Are you working more than 80 hours?

[MacGyver]

Originally posted by Linie
I support some of what the ACGME is doing. But I also have enough experience to have seen and been involved in the care of patients taken care of by too many people, so I know the problems that can crop up even with the best-intentioned sign-outs. That is (just) one reason I think that shorter hours taken to an extreme is seriously flawed.

80 hour limit is considered extreme ONLY by those extremists like you on the other side who think that you are god's gift to medicine whose care is not compromised by lack of sleep.

As I said, there is NO cure for lack of sleep except to get sleep.

There are lots of ways to tweak the system so that patient transitional care issues are addressed.

Once again you are setting up a strawman argument. Your claim is that:

1) 80 hour work weeks are doom and gloom for transitional patient care issues

2) Therefore, 80 hour work weeks are a bad idea.

Thats a strawman argument. Your original premise, that 80 hour work weeks are inevitable to hurting to patients in transition, is false.

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[Linie]

There are lots of ways to tweak the system so that patient transitional care issues are addressed.

Why don't you give us some examples?

 

[buggs]

I can't tell if MacGyver is more concerned about lack of sleep or medical error resulting from sleep deprived residents. (I think he just wants more shut-eye)
Although it is very intuitive that long hours and less sleep means more mistakes, it has yet to be proven.

 

[MacGyver]

Originally posted by buggs
Although it is very intuitive that long hours and less sleep means more mistakes, it has yet to be proven.

The only reason it hasnt been proven is because its ILLEGAL and UNETHICAL to run the kind of experiments you would need in order to prove it.

What HAS been proven is a myriad of effects that sleep-deprived residents experience. Their mental acuity suffers, their cognitive awareness becomes no better than an 8 y/o child. Their motor reflexes diminish, their response time doubles, their reading comprehension drops by more than 50%. Their ability to focus and concentrate drops substantially. Their short term memory is drastically reduced.

Of course, the extremists like Linie will tell you that all of htose things have ZERO impact on patient care.

 

[MacGyver]

Originally posted by Linie
Why don't you give us some examples?

Overlap the shifts so that adequate time is used for transition care issues.

Instead of having resident #1 "clock out" and immediately leave when resident #2 is coming in, have a setup where resident #2 comes in X # of hours before resident #1 is scheduled to leave. Have resident #1 fill in #2 on the relevant issues.

Meanwhile the other residents have staggered shifts such that only one "overlap" session is occuring at any one time.

Transitional care issues are largely a strawman argument, because even with 36 or 40 hour shifts there will be transitional issues.

If a resident works 50 hours straight, he STILL has to hand over patients to the next resident. Which do you think is better? A resident handing over patients to another resident when the first resident is relatively alert, awake, w/ strong mental acuity and memory? Or is it better for a sleep-deprived, exhausted resident to hand over a patient to the next resident?

Since the 80 hour week limits are still relatively new, many programs are still on a learning curve. To point to the mistakes made during the learning curve is a strawman reason for not using the 80 hour limit.

It is analogous to a father saying that his son should never ride a bike again, because the son is just learning to ride it now and has fallen down a couple of times.

 

[DoctorDoom]

Answer the question, what is your training level MacGuyver?

Linie, as far as I can tell, has not said that prolonged exhaustion has no impact on patient care. Many studies do show declines in the parameters you mention but with very monotonous and non-specific tasks. No one advocates that sleep deprivation is good. She simply says that extremism in either direction is flawed. A balance must be achieved between sufficient training and sufficient rest. It will trend towards sufficient training, and rightly so, but to go too far in the other direction is also foolish.

You also don't seem to understand transition issues. Overlap shifts? It only addresses the issue of signing out patients, not a real transition issue. Nor do you address the question of adequate training.

Furthermore, every study indicates that patients who have residents covering them have vastly improved clinical outcomes. Your claim that a tired resident will inevitably lead to negative outcomes is not true. Your posts are inflammatory and smack of the vehemence of the uninitiated.

So answer the question, where are you in the God pipeline? I bet you aren't even in medical school, but are here simply to rile people up for your own reasons.

Rajvosa, your personal information will have to be accepted, but they do not jive with either my personal experience nor does it jive with any information I have. In short, I don't believe you. The fact that you do not have first hand information about even medical school in Europe makes me doubt your claims.

Enough. I've said my piece. Good day.

 

[MacGyver]

Originally posted by DoctorDoom

Linie, as far as I can tell, has not said that prolonged exhaustion has no impact on patient care.

What she has said is that resident lack of sleep is not that big of a deal, because supposedly there are people watching over you who always catch your screwups.

Many studies do show declines in the parameters you mention but with very monotonous and non-specific tasks.

