[kelnos]

A doctor friend of mine claims that the benefits of doctor-patient continuity outweigh any downsides of sleep deprivation. That sounded like a rationalization or cop-out to me, though. I can't imagine how that could be true, or that they're aren't other ways to solve the continuity problem that don't involve zombie doctors.

[Spooky23]

I would agree. In extended hospital sessions that my wife and I have experienced, having continuity was huge, especially as the nurses swap out every 8-12 hours.

In my case, I suffered from this issue after a back surgery when some dumbass hospitalist read my chart wrong and told the nurse to cut off pain medication 10 hours after a spinal fusion. I asked the nurse for meds after she woke me up at 3 AM (to take my blood pressure and ask if my birthday had changed) and she refused and essentially accused me of shopping for narcotics.

When my surgeon checked in on me at the start of his day (5AM), he was shocked and got things fixed.

[rifung]

> some dumbass hospitalist read my chart wrong

But couldn't this also be explained by said person lacking enough sleep?

[mcv]

> and ask if my birthday had changed

Er, why? This reeks of a pretty serious administrative fuck-up.

[Spooky23]

Around here, every interaction with a hospital employee involves a recitation of your birthdate, allergy status and other crap.

When my wife was having our baby, the nurses had to log into three different systems -- an OBstetrics system, the hospitals charting/EMR and the pharmaceutical system. That meant going through the ritual 3 times.

[mcv]

Even then, finishing with your current patient and then going home should still not lead to regular 12 hour shifts.

[kelnos]

Different patients need differing amount of times. We're not talking about doctors who work in private practice and have business hours. We're talking about doctors who work in hospitals and work prearranged shifts and have on-call time.

A doctor can't necessarily predict how much time a patient will need. If a doc is on an 8-hour shift (hypothetical; I doubt any docs are so lucky!), and gets a new patient at the 6 hour mark, it might not be known if the patient will only be in the hospital for an hour, which would be fine, or 4 hours, which would push the doc to 10 hours.

As the argument goes, that patient is safer staying with the doc into his/her 10th hour on the job, versus being transferred to a different, fresher doctor midway through. I think there's enough truth there for it to be persuasive, but 1) there are limits to how effective a doctor is going to be after a certain amount of time, and the benefits of patient continuity must start dropping as the doctor has been working longer, and 2) there seems to be little attention paid to improving the process of handing a patient off between two doctors, which could further reduce problems related to lack of continuity to the point where a doctor who has been working 10 hours will cause more bad outcomes than shifting patients to fresher doctors would.

[mcv]

> If a doc is on an 8-hour shift (hypothetical; I doubt any docs are so lucky!)

But that's a big part of the problem already. It shouldn't be luck to have an 8 hour shift, it should be standard. And of course there may be times when circumstances demand you deviate from that standard, but if you start with 12 hour shifts, you already start wrong, and it can only get worse.

[kelnos]

I think we're deviating from the point I was trying to address. The length of the shift isn't relevant, what's relevant is that different patients need different amount of times, and can arrive at any time during a doctor's shift. Based on both of those variables, a single patient can easily require care beyond a single doctor's shift, so saying "getting done with your current patient and then leaving should never lead to a 12-hour shift" doesn't really make sense, since that "current patient" could have arrived during hour 6 of your shift and then required a 6 hours of attention before being discharged. If you believe that doctor-patient continuity is more important than a doctor's rest, then you can easily justify any shift length up to the point where the doctor falls over.