Hospital Hazing

The New England Journal of Medicine has published a report showing -- to quote the Los Angeles Times' summary -- that "medical interns who drive home from the hospital at the end of a marathon shift…more than doubled their risk of getting into a car accident after being on call, a stint that meant working for 32 consecutive hours with only two or three hours of sleep, on average." The paper is

the latest in a series of studies by researchers at Harvard Medical School and Brigham and Women's Hospital in Boston that aim to quantify the dangers of requiring doctors to work long shifts with little rest. The researchers say that working for more than 24 hours causes interns to make serious medical errors and poses a public safety hazard.

That shouldn't be a surprise, but evidently it's a point that needs to be driven home. When Kevin Drum commented on the New England Journal article, he said that the system's defenders "sound like nothing so much as a bunch of 50s frat boys defending hazing after some freshman has been found dead in an arroyo somewhere."

Hazing is the right metaphor. The system serves the same purpose: It's a brutal initiation to a privileged club. Medical hazing is part of the set of barriers that limit entry to the profession; whatever other reasons there are for it, it's ultimately a byproduct of occupational licensing. Those long shifts don't just undermine public health. They drive away qualified men and women, reducing the supply of doctors and allowing those who survive the trial to charge more for their services.

[Via Alex Tabarrok, who notes that "more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS."]

Comments

[Skeptikos]

I saw a comment on Jane Galt's blog the other day concering a NYT article...
http://www.janegalt.net/blog/archives/005122.html

While this is most assuredly is a result of " occupational licensing" it is also a result of the public buying this hook, line and sinker. Since working in Pharma R & D, I have given up on MDs. At the advice of one of the senior researchers (who held an MD as well as 2 phds) I began seeing an NP-Nurse Practitioner. I had been having a minor, but annoying med problem that was going undiagnosed. NPs (at least the one I use) was trained to correctly observe the body, then research the symptoms in the literature. This is especially viable in the modern world with electronic and web based med resources. It works for me, because an MD is trained to attempt to know everything, and assured after licensing that they do, which is of course impossible, while an NP is trained in observation and research. I have to admit, using a NP has made me feel both more secure in my health, and in my political beliefs.

So, society can break free, healthily and easily, but they won't.

[Thomas Paine's Goiter]

I don't understand this whole ridiculous process. Does ANYONE, outside of existing doctors, think this is a good practice? ANYONE?

[Ministry of Nanniness]

This obviously calls for government action. Government subsidized taxi rides for all medical interns.

[Mo]

One of the ironies noted by Drum is that the AMA did a study on factories and found that the performance of work goes down significantly due to sleep deprivation. Apparently, doctors are super humans not needing sleep like the rest of us mere mortals.

Read the comments section of Drum's page you'll notice some of the justifications (and gain an appreciation of the comments sections here. joe gets treated like a king compared to those who dissent with Drum's audience).

Some justifications include:
They need to learn how to work tired because they'll probably have to do that later on (b.s)
There's a lot of material to learn and they need the experience.
$$$$$ - Residents are cheap labor.

[Sammy Sleep No More]

I don't understand this whole ridiculous process. Does ANYONE, outside of existing doctors, think this is a good practice? ANYONE?

I guess this is necessary in order to train doctors in a reasonable abount of time.

[Philip]

Sleep deprivation:

http://www.epilepsy.com/epilepsy/provoke_sleepdep.html

[B.P.]

These interns need to suck it up and find a reliable supply of crystal meth, like the truck drivers.

[Philip]

These interns need to suck it up and find a reliable supply of crystal meth, like the truck drivers.

Better yet.

Modafinil

[sulla]

Where are the freakin' class-action lawyers when you need 'em?

Better yet, people should start asking doctors working in the hospital "how long have you been awake?" before accepting treatment.

[kevrob]

I have heard one argument for the long shifts put in by interns and residents. It is considered a good idea to have the same physician available when an emergency patient is admitted, so that doctor can be involved with the patient's case from first examination on. Whether you can make a valid trade-off between switching doctors somewhere in a 24-hour period and having rested physicians caring for you, and docs who screw up by passing the baton without a full data dump of the patient's symptoms, I don't know. I haven't got the expertise. With today's communication and computing tech, paging the sleeping first-shifter for a consult would seem a reasonable alternative to Dr. Zombie on call.

Kevin

[pigwiggle]

?It is considered a good idea to have the same physician available when an emergency patient is admitted?

Yah, they call it ?continuity of care?.

[thoreau]

I wonder if the continuity of care issue couldn't be addressed by having doctors see new patients during the first part of a 24 hour shift, and then sleep on a couch for some later portion of it, waking up when a patient from the first portion of the shift needs to be seen again.

Seeing a new patient after 24 hours on the go seems, well, dangerous. Performing surgery seems even worse.

[Amy Phillips]

The "continuity of care" argument also assumes that all of a doctor's patients come in at the beginning of a shift, are seen during the course of that shift, and then are discharged or moved before the end of the shift. So long as all shifts have a finite end point, no matter how long after the beginning point that end point is, there will be many patients who will come in close enough to that end point that they will see two or more doctors. Do hospitals really want to be arguing that your quality of care will be vastly different depending on what time you come into the ER in relation to the timing of the ER's shift changes?