Comments on: More thoughts on work hours http://www.medrants.com/archives/4283 Contemplating medicine and the health care system Sun, 14 Mar 2010 00:12:54 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Bruno http://www.medrants.com/archives/4283/comment-page-1#comment-527864 Bruno Wed, 10 Jun 2009 16:10:09 +0000 http://www.medrants.com/?p=4283#comment-527864 //We have residents getting 4 days off each month and faculty members getting 0 days off during the same month.// Where Definitely not in India //We have residents getting 4 days off each month and faculty members getting 0 days off during the same month.//

Where

Definitely not in India

]]> By: Bruno http://www.medrants.com/archives/4283/comment-page-1#comment-527863 Bruno Wed, 10 Jun 2009 16:09:37 +0000 http://www.medrants.com/?p=4283#comment-527863 //Residency training is rigorous, because it matters. // Bull Shit Residency Training is rigorous because we need to have lot of work done with few people and residents don't question or agitate as their education is in your hands and so you can treat them as bonded labour This is the reality -- In those good old days, when doctors were treated as GOD, a mistake due to sleep deprivation / overwork was overlooked. Not in this era of litigation When times change, we have to change -- //Would I rather have him at 2 am - tired but experienced, or a general surgeon without specific trauma training.// Now you have not specified the meaning for tired And that changes the question Do I want to be operated by a Trauma surgeon who is on Duty from Tuesday Morning 7 AM till Wednesday 2 PM and has to be on duty till Wednesday 6 PM or Do I want to be operated by a General Surgeon who has come to duty on Wednesday Morning 7 AM after a night Off Your answer please -- //Residency training is rigorous, because it matters. //

Bull Shit

Residency Training is rigorous because we need to have lot of work done with few people and residents don’t question or agitate as their education is in your hands and so you can treat them as bonded labour

This is the reality

–

In those good old days, when doctors were treated as GOD, a mistake due to sleep deprivation / overwork was overlooked. Not in this era of litigation

When times change, we have to change

–

//Would I rather have him at 2 am – tired but experienced, or a general surgeon without specific trauma training.//

Now you have not specified the meaning for tired

And that changes the question

Do I want to be operated by a Trauma surgeon who is on Duty from Tuesday Morning 7 AM till Wednesday 2 PM and has to be on duty till Wednesday 6 PM

or

Do I want to be operated by a General Surgeon who has come to duty on Wednesday Morning 7 AM after a night Off

Your answer please

–

]]> By: Bruno http://www.medrants.com/archives/4283/comment-page-1#comment-527862 Bruno Wed, 10 Jun 2009 16:02:45 +0000 http://www.medrants.com/?p=4283#comment-527862 //Well, I can tell you the corporate world of medicine just loves these good old boy, ‘old school’ types who talk about personal sacrifice, and this essentially hazing mentality. What better way to keep the status quo going?// Well said :) :) //Well, I can tell you the corporate world of medicine just loves these good old boy, ‘old school’ types who talk about personal sacrifice, and this essentially hazing mentality.
What better way to keep the status quo going?//

Well said :) :)

]]> By: Bruno http://www.medrants.com/archives/4283/comment-page-1#comment-527861 Bruno Wed, 10 Jun 2009 16:01:17 +0000 http://www.medrants.com/?p=4283#comment-527861 I don't know where you are practising, but I disagree on certain points. Here in India there the situation of residents are much worse. They are forced to work even for 48 hours continously I don’t know where you are practising, but I disagree on certain points.

Here in India there the situation of residents are much worse.

They are forced to work even for 48 hours continously

]]> By: #1 Dinosaur http://www.medrants.com/archives/4283/comment-page-1#comment-527802 #1 Dinosaur Tue, 09 Jun 2009 18:26:52 +0000 http://www.medrants.com/?p=4283#comment-527802 I haven't seen anyone mention the role played by anxiety, as opposed to straight fatigue, in residency stress. Don't you think the farther along in training you get, the better you are able to perform at any given level of fatigue? That said, I think I have a pretty <a href="http://dinosaurmusings.blogspot.com/2009/06/resident-work-hour-restrictions-my.html" rel="nofollow">workable solution</a> to this dilemma. I haven’t seen anyone mention the role played by anxiety, as opposed to straight fatigue, in residency stress. Don’t you think the farther along in training you get, the better you are able to perform at any given level of fatigue? That said, I think I have a pretty workable solution to this dilemma.

