Forums > Social Discussion > The problem with medical training...
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HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
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.
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.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
BRONZE Member
Classically British
5,689 posts
Location: Epsom, Surrey, England
Classically British
5,689 posts
Location: Epsom, Surrey, England
Posted:
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..
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..
Burner of Toast
Spinner of poi
Slacker of enormous magnitude
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
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.
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.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Good Ol' Yarn For Hair
422 posts
Location: Atlanta, GA, USA
422 posts
Location: Atlanta, GA, USA
Posted:
Don't be ashamed, Doc. You're human, and as such, have physical limitations that include the need to sleep. You, of all people, should know that the "devil" as you call it, was your body and mind telling you that you needed at least a couple of hours of crash time to get back to tip top shape.
If you didn't, you'd be a zombie ghoul, and we'd have to quickly dispatch you before you turned on the rest of HoP to munch upon our juicy, juicy brains....
Good thing you're not a zombie, because I kind of like reading your discussions.
Written by: Doc Lightning
I'm ashamed that I had that internal battle, but I'm proud that the angel won it.
Don't be ashamed, Doc. You're human, and as such, have physical limitations that include the need to sleep. You, of all people, should know that the "devil" as you call it, was your body and mind telling you that you needed at least a couple of hours of crash time to get back to tip top shape.
If you didn't, you'd be a zombie ghoul, and we'd have to quickly dispatch you before you turned on the rest of HoP to munch upon our juicy, juicy brains....
Good thing you're not a zombie, because I kind of like reading your discussions.
"So long and thanks for all the fish."
SILVER Member
what goes around comes around. unless you're into stalls.
4,030 posts
Location: Bali, Australia
what goes around comes around. unless you're into stalls.
4,030 posts
Location: Bali, Australia
Posted:
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.
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.
.....Can't juggle balls but I sure as hell can juggle details....
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
Um...
Psst. How did you know?
Written by: Kathain_Bowen
If you didn't, you'd be a zombie ghoul, and we'd have to quickly dispatch you before you turned on the rest of HoP to munch upon our juicy, juicy brains....
Um...Psst. How did you know?
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Good Ol' Yarn For Hair
422 posts
Location: Atlanta, GA, USA
422 posts
Location: Atlanta, GA, USA
Posted:
I didn't. I do now!
Max Brook's Zombie Survival Guide just taught me to constantly vigilant, for, while the zombie might be gone, the threat lives on.
Written by: Doc LightningWritten by: Kathain_Bowen
If you didn't, you'd be a zombie ghoul, and we'd have to quickly dispatch you before you turned on the rest of HoP to munch upon our juicy, juicy brains....
Psst. How did you know?
I didn't. I do now!
Max Brook's Zombie Survival Guide just taught me to constantly vigilant, for, while the zombie might be gone, the threat lives on.
"So long and thanks for all the fish."
BRONZE Member
veteran
1,247 posts
Location: lost, Canada
veteran
1,247 posts
Location: lost, Canada
Posted:
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...
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...
"God *was* my co-pilot, but then we crashed, and I had to eat him..."
BRONZE Member
Carpal \'Tunnel
5,814 posts
Location: Perth, Australia
Carpal \'Tunnel
5,814 posts
Location: Perth, Australia
Posted:
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?
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?
Is it the Truth?
Is it Fair to all concerned?
Will it build Goodwill and Better Friendships?
Will it be Beneficial to all concerned?
Im in a lonely battle with the world with a fish to match the chip on my shoulder. Gnu in Binnu in a cnu
addict
489 posts
Location: Perth
489 posts
Location: Perth
Posted:
It's slowly getting better in Oz.. but I still see my residents on a morning and know they haven't slept for 24hrs +...
It's slowly getting better in Oz.. but I still see my residents on a morning and know they haven't slept for 24hrs +...
SILVER Member
coming to a country near you
4,696 posts
Location: home of the tiney toothy bear, Australia
coming to a country near you
4,696 posts
Location: home of the tiney toothy bear, Australia
Posted:
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.
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.
"but have you considered there is more to life than your eyelids?"
jointly owned by Fire_Spinning_Angel and Blu_Valley
SILVER Member
enthusiast
394 posts
Location: in the clouds..., United Kingdom
enthusiast
394 posts
Location: in the clouds..., United Kingdom
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