The problem with medical training...

So this morning my intern wakes me up at 6AM after I've been sound asleep for about a half hour.

Our 16yo girl with sickle cell disease is having increased chest pain and difficulty breathing, no fever. The immediate concern is that she could have the "acute chest syndrome," which is basically a sickle cell crisis of the lung.

For about 30 seconds, a battle raged in my head between the angel: "Get your arse out of bed, Mike, and potentially save this patient's arse because she's in pain and she's having trouble breathing and she needs you!" and the devil: "I'm so sleepy! I just want to lie here! The next team is coming on in less than an hour and they can take care of it!"

This internal argument should *NEVER* happen in a doctor. The patient should *ALWAYS* come first.

But it happens every day in thousands of doctors who have been forced to work 27-30 hour shifts on a regular basis. You weigh your own exhaustion against the patient's well-being and it's awful.

The counter-argument is "If you shorten the hours that residents work, they won't get enough clinical experience and you'd have to extend residency." While residency is intensive teaching, I also feel that it's slave labor or indentured servitude in many ways. To get paid crap for working 80+ hours a week under the guise of "training," when you are, in fact, providing an essential service to the hospital, is just that: indentured servitude.

My issue is that I hate it because it's being done to me, yes... but after this morning I realize that it's also being done to my patients. Had the devil won that argument just now...

So now I get to spend the rest of my life fighting to reform this system that just got reformed.

There must be the issue of over-tired doctors making mistakes due to lack of sleep and general fatigue, but i'm pretty certain it's the same here.

Not much else to offer.
and to bed with you!
Wait, not to bed with you, just you..

I dunno, Durbs.

You're pretty darn cute. Sure you don't want to come to bed with me?

Oh. Wait. I can't possibly compete with Linda. Darn.

The mistakes I think are only a relatively minor issue. We tend to err on the side of caution and many of our decisions are more conditioned reflex than conscious decisions.

The "mistakes," I think are often due to carelessness, as in not caring because you're too exhausted to give a rat's arse that the patient is suffering and might die. And so you cut corners to try to reduce your workload and the patients suffer.

I'm ashamed that I had that internal battle, but I'm proud that the angel won it.

...tonight.

And the true bitch of it is that I can't even go home until 11 AM even though I've been here since 8. I have to sit in four hours of meetings before I can go home.

This abuse of interns is indeed dangerous and it being entrenched in many medicals systems does not make it OK. As it is people tend to see doctors as 'privileged'. But I think if more hospital patients realised the conditions their 'angels' were working under there might be much more of a publio demand for safer conditions all round.

I have watched many friends fight to change this systemic problem in Canada too...

Oddly we have laws regarding how many hours a transport truck driver can drive a shipment, quite strict ones actually-- but for some reason we think doctors can perform for days on end without sleep... it is ridiculous and alarming, needs to be changed .

The whole tough people will make it through martyr attitude around it must also shift. I know med students that felt it was a test, and honour of sorts, a badge/scar demonstration of trial by fire , having the endurance to make it through proves something,-- but I just find it terrifying.

There are dozens of studies showing how peoples performance functionally declines due to lack of sleep. One comparing sleep deprivation to alcohol consumption and its effects on performance/dexterity/ reflex time etc was really disturbing! Why would this not apply to the performance of doctors too? They are certainly human, and performing complex tasks...

Godd luck creating posative change in this regard!

And sweet dreams...

How much do you truly retain and learn when you are dysfunctional through tiredness and exhaustion. How many docotors do we lose each year through either accidents travelling to and from work and through errors induced by tiredness leading to stress?

It's slowly getting better in Oz.. but I still see my residents on a morning and know they haven't slept for 24hrs +...

its not just doctors, nurses are getting just the same treatment, regularly working double and sometimes triple shifts to maintain quality of care. in the new pay agreement for public sector nursing here in tassie the government is even trying to remove the safe staff per patient model and bring in unqualified carers.

its terrible how taken advantage of healthcare workers are by the administrations.

So true:

http://www.drrant.net/