Thats not accurate. Those studies were done on RESIDENTS IN REAL WORLD CONDITIONS. They followed residents through their shifts, and gave them simple memory, cognitive and alertness tests every 12 hours.

No one advocates that sleep deprivation is good. She simply says that extremism in either direction is flawed.

80 hour work week is NOT extreme. And your argument is just as ridiculous when you say that sleep deprivation is not that big of a deal as it is when you say that sleep dep is "good" for someone.

36 hour shift = sleep deprivation = bad patient care. No way around that, and the strawman argument of "well, the transition issues are even worse" is total bull****.

A balance must be achieved between sufficient training and sufficient rest.

80 hour weeks are a good balance. Your problem, like Linie, is that YOU are an extremist. Nobody is advocating 40 hour work weeks for residents.

It will trend towards sufficient training, and rightly so, but to go too far in the other direction is also foolish.

see above

Your claim that the ACGME regs are "going too far in the other direction" is an extremist position.

You also don't seem to understand transition issues. Overlap shifts? It only addresses the issue of signing out patients, not a real transition issue.

And you havent explained why a 36 hour shift erases all transition issues. There are ALWAYS going to be transition issues, NO MATTER HOW LONG YOU WORK IN THE HOSPITAL.

Both the 80 hour work weeks AND the old system have transition issues to deal with. You are setting up another strawman argument with your claim that transition issues are unique only to 80 hour schedules.

Nor do you address the question of adequate training.

There is no evidence that spending extra time doing scutwork, finding lab results, and running down tests leads to a better trained doctor.

Please dont deny that a substantial portion of resident shifts is devoted to that bull****. I'm sure Linie will deny it. Apparently at Hopkins, residents NEVER do scutwork. Of course, I know people who say otherwise.

Here's a link for you:

http://www.annals.org/cgi/content/full/123/7/512

However, the extra costs associated with teaching hospitals may be related to the fact that residents provide such varied services, many of which do not even require the expertise of a physician. In a time-motion study of internal medicine residents at two urban hospitals in New York City, Knickman [71] found that 19% of internal medicine residents' time was spent on activities that could be done by nurses, laboratory technicians, or other staff and that a meager 3.1% of their time was spent exclusively interacting with patients.

The only people who think that docs will be trained worse under the new system, are those idiots who think that scutwork is a valuable lesson to be learned.

Furthermore, every study indicates that patients who have residents covering them have vastly improved clinical outcomes.

I'd like to read those studies. But even if they exist, what does that prove? Are you telling me that in the old 36 hour shift scheme that a given patient is ALWAYS COVERED BY THE SAME RESIDENT?

thats bull**** and you know it. The average hospital stay is much longer than 36 hours, which means unless you are working 90 or 100 hours straight that you have to hand off patients to other people.

Your claim that a tired resident will inevitably lead to negative outcomes is not true.

Come on. I told you that there is no proof because running those experiments would be ILLEGAL AND UNETHICAL!!

Please tell me how I can go about running an experiment where I subject one group of patients to fully rested residents, and another group of patients to residents who have worked for 36 hours.

Thats yet another strawman argument. Your claim that because there is no proof that it must not be true is bull****. The ONLY reason there is not proof is because the experiments needed to prove it would be unethical and never approved.

Since the proof you demand can come only from illegal/unethical experiments, you'll have to settle for the following:

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12885613&dopt=Abstract

CONCLUSIONS: Resident work schedules lead to sleep deprivation and fatigue. Call-associated sleep deprivation and fatigue are associated with increased technical errors in the performance of simulated laparoscopic surgical skills.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12748477&dopt=Abstract

CONCLUSION: This finding suggests that cognitive function test scores do decrease after on-call duty. Scrutiny of this issue by the Accreditation Council of Graduate Medical Education is justified, and the issue should continue to be evaluated. Our finding suggests that a change in our current educational structure is warranted.

So answer the question, where are you in the God pipeline?

Your attitude is exactly why we are in this mess to begin with. The belief that doctors are gods who can do no wrong is at the heart of the resident work hours issue.

 

[DoctorDoom]

MacGuyver you are clearly taking my comments out of context and purposefully misinterpreting them. For whatever reason you seem to be spoiling for a fight, especially given that I am the one who freely admits that limiting hours is a good thing. That without reforming and reducing scut, training was suffering.

