1. #1
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    Thumbs down Long Hours for MDs Leave Them Driving Dangerously

    I found this article on MSN Today.

    Take a look: http://articles.health.msn.com/id/10...0000/?GT1=5943

    All I have to say is that I hate it for 'em. I have no sympathy for them. People like the members of these forums do that crap all day several times a week (some of us every day). I would say we have it worse then them because some of us pull 48 hour shifts and don't get much sleep, if any, while doing it.

    When we are pulling a shift and we don't sleep and have to drive a rig, does that make us as dangerous as a drunk driver? Maybe we should limit our shifts to 12 hours. I know; funny, right?

    If you don't want to do the time, then get out of the business. It sounds like they just need to get over it.
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    When is the last time you worked 80 hours in a week? Many residents work that many hours a week for months straight. Their system needs to change because it is hurting patients (the academic medicine community is finally getting this).

    If your firefighters' ability to perform is diminishing significantly toward the end of their shifts, the shifts are too long. Tradition, manlyness and the like are not excuses for your department to deliver less than its best.

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    I think there is a big difference in an MD running through the hospital from one side to the other with over 30 inpatients assigned to him and a great number of outpatients, papers, codes, and unexpected admits, surg's, truamas, er admissions...

    And a firefighter sitting in the staion manning a bag of chips and the tv turner or mapping preplans for 80% of his "80 hours" a week shift, and his 20% (if even that) of actual fire fighting operations.
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    Default Re: Long Hours for MDs Leave Them Driving Dangerously

    Originally posted by Firefighter1219
    I found this article on MSN Today.

    Take a look: http://articles.health.msn.com/id/10...0000/?GT1=5943

    All I have to say is that I hate it for 'em. I have no sympathy for them. People like the members of these forums do that crap all day several times a week (some of us every day). I would say we have it worse then them because some of us pull 48 hour shifts and don't get much sleep, if any, while doing it.

    When we are pulling a shift and we don't sleep and have to drive a rig, does that make us as dangerous as a drunk driver? Maybe we should limit our shifts to 12 hours. I know; funny, right?

    If you don't want to do the time, then get out of the business. It sounds like they just need to get over it.
    Dude, you forgot to post that little smiley thing at the end of your post to show us that you were just kidding.

    On an intelligent note, you may find it interesting that there is legislation in NJ that makes driving while not having adequate sleep roughly equivalent to DWI.

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    Let's think about this for a second. Let's say your on a engine company that sees some action -- 2,500 runs a year. That's about seven per 24 hour shift. We'll give you a working fire for three hours, two AFAs for just a few minutes a piece, three EMS runs that last about 20 minutes each and an MVA for 30 minutes. With all of that, you still have roughly 19 hours left on your shift to sleep, do station work & handle daily assignments.

    How does that compare with 80 hours a week managing as many patients as you possibly can? How does that compare with being up for most of a 24 hour shift as part of your normal workday? How does being an Firefighter/EMT compare with being a brand new physician?

    Being a firefighter can be a stressful job. But let's not make it out to be more than it is. Sure, we often have to work our tails off. However, most of us have the good fortune to work in houses that aren't running the tires off the rigs. Many of us have the chance to catch some sleep while we work. With that in mind, I have all the sympathy in the world for those interns.

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    This is a tough situation. Having gone through medical school and residency, I can absolutely say that it was extremely intense and demanding. There probably were times when I should not have been driving. Thankfully I never had an accident during that time.

    I think that the public perception (in some cases) is that the training of physicians is intense and requires long hours only to achieve some sort of "hazing" or weeding out. That is not the case. The real problem is that physicians in training need lots of patient contact while in a supervised setting. While one learns a great deal from the classroom and lab work of the first several years, there is simply no substitute for seeing and doing while having the ability to confer with an experienced attending physician. Without a critical minimum number of "cases" under your belt, you simply are not prepared to enter the world of private practice.

    If we changed medical residency to a nice calm 40 hour week, it would probably take at least 19 years after college to get the required experience in the supervised setting, rather than the current 7 to 10 years. It's simply not practical.

