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No Doctor Should Work 30 Hours Straight with No Sleep

by BDGC on 12/20/16, 6:41 PM with 197 comments

• by snowwrestler on 12/21/16, 12:52 AM

  A friend of mine is a PA who works in emergency medicine, which means he pulls 30 hour shifts sometimes.

  I challenged him about how, with what we now know about sleep deprivation, he could defend that schedule.

  He pointed out that much of medicine, especially emergency medicine, requires deep complex analysis of a wide variety of symptoms, some of which might seem unimportant or unrelated at first. We've all seen shows like House where it takes a genius to diagnose the root cause of a set of weird symptoms. While that is obviously exaggerated, the reality is that diagnosis is often difficult and in an ER, happens continuously with treatment.

  He said there is no way that a doctor or PA can fully hand that mental flow state off to another one. So the scariest thing to him is handoff--what if he forgets to document or mention some seemingly minor detail that ends up being crucial??

  Long shifts give medical personnel more continuous time with each patient, reducing the chance that handoff will come too early in treatment, when mistakes or misses have a greater impact. It also permits long periods of overlap between shifts.

  "Being sleep deprived is bad for care," he admitted, "but so are handoffs." He feels that as long as the total time per week does not exceed too many hours, long shifts are good for care.

• by jseliger on 12/20/16, 7:47 PM

  The culture of medicine, at least at the physician level, is completely insane; it's so insane that describing its insanity is part of the reason I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...). Residents in particular have no power, and even physicians themselves frequently feel they have no choice but to match the death-march pace set by administrators or their most deranged colleagues.

• by minimuffins on 12/20/16, 9:11 PM

  Learning about new ways that our medical industry is totally dysfunctional is baffling and infuriating. It seems to be an inexhaustible well of misery for workers and patients alike. These conditions are like something out of a 19th century factory town. One more way the US healthcare system is a ridiculous anachronism.

  My first questions are

  1) Is sleep deprivation and the generally toxic work culture for doctors and healthcare workers a uniquely American thing? Like does a doctor in Denmark or the UK or Mexico have such a brutal work regime?

  2) What's the solution to this? I'm inclined to think healthcare workers have to organize themselves to oppose it and demand new policies because who else will? It seems no one in hospital administrations, regulatory bodies or government has any incentive to push for change here, in fact they're doing the opposite by expanding allowed hours worked.

• by djsumdog on 12/20/16, 6:46 PM

  I remember hearing about sleep deprivation in the medical field before; especially for people who work in the ER or as surgeons. The demand in the US for nurses and doctors is very high, and so are the education costs which can be prohibitive to people getting into medicine.

  There's a whole system of failures, from the cost of education to the student loan systems to medical insurance and billing, that has led directly to overworked doctors. Many med students today feel that they can't become GPs because they simply won't make enough to pay back their student loans.

• by finid on 12/20/16, 8:09 PM

  30-hours of non-stop work is almost 4 days of work, assuming 8 hours per day.

  Next time you read that a surgeon left one of his/her tools inside a patient, now you know why.

• by dnautics on 12/20/16, 7:21 PM

  Didn't they do a study and find that decreasing doctor hours caused an increase in patient mortality because of handoff errors? And that digitizing records didn't help because of a combination of inaccurate measurement by the staff and because of factors that can't be measured (intuitive observation, etc).

• by finid on 12/20/16, 9:24 PM

  The interesting part of this is that truck drivers are heavily regulated, as they should. They are forced to take breaks after driving a certain number of hours. Not sure exactly, but I think it's about 8 hours.

  The same treatment for doctors won't be a bad idea.

• by throwaway2016a on 12/20/16, 8:01 PM

  I know what my code looks like after 30 hours of coding with no sleep (unfortunately)... it's not pretty and takes days to recover from. Thank goodness no one's health depend on my code.

• by noskillz on 12/20/16, 11:20 PM

  My wife was a surgery resident when we had our first child. It was tough with her working 30 hour on-call shifts. Plus the normal 80+ hour (sometimes it would be as much as 130) work weeks. She eventually decided that instead of killing herself for a job she would stop being a doctor and focus on the kids. This worked out for us but it took some guts to call it quits after 10 years of training to get where she was at. We have a ton of debt because of it as well.

  Besides the tough work schedules I find it kind of crazy we require 20-something year olds to choose a speciality and stick with it. Very few people can do this and not have some regrets. On top of the insane work hours they also put up with people dying on them and delivering the bad news to family members (at least for surgeons this happens a decent amount).

