[hammerzeit]

My spouse is a doctor as well, and I've also observed the issues the author discusses. I don't think your read of the causes here is correct.

It's worth reading more about the history of medicine to truly understand what's going on here -- the culture of abusive overwork in American medicine goes at the very least back to Osler and the invention of the modern residency program, and has as much to do with cocaine than any corporate malfeasance. Certainly hospitals and the medical industry profit from this culture, but they hardly created it.

Also, on what basis do you say that longer hours with fewer tradeoffs don't improve patient outcomes? You frame it as though it's obvious but is there any evidence to back that up? My wife and most other doctors I know all claim they'd rather have longer hours with fewer handoffs.

[trowawee]

Every single study of the effects of fatigue on human cognitive ability that I am aware of indicate that A) fatigue can have massive deleterious effects on peoples' abilities to perform even simple tasks, and B) people are generally terrible at evaluating their own levels of fatigue. There's a good overview of a lot of this research here: https://hbr.org/2015/08/the-research-is-clear-long-hours-bac.... I don't know exactly what the costs are for more handoffs; my fiancée is a doctor, and she and multiple doctors have told me they have that same concern. But we have mountains of evidence demonstrating how rapidly cognitive ability degrades with fatigue. The idea that doctors, frequently working in a massively demanding, massively stressful setting, are somehow immune to those effects defies logic.

[IIIIIIIIIIII]

> The idea that doctors ... are somehow immune to those effects defies logic.

That claim was never made by OP. Can we have a discussion without attacking a straw man, please? You yourself acknowledge you only know one side of equation. If the other components are larger it would not matter that you have shown one aspect - that nobody disputes, incl. OP! - to be negative.

https://news.northwestern.edu/stories/2016/02/longer-shifts-...

> A new [...] study [...] showed allowing surgical residents the flexibility to work longer hours in order to stay with their patients through the end of an operation or stabilize them during a critical event did not pose a greater risk to patients.

> “It’s counterintuitive to think it’s better for doctors to work longer hours,” said principal investigator Dr. Karl Bilimoria [...]. “But when doctors have to hand off their patients to other doctors at dangerous, inopportune times, that creates vulnerability to the loss of critical information, a break in the doctor-patient relationship and unsafe care.”

I have no doubt that overall the long hours are bad, I only respond because you attack a position OP didn't take. Also, the long hours may still be a logical conclusion and even beneficial - within the twisted logic of dysfunction in the larger system: "For evil to triumph, all that is required is for good men to respond rationally to incentives."

[trowawee]

The parent comment:

> Also, on what basis do you say that longer hours with fewer tradeoffs don't improve patient outcomes? You frame it as though it's obvious but is there any evidence to back that up? My wife and most other doctors I know all claim they'd rather have longer hours with fewer handoffs.

I responded with evidence.

And yeah, I've seen the FIRST study. The control group, in this case, is working a 16 hour shift. Even if they only need one hour on either side of that shift to go from asleep to work and then back to asleep (which is not what I have seen), that control group is maxing out at 6 hours of sleep, well below the level where all but a tiny percentage of the population starts to see serious performance declines. https://hbr.org/2015/08/the-research-is-clear-long-hours-bac.... A more useful study would look at residents who are actually well-rested - who have gotten the consistently required eight plus hours of sleep over a significant enough period of time to have eradicated their existing sleep debt - and then compare their performance going forward while they continue to get enough sleep to residents working 16 or 28 hour shifts.

[IIIIIIIIIIII]

I repeat:

> The idea that doctors ... are somehow immune to those effects defies logic.

That claim was never made by OP.

It doesn't matter that you responded with "evidence" to a claim you yourself made-up. Just stick to the topic and don't invent stuff.

[ploxiln]

Maybe patient handoffs are so dangerous because of the dysfunction everywhere else in the system. Maybe patient current-state summary and recent-changes log could be much better maintained, if doctors had a bit more time and the forms/systems for it were refactored a bit.

Doesn't it sound like medicine is like a web service infrastructure where everything is on fire, and there's just no time to really fix the root causes?

FWIW, my mother is an MD, a Family Practitioner. She eventually became head of FP for a small commercial hospital chain in the US. Two years ago, after perhaps 18 years of professional practice, she moved to New Zealand and is a FP in a small town. She takes 3 days off a week, has reasonable hours, does less paperwork, does more with her own hands which she would refer to specialists in the US. She absolutely loves it.

[killjoywashere]

> patient handoffs are so dangerous because of the dysfunction everywhere else in the system

Anyone who has participated in a root cause analysis at a hospital knows that.

[markroseman]

Agreed, this culture of abuse goes way back, and is as much rooted in a macho "I went through this, you're damn well going to" mentality.

I do think the increasing corporatization of medicine in the USA has accelerated the loss of autonomy and satisfaction, which makes the abuse and overwork far more difficult to take.

[m_fayer]

Yes I think this is an important point, medical culture plays a big role in this. The only place I've seen a similar culture is in the army.

If you're exhausted or in physical pain or have a cold, you not only power through it but you suck it up and refrain from complaining, even if you're assisting a surgery. You may be officially encouraged to know and respect your limits, but if you actually do this you quickly go from being a "brother in arms" to weak and unsuited for the profession.

[upvotinglurker]

> If you ... have a cold, you not only power through it but you suck it up and refrain from complaining, even if you're assisting a surgery.

Where all those hospital-acquired infections come from?