The God pipeline comment was a reference to your signature line and your obvious pathological fixation. I don't think 36 hour shifts will solve transition issues, just that your system won't work. What the outcome studies proves is that a tired resident does not equate with bad patient care. Just because you haven't read them doesn't mean they aren't meaningful. You assume that only by running experiments with tired residents can you evaluate resident performance, yet you are willing to accept peripheral vidence that everyone agrees with. Of course motor function declines, of course large amounts of scut is bad, of course things needed improvement, but no one said people who were cutting hours adocated a 40-50 hour work week, only rajvosa thinks that's possibly acceptable. You told me? I don't trust you, especially when your discussion style is apparently one of substituting insistence and rudeness for facts and logic. Strawman? you are the only one setting up a strawman, the resident who loves the 150 hour work week and all the scut in the world, accuse me and Linie of being that, and then make simplistic arguments to show us we are unreasonable.

Get a grip, learn to calm down, have a sense of humor, and try to actually read other people's opinions before haranguing them with profanities. I'll bet if we we're in the same room you wouldn't be so florid.

Still, you have not answered the question, where are you in the pipeline?

 

[rajvosa]

Rajvosa, your personal information will have to be accepted, but they do not jive with either my personal experience nor does it jive with any information I have. In short, I don't believe you. The fact that you do not have first hand information about even medical school in Europe makes me doubt your claims. [/B]

What are you talking about? Where did I mention european med schools except for telling you the lenght differences? In fact, I do not believe your bull$hit when you said that you "the famous MS3 from the States" were teaching british surgical residents how to do lap chole. In fact, I think you may have forgotten to mention all those ground rounds that you presented on lap. chole techniques at the British Surgical Society...hahahahaha...you *****.

 

[Foxxy Cleopatra]

120 hours a week is fun! I love paperwork as well- give me more scut!

Just kidding, and as much as it pains me to say this because I really despise inefficiency and think that sleep is a good thing, continuity is a serious issue. My verdict is still out as to how it will affect patient care, but for learning opportunities, I think working up and following the same patients is invaluable. Especially early on in your training- rationale behind some clinical decisions can be lost when you are not following the patient day in and day out.

If only we could find a way to cut out the BS work...

 

[roja]

I havent' worked over 80h/week yet. Granted, EM has never really been a big proglem with Bell comission violations. Our program is quite adamant about us not working over it. Occasionally someone will if they switch shifts so that they can have a large block of time off, but otherwise not.

I also didnt come close to violating it when I was on MICU. We were not so subtly told to leave when post call and were pretty much shoved out the door.

 

[MacGyver]

Originally posted by Foxxy Cleopatra
as much as it pains me to say this because I really despise inefficiency and think that sleep is a good thing, continuity is a serious issue.

Myth: In the old system, patient continuity was perfect, its only a problem in the 80 hour system.

Fact: The average hospital stay is 8-13 days. Unless you work 8 days straight (192 straight hours) it is IMPOSSIBLE to ensure continuity on the average hospital patient.

Anybody who tells you that in the old system patient continuity was not a problem is a fool. There are ALWAYS going to be continuity issues, unless residents work 24 hours a day, 7 days a week, or unless all of their patients problems are resolved within 3 or 4 days. How many patients do you know who stayed only 3-4 days in the hospital? Answer: not that many

My verdict is still out as to how it will affect patient care, but for learning opportunities, I think working up and following the same patients is invaluable.

You can still do that in the 80 hour setup, you just cant follow them from admit to discharge. Of course, that hardly distinguishes it from the old system. How many patients did residents follow from admit to discharge in the old system? Answer: very few. The average hosptial stay is WAY too long for that to happen with any frequency/regularity.

Especially early on in your training- rationale behind some clinical decisions can be lost when you are not following the patient day in and day out.

80 hour setup still allows you to follow patients day in and day out, just not every hour they are there. Of course, the old system didnt do that either.

again, please explain to me how residents were able to follow up patients when the average hospital stay is 8-13 days. Are you honestly advocating that residents work 8 day shifts just to ensure that they are there for every hour the patient is in the hospital?

If only we could find a way to cut out the BS work...

Your boss and administration KNOW how to do this, they just dont want to pony up the money to do so. They'd rather have you as their "yes man" who doesnt ask questions, doesnt raise a ruckus, and behaves like the nice little slave girl resident they want you to be.

Its quite easy to prey on residents when none of them has any balls to do anything about it. Its even better when you can brainwash them into believing the mantra that you must be in the hospital 24-7 to be a good doctor.

 

[Foxxy Cleopatra]

Originally posted by MacGyver


80 hour setup still allows you to follow patients day in and day out, just not every hour they are there. Of course, the old system didnt do that either.

again, please explain to me how residents were able to follow up patients when the average hospital stay is 8-13 days. Are you honestly advocating that residents work 8 day shifts just to ensure that they are there for every hour the patient is in the hospital?


Your boss and administration KNOW how to do this, they just dont want to pony up the money to do so. They'd rather have you as their "yes man" who doesnt ask questions, doesnt raise a ruckus, and behaves like the nice little slave girl resident they want you to be.

