Thursday, March 23, 2017
Saturday, March 11, 2017
Work hours for Interns
There's a lot of uproar about the fact that the maximum shift for first year residents (interns) has been extended to 24 hours again. I was an intern twice (don't ask) and worked first under no restrictions and then under the 80 hour work week. I had a variety of chief residents who fiddled the schedule in various ways.
I did a number of 36 hour shifts, they suck. Unless you are one of those people who is wired that way, they are complete misery. I found out later that a lot of my fellow residents used adderall to get through.
Twenty-four hours, when you were done at morning sign out, was not that bad. You had a whole day, often during the workweek, to use as you wanted. I tended to spend the morning in the hospital finishing up paperwork, left at noon as directed and went home, did laundry and went to bed at 7 or 8 pm and slept through to the next morning. If the night had been horrible, I would go straight home, shower, put on my jammies, sleep if I could and work on catching up medical records via a Virtual Private network in to the hospital computer system. (I LOVED that, from my standpoint it was the best invention ever.)
What I hated was having call, and then being assigned the next morning do cover something, a surgery or the floor on patients I didn't know. It is one thing to be dog tired and delivering a baby after getting to know the woman all night, another to have to hang around for a stranger because there's no one else. It was being allowed to stay for something you wanted to do, versus being forced.
Hand-offs are their own kind of danger. Hand-offs create more problems at the lower (less experienced) levels. There was a study on this in JAMA, I'm not going to go find it. I read it during my semi-annual CME binge. For senior residents, sleep may be more important than familiarity. For juniors, this may not be true. As someone who does only office work now, my middle of the night phone calls are non-existent. But for a few years I worked in a general clinic where I took the middle of the night calls from my patients. These were relatively few, and always on point. Because I knew the patients well I could triage between "go to the ER" and "Be at the office at 8am," pretty easily.
I found a certain amount of value in the learning I did when bone tired. I learned that I prefer to do my thinking ahead of time and I develop routines and workflows that keep me from missing things. This still serves me well, even as I get a full night sleep every night.
I think there is a possibility that period 24 hour shifts are NOT the problem. That the problem is frequency of them, and the casual disregard of people's health the rest of the time. I really enjoyed a Q6 call schedule, and still kind of miss it.
I did a number of 36 hour shifts, they suck. Unless you are one of those people who is wired that way, they are complete misery. I found out later that a lot of my fellow residents used adderall to get through.
Twenty-four hours, when you were done at morning sign out, was not that bad. You had a whole day, often during the workweek, to use as you wanted. I tended to spend the morning in the hospital finishing up paperwork, left at noon as directed and went home, did laundry and went to bed at 7 or 8 pm and slept through to the next morning. If the night had been horrible, I would go straight home, shower, put on my jammies, sleep if I could and work on catching up medical records via a Virtual Private network in to the hospital computer system. (I LOVED that, from my standpoint it was the best invention ever.)
What I hated was having call, and then being assigned the next morning do cover something, a surgery or the floor on patients I didn't know. It is one thing to be dog tired and delivering a baby after getting to know the woman all night, another to have to hang around for a stranger because there's no one else. It was being allowed to stay for something you wanted to do, versus being forced.
Hand-offs are their own kind of danger. Hand-offs create more problems at the lower (less experienced) levels. There was a study on this in JAMA, I'm not going to go find it. I read it during my semi-annual CME binge. For senior residents, sleep may be more important than familiarity. For juniors, this may not be true. As someone who does only office work now, my middle of the night phone calls are non-existent. But for a few years I worked in a general clinic where I took the middle of the night calls from my patients. These were relatively few, and always on point. Because I knew the patients well I could triage between "go to the ER" and "Be at the office at 8am," pretty easily.
I found a certain amount of value in the learning I did when bone tired. I learned that I prefer to do my thinking ahead of time and I develop routines and workflows that keep me from missing things. This still serves me well, even as I get a full night sleep every night.
I think there is a possibility that period 24 hour shifts are NOT the problem. That the problem is frequency of them, and the casual disregard of people's health the rest of the time. I really enjoyed a Q6 call schedule, and still kind of miss it.
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