My friend and twentor, Vinny Arora, has this insightful blog post today – Resident Duty Hours: Take for a Wake-up Call
Of course, no one wants a tired doctor. But, the more relevant question is whether you prefer a tired doctor that knows you or a well rested doctor that doesn’t know you? Acknowledging the tradeoff makes it harder to answer. My answer – it depends. For a simple procedure, I would choose the well-rested resident (the one that’s most experienced in fact). But, for a more complex decision where familiarity with the patient matters, I prefer the resident who may be tired, but knows me better. Of course residents can’t work 24/7 (like they did when they were truly lived in the hospital hence ‘resident’) so handoffs will occur and limits on hours are needed. But, to arrive at the best solution, we must present this debate in a more informed way for the public.
Vinny avoids answering the questions she poses, but she very nicely paints a complete picture of the problems. This year we have changed our family medicine residency call to a maximum of 14 hours (to allow for 10 hours off each day). The new system has overlaps scheduled for careful handoffs.
Here is the problem, not everyone can sleep during their time off. This system seems to particularly disadvantage women residents with small children. They work all night (in our system for either 3 or 4 nights consecutively) but do not get enough sleep during the days. Some residents clearly prefer the 30 hour shift and several day recovery.
This question has no correct answer. The sleep proponents have the classic sub-specialty prism – everything is about the sleep. But patient care does not just involve sleepiness. Many residents working days will come to the hospital sleepy the next day because they do have a social life (as Vinny discusses clearly).
I believe the IOM report is not balanced. The sleep researchers have overinfluenced the conclusions. But read the article from FutureDocs to really understand.
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we talk a lot in this debate about what’s best for patients, but what about decreasing personal risk to physican trainees? This issue became so crystalized for me when as a fellow after 36+ hours in the hospital (and every one of those hours was busy) I nearly got into an accident at 60mph on the way home. Now, sure I could have decided not to drive, but my decision making capacity at that point was so eroded that I was not in fact capable of making that decision.
OSHA makes rules all the time based on the safety of the workers (just look at your safe-sharp needles)! but why is it that it’s only the good of the patients that you talk about in this debate?
I don’t think anybody’s doctor owes it to anybody to put themselves at risk of burnout, fatal car accidents, etc, just so that there can be fewer handoffs, and in reality, everybody has to go home, eventually, so docs in training need to learn handoffs anyway.