I agree with the idea that whether you work 60 or 120 hours a week, at some point you are not in the hospital and have to sign out. I think some of the difficulties we are seeing now are simply because we are still getting used to doing that. In that aspect, I think we can adapt.

However, even in the past 7 months, I have seen ways where my program has changed things to be in compliance. I'm not going to lie- I can certainly manage to enjoy my extra free time.

The thing that I have seen to be problematic is that to be compliant, we often have a few consecutive days away, followed by broken up days where you are so busy that your head spins. It can be hard to keep your head above water and you often do not get to see the results of your ideas/ patient management changes.

A part of this is because the patient load is still the same as it was before. The part that I hope does change in the future is willingness to hire others to efficiently deal with paper/social/ancillary/transport issues, so that less of our time is spent wasting time.

 

[DoctorDoom]

Originally posted by rajvosa
What are you talking about? I do not have first hand info about med schools in Europe? You must be on some drugs buddy.
Where did I mention european med schools except for telling you the lenght differences? In fact, I do not believe your bull$hit when you said that you "the famous MS3 from the States" were teaching british surgical residents how to do lap chole. In fact, I think you may have forgotten to mention all those ground rounds that you presented on lap. chole techniques at the British Surgical Society...hahahahaha...you *****.

Easy junior... I have not been rude to you. Do not be rude to me. Check yourself. Reread my post, and your own. Your original post you said you thought that medical schools in Europe were of this or that length. That's supposition, which you then followed with your personal information. My doubts should have been properly directed to your information regarding residency. My poor writing.

Answer the questions presented to you in a reasonable way. I am not your buddy, nor am I a *****. If we were in the same room you wouldn't have the stones to behave in this uncivil manner, so don't do it hiding behind the computer screen.

 

[rajvosa]

Sorry but you obviously misread my post.
I appologize.


PS. I still do not believe you about lap chole though.

 

[rajvosa]

Hope you accept my appology.

 

[freelancewriter]

There is an article on CNN.com headlined "Study confirms sleep essential for creativity"
http://www.cnn.com/2004/HEALTH/01/21/sleep.creativity.ap/index.html

Just thought I'd throw that out there.

 

[scutking]

Another thing about the 80 hour week that we have to keep in mind is that the amount of work doesn't decrease proportionally with our hours. At my institution (a large, public, Level I trauma center), we were extremely busy prior to the work restrictions. Now, with the 80 hour rules, we are getting destroyed on call because we're cross-covering patients for other teams. Patient care has suffered, injuries have been missed, we're blowing through our work post-call to get out by noon, and when we check out to the on-call team, they're already behind with their own stuff so how can they adequately take care of our patients as well? This is going on while hospital volume is increasing, the number of OR cases is increasing, and trauma volume is increasing - while the hospital is cutting support staff due to budget constraints. I love time off as much as anybody, but I truly feel a 24-hour sense of committment to my patients, especially after I operate on them. I do a better job taking care of them tired than does some other resident who is getting killed on call and has never seen my patient before in their life.

 

[beyond all hope]

As far as I know, surgeons seem to be the only ones against the 80 hour work limit. You raise some valid points, but I think that the basic premise of the work limits is being missed.

The reason that you're working so much harder with the 80 hour limit is that they probably haven't hired additional staff to help you out. The problem is not the 80 hour limit, it's understaffing by the hospital. The hospital should supply extra residents, PAs, nurses, attendants, whatever in order to make 80 hours a week enough to care for your patients.

As for 'budget constraints', we're all familiar with those terms. The reason that the problem has been ignored for so long is that valiant residents were more than willing to work the extra hours so that administrators could save money. Wait until the lawsuits start rolling in for fumbled patient care and see if you don't see where the money is hiding.

It's noble that you think working more hours will help your patients, but I believe that it's not correct. There is very good evidence that working without sufficient rest makes you inefficient and prone to mistakes. I'm sure that many surgeons will counter with "I'm at my best when I work 110 hours a week." Frankly, I doubt it. Ego should take a back seat to patient care.

I think it's important to realize that not all problems can be fixed by fortitude and diligence to duty. Some problems are simply larger than our ability to handle, and we need to know when to ask for help.

 

[Apollyon]

Originally posted by roja
We were not so subtly told to leave when post call and were pretty much shoved out the door.

That's what I said!

