot imagine a resident in internal med, oby-gyn or surg NOT sleeping with that long of a break available to them if they had the chance.

I dont nearly work the kind of hours (as a psych res) others do in some of the more grueling specialties. I however greatly value a brief break when I am going straight for hours on end.