Death By Overwork - Comments?

[Morgus]

Hi everyone! I think the following post should be required reading for all involved in the training of resident doctors.

http://www.thetimes.co.uk/article/0,,7-2001296020,00.html

TUESDAY AUGUST 28 2001

Death by overwork
BY ANJANA AHUJA

As pressure intensifies in our working lives, scientists are discovering that stress not only triggers illnesses but may be a killer in its own right
It could be the most perfectly designed killing machine of our time. It is usually implicated but never convicted; usually present, but leaving no physical trace.

In the rigorous world of epidemiology, nobody dies of stress. Stress, of itself, will not send you from this world to the next. But epidemiologists will tell you that this curse of modern life is a constant presence behind other more familiar diseases, such as heart disease, stroke and cancer. It may be the furred arteries or the malignant tumour that ultimately gets you, but the journey to your grave is more likely than not to be quickened by chronic worry.

Stress may soon, however, step out the shadows as a killer in its own right. The parents of Alan Massie, a junior doctor who collapsed and died after working an 86-hour week at a Cheshire hospital, say that their 27-year-old son was worked to death. A coroner ruled that he died from natural causes and attributed it to Sudden Adult Death Syndrome, a rare heart abnormality that claims otherwise fit and healthy young victims. There have been numerous reports of young people, particularly men, suddenly dropping dead, with post-mortems revealing nothing. Dr Massie complained of feeling unwell; he then collapsed and died in front of his girlfriend, despite frantic attempts by a doctor flatmate to revive him.

George and Margaret Massie reject the coroner?s verdict, saying that it was stress alone that led to his death. There have been newspaper reports that the Massies will sue the health trust that employed their son. They reject such talk as premature but, in a conversation with The Times, they refused to rule out the possibility of legal action. Mr Massie says that his son?s death certificate should have read ?death by overwork? instead. The Massies insist that if Alan was not a junior doctor, he would still be alive today.

?Alan used to come home and tell me he?d worked 127 hours,? his mother says. ?He said he felt like throwing his bleeper at the wall.

?On the last day of his life he became so forgetful. But I never expected him to die. He was far too dedicated to his work. We feel his work cost his life. Our daughter feels that way, as do our sons. His friends feel like that. It?s a dreadful waste of a life. Nobody needs to ask me whether stress cost his life ? could anyone work night and day without sleep??

Whatever happened to Dr Massie, it was a tragic aberration. Overwork is common among junior doctors, while sudden death is not. However, the unnerving possibility remains that, in a handful of unlucky individuals, stress will trigger an untimely demise. There is a weight of anecdotal evidence to suggest that stress is a more pernicious and direct adversary than previously thought. As one junior cardiologist, who wished to remain anonymous, says: ?My gut feeling is that stress is a primary factor in causing heart disease. When you have the luxury of time to delve into a patient?s history, you can usually find a stressful event that triggered angina pains or a heart attack, or even an asthma attack.

?The problem is the quality of evidence ? it?s anecdotal. But you can?t just dismiss it. You can measure packs of cigarettes, cholesterol level and blood pressure, but how do you reliably measure stress??

On this Labor Day Weekend in the US, it's interesting to consider that the concept of reasonable working hours for all jobs and professions--EXCEPT MEDICINE--was enacted into law by the Federal Government some 100 years ago. When are we doctors going to stop making excuses about why 100-120 hour and higher work weeks are "necessary for effective training"?

State Medical Boards that deal with the problem of "The Impaired Physician" readily tackle issues of incompetence in medicine induced by alcohol and drug abuse, but look the other way at hours in residency programs. Sleep doctors and scientists have rigorously shown evidence that sleep deprivation causes structural and biochemical brain damage, some of which is irreversible, as well as evidence of massive systemic cellular and humoral immunosuppression from chronically elevated cortisol levels so resultant. I did a sleep medicine elective rotation, and repeatedly asked why the science coming from the studies being conducted never made it into the medical workplace itself. There was never an acceptable response.

Those who believe that 36 hour call makes for better doctors should ask for an airline pilot who has been up for 30 hours the next time they take a 6 hour flight. It would only be fair to require the same level of performance from others that you require from resident doctors. And, of course, to experience the same risks that are experienced by those doctors and their patients.

Again, whether we agree or disagree, I ask all to give their honest opinions here based on lucid thinking, without primitive savagery more becoming of Australopithecus africanus.

Best to all,
Doctor Morgus

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[MacGyver]

Bravo, Dr. Morgan, I agree completley.

I am so sick of hearing program directors and attendings claim that the ONLY way to get fully trained is to go into sleep deprivatin to do so.

After all, why dont we see these attendings/PDs working 130 hours a week? Why dont we see them try to stay up for 50 hours straight instead of the normal 36?

Surely we could learn EVEN MORE if we required our residents to work 150 hours a week instead of a paltry 130. Come on, you cant even learn anything with such a weak schedule.

Its time this line of reasoning is exposed as the fraud that it truly is. Nobody learns complex, new surgical procedures after beign up 36 hours strait. In fact, you dont learn much of anything and can barely think clearly after such long periods.

So lets stop fooling ourselves into thinking that we are really learning new stuff when its perfectly clear those are just wishful thoughts.

 

[DCStudent]

Dr. Morgus,

Please check your profile for a private message I sent you.

Thanks,

Adam Alexander