 

[MacGyver]

Originally posted by scutking
Another thing about the 80 hour week that we have to keep in mind is that the amount of work doesn't decrease proportionally with our hours. At my institution (a large, public, Level I trauma center), we were extremely busy prior to the work restrictions. Now, with the 80 hour rules, we are getting destroyed on call because we're cross-covering patients for other teams. Patient care has suffered, injuries have been missed, we're blowing through our work post-call to get out by noon, and when we check out to the on-call team, they're already behind with their own stuff so how can they adequately take care of our patients as well? This is going on while hospital volume is increasing, the number of OR cases is increasing, and trauma volume is increasing - while the hospital is cutting support staff due to budget constraints. I love time off as much as anybody, but I truly feel a 24-hour sense of committment to my patients, especially after I operate on them. I do a better job taking care of them tired than does some other resident who is getting killed on call and has never seen my patient before in their life.

1) Dont piss in my ear and tell me its raining

2) Maybe if the hospital wasnt paying your neurosurg attendings 400k on average they'd have some money to pay PAs and other staff.

3) Your strawman argument that 80 hour workweek INEVITABLY LEADS TO THE PROBLEMS YOU DESCRIBE IS bull****. Your hospital has chosen that fate, because they are either too greedy or too stupid to know the difference.

4) Why dont you ask your hospital for a list of all the salaries of its top officials. I guarantee you there will be multiple people on that list making 1 million dollars or MORE per year. Yet that same hospital tells you that they cant hire PAs or nurses because there's no money available. Please see #1.

 

[dry dre]

Originally posted by scutking
Another thing about the 80 hour week that we have to keep in mind is that the amount of work doesn't decrease proportionally with our hours. At my institution (a large, public, Level I trauma center), we were extremely busy prior to the work restrictions. Now, with the 80 hour rules, we are getting destroyed on call because we're cross-covering patients for other teams. Patient care has suffered, injuries have been missed, we're blowing through our work post-call to get out by noon, and when we check out to the on-call team, they're already behind with their own stuff so how can they adequately take care of our patients as well? This is going on while hospital volume is increasing, the number of OR cases is increasing, and trauma volume is increasing - while the hospital is cutting support staff due to budget constraints. I love time off as much as anybody, but I truly feel a 24-hour sense of committment to my patients, especially after I operate on them. I do a better job taking care of them tired than does some other resident who is getting killed on call and has never seen my patient before in their life.

Sounds like your hospital needs more residents and/or attendings.

I don't mean to piss on your effort or that of your collegues. This problem is the same everywhere, though it seems that people generally like longer work weeks than having more med school seats .

 

[LaCirujana]

MacGyver's favorite throwaway phrase="strawman argument"

*snicker*

 

[Linie]

MacGuyver still hasn't fessed up about his level of training. I'm beginning to wonder if he's in medicine at all.

 

[scutking]

I agree with you dry dre - my hospital needs to hire more support staff. The problem is, they are a public (county) hospital and anybody who's ever trained in one of those knows the chronic budget problems they endure. They are actually cutting support staff and volumes are increasing. I agree with improving work hours, and I love my day off a week, but there has to be a happy medium between forcing residents out of the hospital and getting your work done for your patients. It's a tough dilemma for everybody.

 

[The White Coat Investor]

I don't see what the big deal is...one specialty has been enforcing a 60 hour work week for years...Emergency Medicine.

But I must say, I feel bad for some of the surgical subspecialists, who go to the hospital at 6 am, wait until 7 pm for something cool to come into the ED, operate on it, sleep all night, and then get sent home at 9 am when something cool has just come into the ED again. I think there may be some "missing out" on stuff of educational value by those in some surgical subspecialties due to the 80 hour work week.

 

[fourthyear]

I hope desparado as kind of tounge-in-cheek about the above comment about surgery residents just wating all day and all night for something to come through the ER so they have something to do...surgery residents DO have patients in the hospital other than those who come thru the ER - we have clinic, scheduled cases, consults on inpatients from other services - please don't mislead the young ones who read this board into thinking surgery residents have no work to do other than waiting around to operate. I know most people realize that's not true, but your comment about "sleeping all night" makes it seem like you don't have a clue what surgery residents do all day and night.

 

[The White Coat Investor]

It actually wasn't tongue in cheek, and I'm currently an intern on a surgical rotation (ortho.) No, I don't sleep all night every night, but I frequently get 5+ total hours of sleep.

You see, at night surgeons don't have clinic patients etc, they just have floor calls, the occasional emergent floor consult, and what comes in the ED. I promise you they don't wait around for "interesting" calls from the floor and most subspecialists dislike consults from other services because they don't often lead to an operation and the patient frequently has numerous other medical problems. So the "fun" is what comes in the ED.

Keep in mind the post referred to surgical subspecialists, not general surgeons. I rarely see general surgeons sleep, and didn't get much when I was on trauma (4 hours total in 9 calls) Trust me, I know what surgeons do all day and all night.

The point of my post was this...sometimes surgeons (particularly subspecialists) don't get killed all night, and would prefer to stick around a few hours during the day to do a case. The new rules can potentially prevent that, and I can understand why they might think that was a bad thing.