• by diimdeep on 12/20/16, 10:48 PM

  In the US alone, the Association of American Medical Colleges (AAMC) estimates a shortage of 91,500 physicians by 2020 and up to 130,600 by the year 2025. https://en.wikipedia.org/wiki/Physician_supply#Global_View

• by pmoriarty on 12/20/16, 8:26 PM

  Do doctors and nurses get paid by the hour? If not, they should be, with double or even triple pay for overtime.

  That would get penny pinching administrators to stop overworking their medical staff.

• by KVFinn on 12/20/16, 11:30 PM

  Usually this discussion is around residents' performing worse while deprived. A big problem no doubt.

  But I wonder why people don't bring up another aspect: sleep is essential for actually retaining and making any learning from practice permanent. Anyone who has trained or studied anything knows this well and it's clear in the literature. How can we expect these doctors in training to be actually learning and improving if they are so often sleep deprived?

• by matryoshka4811 on 12/20/16, 10:01 PM

  It's hard to comprehend how many hours a doctor can keep going unless you see them everyday. My mother is an OBGYN. I remember growing up surrounded by MCAT and medical school books and the residency nights when she wasn't home when I went to sleep and when I woke up. I don't really remember when the doctor lifestyle wasn't a dominant part of how my immediately family functioned. (She had both of my siblings during her residency.)

  And now, after she's been in practice for almost two decades, it really isn't much different. She's the head OB at a hospital/clinic that is the only one for several counties. She gets multiple cases a year when women show up in labor that she's never seen before. She's had to report multiple births to child services because the mother is an addict. On a personal level, it means that she never makes it to both Thanksgiving and Christmas, sometimes neither, and she's on call pretty much all the time.

  All of this to say that she's inspiring really. I've never known someone who works harder or more tirelessly. I worry though that she'll work herself to death. Even then, I know she won't regret any of it.

• by seanwilson on 12/20/16, 9:44 PM

  Nobody should work 30 hours straight without sleep whether you're a doctor or not.

• by chirau on 12/20/16, 9:11 PM

  Generally, no one should work 30 hours straight with no sleep. No?

• by dirtyaura on 12/20/16, 7:50 PM

  I wonder why sleep monitoring is not used for pilots and doctors and other people working on mission critical jobs.

• by squozzer on 12/20/16, 7:56 PM

  We shouldn't discount the possibility that the regimen is designed to break doctors down psychologically.

• by pavel_lishin on 12/20/16, 9:06 PM

  Doesn't this level of overwork originate with one medical instructor, who was a habitual cocaine user and thought nothing of going without sleep?

  I remember reading this somewhere, but can't remember where.

• by Rylinks on 12/20/16, 9:01 PM

  This is only one side of the tradeoff. Both tiredness and shift hand-offs cause bad judgement, and both can kill people. An analysis that only looks at one is incomplete.

• by tn13 on 12/21/16, 4:16 AM

  As a rule of thumb I would not recommend anyone working that long without sleep. A truck driver with lack of sleep can kill more people than a driver.

  Even a coder returning home driving might kill someone if he has not slept in 30 hours straight.

  For doctor unless he is doign surgeries chances of his mistake resulting into death might be lower.

• by wenbert on 12/20/16, 10:59 PM

  Jesus. 30 hours straight. I know I wouldn't work 30 hours straight in IT - I think everybody is bound to make expensive mistakes when they're tired. And how much more for doctors? When what's at risk isn't just money but someone else's life.

• by ghufran_syed on 12/21/16, 8:18 AM

  Should any parent be "allowed" to care for a newborn baby for 30 hours straight witg no sleep? Perhaps we should ensure that parents do not care for their children for more than 8 hours in a row, to ensure an appropriate quality of care.... :)

• by mpcadosch on 12/20/16, 8:05 PM

  Has anyone tried this service?

  http://circadienhealth.pagedemo.co/

  It seems targeted towards nurses, but could be applicable to physicians as well.

• by walrus01 on 12/21/16, 5:35 AM

  I barely trust myself to do anything with 'sudo' on a production system after 24 hours without sleep, 30 hours without sleep and making life or death medical decisions is scary as shit.

• by intrasight on 12/21/16, 12:01 AM

  No Doctor Should Work 30 Hours Straight with No Sleep - unless it is some major emergency.

  Never say never

• by prodmerc on 12/20/16, 7:43 PM

  The medical system will disagree: all doctors should work 30 hours straight with no sleep, else they're not real doctors and slacking off.

• by edblarney on 12/20/16, 7:49 PM

  You wouldn't want your airline pilot to be sleep deprived so why would you want your doctor to be?

  Unless you're a field medic in the army or whatever. No thanks.

• by acedinlowball on 12/20/16, 8:25 PM

  Doctors should only have to work like 5 hours a day but should still get paid large amounts of money.

  It's important that the people responsible for our health are well rested and well-rewarded.