Should residents take the day off when they are sleepy?
Should residents take the day off when they are sleepy?
The new medical culture
When I was a resident, I worked 7 nights of 12 hour shifts alternating with 7 days of 14 hour shifts. The jet lag was like flying to Moscow. I also worked 28 hour shifts Q4 (on paper), which actually ran as high as 32-36 hours (in reality). Often, I was tired.
Whether or not residents need to work long hours, and what they do during that time is an open debate. I tend to believe that we can restructure training to focus more on doctor skills (and not paperwork skills). We can preserve long hours when medical situations demand, but not long hours just to order colace. Unfortunately, that hasn’t happened yet. Instead of thoughtful reform, we find examples where individuals decide the hours are not right for them.
Here is the latest.
What I find interesting about the post is both the thesis: It is entirely reasonable, and laudable even to take the day off if you are tired/ sleepy, obliging a colleague to cover you. Of course, I will pay that back later.
(This ironically takes away the rest/ recovery time of another resident on jeopardy).
And the secondary thesis: It is important to share the fact I did this with the entire world because I am convinced I did the right thing, and it is worthy of broadcasting that on a public forum. (Rather than silently do it, and keep it to myself)
My first question then is:
And my second question is:
How do we balance having a medical training program that teaches trainees that medicine is not a profession where taking the day off should be done lightly with a medical culture that actually promotes fairness and learning?
And my third question is:
What do you all think?
Transport does indeed run 24/7. You ever drive on a highway in the wee hours of the morning or work a gas station during third shift?
I am not talking common sense, I am talking common knowledge. There are institutions that study nothing but sleep. I myself have and continue to get too little sleep. I have been surrounded from time to time with those who are long on hours and short of sleep. It appears that the only field of the many we humans go into who do not understand the need to get a certain number of hours of sleep each and every 24 hour period is the medical field.
Handover errors are communication errors. What the Fauci you guys do at turn over, “I had it, you got it.”, and leave? If handovers are such a problem with you, adopt the Japanese way and do away with them all together and stay with your patient until they leave, either to the crematorium or to home.
Taxi vouchers? Are you Faucing kidding me? In my home town, there we do not have a taxi service in the entire country. Guess you could hitch hick back home. Ride a bicycle or just walk.
We, your customers, do not like being seen by people who are just as sleepy as we were when we got into the accident that brought us to your hospital at 3 am.
Interesting question (should residents take the day off when they are tired), but it's framed so as to invite a binary response and a dialectical discussion. The unsatisfying answer, considering all trainees, is "maybe." Should the resident who has a long commute and a chronic health condition take the day off when he or she is tired? Sure. Should a resident on the exact same team, who lives within walking distance of the hospital, and has no health conditions take the day off when he or she is tired? Maybe not. I worked a 30 hour shift as a resident and then drove to San Francisco a few hours later; to be honest, I wasn't particularly tired, but I'm a heavy coffee drinker. I still got pulled over for suspected drunk driving and had to do a sobriety test, suggesting that my driving stood out as impaired. Another resident I worked with worked 36 hours straight, drove home a short distance from the hospital, and fell asleep at the wheel- driving into a ditch in the process. Perhaps these were learning experiences, but they weren't safe, nor did they show commitment to helping save lives. Some people seem more impaired without 7-8 hours of sleep per night than others, and many of the rest of us are probably more impaired than we think we are when we try to get by with less. I used to brag that residency taught me how to be highly effective even when highly sleep deprived; but I suspect that it really taught me to THINK of myself as a "highly effective person" when highly sleep deprived. In other words, residency taught me, among other things, to be highly delusional. And I would argue that we are deluded when we think we know how tired another trainee is, and how that feels. They are more likely to work hard and be dedicated if we respect them and believe them when they say they need a break.