 

[SweetMD]

Originally posted by rajvosa
source...hmmm....let's say I was born in Europe and my father is a cardiologist there. I lived there for 23 years, went to med school there (initiallly) and have a friends doing their residencies. Is that enough for you?

Regarding residency in Europe;

Rajvosa - you gotta be kidding me!!!!!
What kind of BS are you spreading here??

that your daddy is a cardiologist doesn't mean that YOU know SH.., you have friends doing residencies in Europe? Germany?
Ehm... do you ever TALK to them???

You have been to med school in Germany and did not realize that ONLY doctors do phlebotomy and IV's ? Because the US style IV teams and nurses starting IV's is a concept totally unknown in that part of Europe???

Your ' friends' in Germany all work 40 hours per week during residency... that's .... great... my friends in Germany work 60 to 80 hours per week (depending on specialty) while it takes them over 5 years to complete a residency in Medicine or FP or Peds and many more for surgery, if you're lucky - since residency is not organized in Germany as it is here and it's at your chairman's disgression how 'fast' you advance and whether you get the procedures/exposure you need to take the specialty boards.

And as far as length of training - if you had finished med school in Germany you would know that you take your last board exam months after your last rotation and thus graduate after 6.5 yrs, plus you have 13 yrs of high school in parts of the country, plus guys have to do military or social services for 1+ yr. Bottom line - time/age wise it comes out to about the same.

Granted, everyone gets 6 weeks vacation, which is very nice.

 

[DoctorDoom]

Well, well, and here I was thinking I had lost my mind, or that things had changed in the 8 years since I was last in Europe for clinical work... interesting info SweetMD.

You can doubt me as I doubted you rajvosa, but what say you now?

 

[Pilot]

4th year medical student - just completed 288 hours in a row. Required to be at the hospital 24hr/day for 12 days, then get two weekend days off. 80 hrs/week sounds great to me...... Got 1 more month to go until finished with this site.

 

[SweetMD]

What med school is this??
are you camping there for the 12 days?
you have my sympathy...

 

[BPKurtz]

This is fishy. I refuse to believe you didn't volunteer for whatever rotation that doesn't let you leave the hospital for 12 days. If that's the case, a) you deserve what you volunteer for, and b) I think you are kind of stupid. If you didn't volunteer, why on God's green earth would anyone ever choose your med school when there are perfectly good ones with attendings who have a reasonable degree of sanity?

bpkurtz

 

[magicman]

Jason:

I do'nt have any personal stories to tell since I'm a medical student, but how about a couple of facts: the 80 hour work week is pretty much a joke at the big name institutions. No one there is going to piss anyone off, and most residents who get into the big names don't care about 80 hours anyway. A large number of them probably got in there by busting their ass anyway. I know this admittedly on a small selection sample, but it comes up often enough that I feel confident making this generalization.

2nd: medical students aren't subjected to the same restrictions. Now, they don't normally have primary responsibility for patients, but I find it ridiculous that residents leave the hospital after 24 hours straight but medical students sometimes don't.

3rd: a far more interesting story to me, and one that I've been dying for a good reporter to delve into, is how ridiculously poor the quality of care is in today's medical world. I could go on and on about just how pathetic it is, but basically medicine is unbelievably inefficient, a lot of what we do is more toxic than the actual disease, it's become incredibly dehumanizing, and basically just sucks all around. There are so many freaking problems with medicine I don't even know where to start. I suppose law, business, etc. are probably also imperfect, but I hate medicine's high and mighty attitude and hierarchical nature. only like 10% of what we do is evidence based, and even that 10% is mostly thinly veiled pseudoscience. Pharmaceutical companies control so much of the research it's sickening. A good researcher and statistician can manipulate results, and get results without even making things up. It's a joke.

 

[margaritaboy]

pilot,

put of out of our misery and tell us what hospital you're in, or at least what city. I've never heard of a 288 hour shift!! That's incredible!

 

[BPKurtz]

Perhaps he was required to be in the hospital 12 days straight because he was on the psych ward... as a patient?

bpkurtz

 

[Pilot]

Sorry, I forgot I posted this and was just reviewing my posts to see if I needed to tie up loose ends. I guess I did since I have been called crazy, and the story "fishy."

The medical school is Oklahoma State University, and the rotation is the Community Hospital Rotation at Pauls Valley, OK. The required rotation is with the only internist in town, who shares a clinic with the only surgeon in town, so I not only had all the internist admits and consults, I also did surgery every day of the week. The rotation is normally two months long, but I only had to do six weeks due to Step 2 Boards.

