Friday, December 5, 2008

residents and sleep



photo courtesy of the New York Times 

The other day, I mentioned the new report about decreasing residents' fatigue. Today, in the NYTimes, there is a very interesting piece on this as well. In fact, I love this. It really illustrates that nothing comes without strings attached, and sometimes we're not sure which is better. I wonder what the dialogue is in medical schools about this. 

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3 comments:

Anonymous said...

From the article: "I did not feel pressed to maximize my clinical learning within a certain amount of time but could linger, hover even, at my patients’ bedsides to hear all they wanted to tell me about their illness experience and not just what I, with my relative clinical and personal inexperience, might have deemed as the important facts."

How idealistic. Having been a surgical patient last February, I can tell you that my reality was that the patient is lucky to meet the resident and fellow assigned to the case for all of 3 minutes pre-op... and the idea of a post-op hovering, lingering discussion of the illness experience is a joke. The patient is already gone... pushed out the door by a physician trying to keep the insurance companies happy.

A couple of days after my surgery, with staples falling out and a gaping wound that had to be packed, the associate covering for my surgeon announced that he might be sending me home the following day. When I replied that I needed to know early enough to arrange for transportation because I lived hours away from the hospital, and inquired whether there were any more snowstorms in the forecast (we'd had a near-blizzard the day before), he announced, "That's not my concern."

I thought he was an unconcerned, insensitive jerk..... maybe he just needed more sleep. *wink*

December 6, 2008 at 12:00 AM
jaime said...

That was the point, though, of the article - unfortunately, with the cap on the hours, doctors can't linger with patients because they have to maximize the hours that they have....they can't hear about patients' experiences because they have to squeeze in "learning" in their 80 hour weeks.

December 6, 2008 at 10:14 AM
Miriam said...

I have to say though, having inside information from my medical student husband, competitive teaching hospitals do NOT follow the 80 hour a week mandate. Residents still regularly work 110 and 120 hour weeks. It's basically like hazing...since their attendings did it, they're expected to as well, regardless of the regulation. So maybe a lower regulation will actually decrease their hours so that they can actually work 80 hours a week. Which is still insane.

I also don't really buy the whole argument that residents these days have to decide what to do with their last two hours on the shift....it would have been nice to hear from a resident who is working 80 hours a week rather than a doctor idealizing his time in residency. I have a feeling that it becomes very hard to be an empathetic, caring doctor after 80 or 100 hours at the hospital anyway.

December 19, 2008 at 9:35 AM

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