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?
I was recently a patient in a teaching hospital with a very serious situation, and it was obvious to me that almost every person who was involved in my care was exhausted, overextended, and in adrenaline mode. Some even seemed raw. They had little capacity for communication. It was frightening and I felt even more vulnerable than my physical difficulties warranted because of my lack of trust in the condition of the staff. The residents could hardly walk straight, although they brushed their exhaustion off, “Oh, I’m used to it.” The idea that they would operate on me if need be? OMG! The system is completely broken.
Thank you for the shoutout, Dr. Prasad! I feel very honored to be mentioned. A colleague shared this forum with me and I appreciate that my tweet has elicited such a thoughtful discussion; that was the intention!
The circumstances surrounding me calling off for work were more than just merely being a little tired and fatigued (every day of residency is tiring, haha!) but rather were after several days of severe sleep deprivation affecting my physical health. The full details need not be shared, but the message that it’s laudable to call in when you’re TRULY unable to care for patients is one I will continue to support. I am so happy a fellow resident was in a good place themselves where they were willing to lend a helping hand. It would be nice to have a system where someone else doesn’t need to get called in. But currently that’s unrealistic and that’s why we (at least in my residency) always have a solid number of people in the float pool. There’s always one person willing to help out, and knowing I’ll get to do the same for someone in the future makes me feel good. When someone’s really struggling, I want to be there for them. That’s why I went into medicine. I am sure many of us can relate.
The unfortunate irony of sharing details of personal experiences in an effort to improve systems for others means taking a risk of being viewed as selfish and attention-seeking. I’ll be honest, I actually WAS seeking attention from this post (isn’t that the point of Twitter? :D) - specifically I wanted the attention of other residents and healthcare workers. I want to encourage others to do exactly what I did, to share their own related experiences, and to hopefully feel less guilty in the process as we cultivate a culture where asking for help becomes less “taboo” and stigmatizing. Many of us in healthcare are people pleasers and it’s SO hard not to feel guilt or shame when asking for help - especially if it’s going to inconvenience someone else. The aim of my tweet was to elicit meaningful conversation and reflection about this. Because I definitely agree there is a delicate balance - as eloquently described- “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.” We have to work together - through vulnerability and collaboration - to understand that balance. Conversation is the first step towards improving systems.