I was required to be in hospital for 12 days in a row, then got a weekend off. I was allowed to "sign out" for three hours if necessary, but the one time I did (to go to dinner with my family), I had 3 admits in that time period. New admits at night - I was called. Need a medication change - call the student. Need help moving a patient - call the med student. Code Blue - "where's the med student?" - I actually had an ER doc try to "report" a code patient to me when I walked in the room - I politely began chest compressions and didn't acknowledge him so he wouldn't leave.

Since I am in my last year of school, I didn't want to rock the boat. Just put my time in, and smiled. I did learn a lot, and the rotation overall was very good. Just sucked being away from my wife and kids that long.

Now I am on another rotation in a small town where I have to live at the hospital again, but I get to home every weekend, and I can leave the hospital to run, explore the town, etc. 17 days to go, then medical school is done for me... And speaking of living in a psych ward - the rotation I was originally assigned to for this month did place the student in a lock-down psych ward, in a room without a lock (all the "patients" could walk in), with no TV or phone in the room, and a community shower. Luckily, I was able to switch.

 

[Masonator]

The only reason it hasnt been proven is because its ILLEGAL and UNETHICAL to run the kind of experiments you would need in order to prove it.

What HAS been proven is a myriad of effects that sleep-deprived residents experience. Their mental acuity suffers, their cognitive awareness becomes no better than an 8 y/o child. Their motor reflexes diminish, their response time doubles, their reading comprehension drops by more than 50%. Their ability to focus and concentrate drops substantially. Their short term memory is drastically reduced.

Of course, the extremists like Linie will tell you that all of htose things have ZERO impact on patient care.

They've done some research that sleep deprivation impairs you in similar ways to drinking too much alcohol. Unfortunately I don't have the source. It's funny that one will get your liscence yanked and the other is ignored.

 

[Masonator]

Sorry, I forgot I posted this and was just reviewing my posts to see if I needed to tie up loose ends. I guess I did since I have been called crazy, and the story "fishy."

The medical school is Oklahoma State University, and the rotation is the Community Hospital Rotation at Pauls Valley, OK. The required rotation is with the only internist in town, who shares a clinic with the only surgeon in town, so I not only had all the internist admits and consults, I also did surgery every day of the week. The rotation is normally two months long, but I only had to do six weeks due to Step 2 Boards.

I was required to be in hospital for 12 days in a row, then got a weekend off. I was allowed to "sign out" for three hours if necessary, but the one time I did (to go to dinner with my family), I had 3 admits in that time period. New admits at night - I was called. Need a medication change - call the student. Need help moving a patient - call the med student. Code Blue - "where's the med student?" - I actually had an ER doc try to "report" a code patient to me when I walked in the room - I politely began chest compressions and didn't acknowledge him so he wouldn't leave.

Since I am in my last year of school, I didn't want to rock the boat. Just put my time in, and smiled. I did learn a lot, and the rotation overall was very good. Just sucked being away from my wife and kids that long.

Now I am on another rotation in a small town where I have to live at the hospital again, but I get to home every weekend, and I can leave the hospital to run, explore the town, etc. 17 days to go, then medical school is done for me... And speaking of living in a psych ward - the rotation I was originally assigned to for this month did place the student in a lock-down psych ward, in a room without a lock (all the "patients" could walk in), with no TV or phone in the room, and a community shower. Luckily, I was able to switch.

I've actually heard about some of those OSU community rotations being brutal. The medical students basically have resident authority and responsibility. I think you learn alot but it is at the expense of your life. I bet you will be a better doctor for it. You may want to think twice about rural medicine though!

 

[erinmed2k4]

That is amazing that you were called for all of those things. med changes? can med students even do that????? During codes at my hospital, med students are only asked one thing...get out of the way. I guess that is the biggest downside of "learning" in a tertiary care center.

 

[Homunculus]

That is amazing that you were called for all of those things. med changes? can med students even do that????? During codes at my hospital, med students are only asked one thing...get out of the way. I guess that is the biggest downside of "learning" in a tertiary care center.

community hospitals are definitely a great place to learn. i go to OSU as well, and the medical students are basically given attending privileges when it comes to orders and admissions. the nice thing is you are actually treated like a physician-- the nurses and ancillary staff actually do what you tell them and treat you (at least to your face, lol) with respect. the downside is that the leanring curve is pretty darn steep, and you can get in over your head if you're not on your toes. it's definitely a sink or swim environment, but it's some darn good learnin'

 

[Blade28]

Hey, as a 3rd yr med student in Surgery I'm working more than 80 hrs/wk!

Yeah, the rules don't apply to med students.

Not that bad though...I never worked more than 80 hours in any rotation besides OB/GYN and Surgery. Around 90 hr/wk max for OB, up to 100-105 for Surgery.

