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Forums > Social Discussion > The problem with medical training...

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
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... mad

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

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Durbs
BRONZE Member since Sep 2001

Durbs

Classically British
Location: Epsom, Surrey, England

Total posts: 5688
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.
hug and to bed with you!
Wait, not to bed with you, just you..
wink


Burner of Toast
Spinner of poi
Slacker of enormous magnitude

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
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.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Kathain_Bowen


Kathain_Bowen

Good Ol' Yarn For Hair
Location: Atlanta, GA, USA

Total posts: 422
Posted: 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. hug


"So long and thanks for all the fish."

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newgabe
SILVER Member since Mar 2005

newgabe

what goes around comes around. unless you're into stalls.
Location: Bali, Australia

Total posts: 4030
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.

.....Can't juggle balls but I sure as hell can juggle details....

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted: 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....




eek Um...

Psst. How did you know? wink


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Kathain_Bowen


Kathain_Bowen

Good Ol' Yarn For Hair
Location: Atlanta, GA, USA

Total posts: 422
Posted: Written by: Doc Lightning


 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....




eek Um...

Psst. How did you know? wink




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. ubbrollsmile


"So long and thanks for all the fish."

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BansheeCat
BRONZE Member since Jul 2005

veteran
Location: lost, Canada

Total posts: 1247
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...


"God *was* my co-pilot, but then we crashed, and I had to eat him..."

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Gnor
BRONZE Member since Mar 2003

Gnor

Carpal \'Tunnel
Location: Perth, Australia

Total posts: 5814
Posted:ditto

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

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natasqi


natasqi

addict
Location: Perth

Total posts: 489
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 +...

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Mr Majestik
SILVER Member since Mar 2004

Mr Majestik

coming to a country near you
Location: home of the tiney toothy bear,...

Total posts: 4693
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.


"but have you considered there is more to life than your eyelids?"

jointly owned by Fire_Spinning_Angel and Blu_Valley

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TinyPixie
SILVER Member since Apr 2006

TinyPixie

enthusiast
Location: in the clouds..., United Kingd...

Total posts: 394
Posted:So true:

http://www.drrant.net/


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