]]> By: Dr. Grumpy http://www.medrants.com/archives/4283/comment-page-1#comment-527235 Dr. Grumpy Wed, 27 May 2009 02:36:14 +0000 http://www.medrants.com/?p=4283#comment-527235 After 11 years in practice my workdays are still 12-14 hours at times, and when on call for the weekend at a local trauma hospital I will sometimes get 8-10 hours of interrupted sleep in a 63 hour weekend. I agree that some degree of learning to handle sleep-deprivation is needed in training. This can be done within reason, and without jeopardizing safety and patient care. After 11 years in practice my workdays are still 12-14 hours at times, and when on call for the weekend at a local trauma hospital I will sometimes get 8-10 hours of interrupted sleep in a 63 hour weekend.

I agree that some degree of learning to handle sleep-deprivation is needed in training. This can be done within reason, and without jeopardizing safety and patient care.

]]> By: Jay http://www.medrants.com/archives/4283/comment-page-1#comment-527212 Jay Tue, 26 May 2009 14:00:01 +0000 http://www.medrants.com/?p=4283#comment-527212 Well, I can tell you the corporate world of medicine just loves these good old boy, 'old school' types who talk about personal sacrifice, and this essentially hazing mentality. What better way to keep the status quo going? Well, I can tell you the corporate world of medicine just loves these good old boy, ‘old school’ types who talk about personal sacrifice, and this essentially hazing mentality.
What better way to keep the status quo going?

]]> By: solo dr http://www.medrants.com/archives/4283/comment-page-1#comment-527200 solo dr Mon, 25 May 2009 22:09:27 +0000 http://www.medrants.com/?p=4283#comment-527200 I trained prior to the shift limits for my first two years and then during the shift limits during my last year. Prior to shift limits, it was not unheard of to start at 5:30 am on one day and then go home the next day around 6:30 PM. After about 24 hours, the brain starts hurting and you go on autopilot to get through the rest of the day. Lots of caffeine and high carb foods to maintain the energy, along with increased water and protein intake for the aching muscles. The advantage of doing long shifts is that, once I completed residency, private practice was a lot easier overall. I saw and learned a lot in residency, with a strong background to enhance my private practice experience. The shift limits did not effect me for call, in that they came into play during my third year, when call was only backup. First and second years were limited to call and time on the campus, I think to 16-24 hours. What ended up happening was third year residents and/or attendings would have to takeover care of the patients, do notes, checkup on labs from the on call resident. I don't think the training suffered overall with the reduced hours, but in private practice, there are no limits to how long a doctor can work. I typically work 70 hour weeks and am on call 24/7 in my solo practice, unless I take a formal vacation. My patients rarely call me after hours, but ERs/Nursing homes do call on the weekends and after hours. You learn to wake up and go back to sleep quickly to survive. The advantage of my private practice is that I have a futon in my office, where I can rest if needed. My inner drive to succeed was honed during residency, when I was able to set new standards for myself to succeed the long hours and dozens of patient admissions. Without the longer hours, I don't think I would have the drive that I do in private practice. Now I can take breaks when needed and rest when needed throughout the day, with a lot fewer pages but a lot more patients than in residency. I trained prior to the shift limits for my first two years and then during the shift limits during my last year. Prior to shift limits, it was not unheard of to start at 5:30 am on one day and then go home the next day around 6:30 PM. After about 24 hours, the brain starts hurting and you go on autopilot to get through the rest of the day. Lots of caffeine and high carb foods to maintain the energy, along with increased water and protein intake for the aching muscles. The advantage of doing long shifts is that, once I completed residency, private practice was a lot easier overall. I saw and learned a lot in residency, with a strong background to enhance my private practice experience.
The shift limits did not effect me for call, in that they came into play during my third year, when call was only backup. First and second years were limited to call and time on the campus, I think to 16-24 hours. What ended up happening was third year residents and/or attendings would have to takeover care of the patients, do notes, checkup on labs from the on call resident. I don’t think the training suffered overall with the reduced hours, but in private practice, there are no limits to how long a doctor can work.
I typically work 70 hour weeks and am on call 24/7 in my solo practice, unless I take a formal vacation. My patients rarely call me after hours, but ERs/Nursing homes do call on the weekends and after hours. You learn to wake up and go back to sleep quickly to survive. The advantage of my private practice is that I have a futon in my office, where I can rest if needed. My inner drive to succeed was honed during residency, when I was able to set new standards for myself to succeed the long hours and dozens of patient admissions. Without the longer hours, I don’t think I would have the drive that I do in private practice. Now I can take breaks when needed and rest when needed throughout the day, with a lot fewer pages but a lot more patients than in residency.

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