Ah, good times.

 

[aliraja]

I think that there's some underclassmen at my school are are trying to get the Dean to okay an 80 hour week for med students on teh wards. I don't know too much about it since I haven't kept up... but I'm sure that it's happening at other places too.

 

[Blade28]

I think that there's some underclassmen at my school are are trying to get the Dean to okay an 80 hour week for med students on teh wards. I don't know too much about it since I haven't kept up... but I'm sure that it's happening at other places too.

Yeah, I don't know if that rule would ever get passed nationally. We're not employees of anyone.

 

[care bear]

hi, i'm going to med school class of 2008. . .but the idea of working 80 hours or more down the line just scares me; i don't know if i'll be able to function.

i get so stressed just working 50+ hours as a lab tech now; often i think that for that reason maybe i am not cut out for medicine. can anyone offer some words of encouragement? does everyone just metamorphosize into a stronger, more resilient person sometime during med school? or are people who like to sleep the exception to the rule in medicine in general?

and yes, i know i don't have to worry about this now, and that i should wait and worry abt it when i get there. . . but that being said. . .any other thoughts?

 

[DrIng]

OK, I am very scared. I'm currently an intern in Australia and have just completed my time sheet for the fortnight- 98 hours. Now that's a little below average but I have never worked in the 4 months I've been in this job more than 60 horus a week and it's closer to 50-55, and they're paying me. (And anythign I work over a 40 hour week I get paid extra for).
As a medical student I did 9-5 Monday to Friday with an occaisonal weekend but quite a few atfernoons off in that time. Would someone please tell me that these kind of hours are a cruel joke or else why don't you all come and work in Australia where we have humane working hours. I don't know about you but if I was the hospital for 288 hours straight I'd be killing people through themistakes you'd make through sheer exhaustion. Inf act I remember the UK used to ahev working horus like those described but had to stop them after too many patients were killed due to fatigue induced mistakes.
A study done a few years back indicated that 24 horus of sleep impairs your performance in an equivalent amnner to a blood alcohol limit of 0.05. How would you react if a colleague were drunk at work!!!
Secondly, it sounds like you have a scary amount of authority as a medical student- correct me if I'm wrong but you aren't actually liscenced to practice medicine yet? How does this happen in a country as litigious as the US? I'm confused....

 

[care bear]

bumping to get some responses to my question above. . .

 

[kinetic]

hi, i'm going to med school class of 2008. . .but the idea of working 80 hours or more down the line just scares me; i don't know if i'll be able to function.

Don't worry about it. First of all, nobody LIKES working 100+ hours, so just because you're not jumping up and down clapping your hands at the prospect of this, doesn't mean you're not cut out for it. Secondly, you sort of do what you have to. If you're on a long, grueling service and carrying tons of patients you work all day and night and then come home and collapse and fall asleep. But you also have light consult/clinic services where you do not much of anything from 9-to-5 (which, pathetically enough, feels like a vacation for physicians). The long services grate on everyone - that's why the more overworked guys (classically, surgeons) are chronically grumpy and tired. Unfortunately, waking up before the sun rises and working until after the sun sets six days a week makes subclinical depression a fact of life for many residents.

I don't mean for this to be a downer, but you should know the realities of being a physician. On the other hand, it's rewarding work and I wouldn't trade it for deskwork in an office from 9-to-5 with weekends off and vacation time (well, not usually ...heh heh heh).

 

[Catfish John]

Just a 3rd year medical student, but from those that I've spoken with it's not really the number of hours worked that 's the problem, because people want to put in the time to be trained to the highest level.

The real issue is the continuing erosion of autonomy, the ever-declining reimbursement almost across the board in medicine, the ever-rising cost of a medical education, and being caught in the crossfire between trial lawyers, pharmaceutical companies and corporate medicine. The answer isn't to say that surgery residents should have their hours capped, it's a little more complex than that.

 

[care bear]

thanks for the replies abt my concerns. yeah, my PI says the same thing: 'you just gotta plow through'.
i guess that's just not the mentality that i'm used to. ..i can't stand to do something while i'm unhappy about doing it; i want to love the process and not just the result. but i guess medicine will bring out that endurance in me? hopefully.

i think it also bothers me to know that my prime childbearing years are essentially wiped out by plans to learn medicine. most of my friends (early 20's) would probably like to have children in their late 20s. some earlier, some later, but i would say that's what most college educated women are aiming for these days.

so maybe more than just the cruel hours, i dread the feeling of wondering if my time could be put to better/more appropriate use. . .but hey, i guess taking care of 20 children per day (peds residency for me maybe?) should actually be more satisfying from a utilitarian standpoint than taking care of your own 1 or 2. . .let's hope so!