    True, it was very difficult to keep up the pace. The longest work week I can remember was 121 hours on the general surgery service. Usually my weeks averaged about 95 to 105 hours. Do not take this as whining- I did it willingly- just an effort to explain the logistical problems associated with medical education. I can understand the problem of the drowsy driver mentioned in the article- it's very real. I am not sure what can be done about it. I usually lived within walking distance of the hospital so I was only subject to the effects of "walking while drowsy". VfdDoc

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    Originally posted by vfddoc
    This is a tough situation. Having gone through medical school and residency, I can absolutely say that it was extremely intense and demanding. There probably were times when I should not have been driving. Thankfully I never had an accident during that time.

    I think that the public perception (in some cases) is that the training of physicians is intense and requires long hours only to achieve some sort of "hazing" or weeding out. That is not the case. The real problem is that physicians in training need lots of patient contact while in a supervised setting. While one learns a great deal from the classroom and lab work of the first several years, there is simply no substitute for seeing and doing while having the ability to confer with an experienced attending physician. Without a critical minimum number of "cases" under your belt, you simply are not prepared to enter the world of private practice.

    If we changed medical residency to a nice calm 40 hour week, it would probably take at least 19 years after college to get the required experience in the supervised setting, rather than the current 7 to 10 years. It's simply not practical.

    True, it was very difficult to keep up the pace. The longest work week I can remember was 121 hours on the general surgery service. Usually my weeks averaged about 95 to 105 hours. Do not take this as whining- I did it willingly- just an effort to explain the logistical problems associated with medical education. I can understand the problem of the drowsy driver mentioned in the article- it's very real. I am not sure what can be done about it. I usually lived within walking distance of the hospital so I was only subject to the effects of "walking while drowsy". VfdDoc
    The only problem with this archaic and idiotic way of training doctors is that the patient doesn't have a chance to opt out of a procedure if the doctor is in his 100th hour of work for that week.

    I also do not buy the innocent claim when it comes to hazing or a rite of passage. If it so all fired important to have lots of patient contact, why not reconfigure the residency period so that it can work. I know that there are some states that are prohibiting this type of barbaric residency requirement?

    Not to mention the driving problem...

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    I was afraid that by opening my mouth I would be the guest of honor at a messenger-shooting party...

    Your point, George, about being the patient at the 100th work hour is a good one. At least in the setting of a residency program the trainee will be working with an experienced attending physician who has not been up all night. If the state limits the hours for the resident but does not change the overall length of the program (as I discussed before) then the risk is transferred to the patients who see that MD in private practice, with no supervision. For example, if the resident works in the current system, he might have done 100 procedures of a given type, lets say appendectomy. These would have been done in company with an attending physician and probably senior residents and fellows. If he works the shortened hours, he might only have done 10 when he gets out, and you would be his 11th, only with no attending to hold his hand.

    I respect the points you make, George, and I agree that this is a problem. I just don't think it is easily fixed by a work-hour limitation. Maybe after I get rested up I'll have some better ideas. VfdDoc

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    At least in the setting of a residency program the trainee will be working with an experienced attending physician who has not been up all night.

    Dude, my wife is an ED nurse. The concept of "working with" is open to great interpretation.

    I'm not after you. You didn't invent the system. when you get to be a big shot-change it.

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    vfddoc,

    You have a point that I am dreading myself. I hit my clinical year of PA school in 5 months and the surgical rotations have me a bit apprehensive, but as you said I do it willingly. I want to work in the surgical specialties after (probably burns or trauma) and like you said, the best way for me to get ready for these high volume, critical care specialties is to simply work more hours, and you cannot get the skills, procedures, experience, and training without it.

    As it is, residencies are at a minimum of 3 years in length. When you start talking about neurosurgery, transplant, cardio-thoracic surgery, trauma, burns, and other specialties the residencies and fellowships can easily hit 8 or 10 years, simply because it takes so long to get all of those critical care procedures down and be able to compensate for the patient playing tricks on you because they didn't read the book. If I recall correctly, that 80 hours is a weekly average over 2 or 4 weeks as well, so all is not what it would seem. From what I hear, the federal government is really keeping their eye out this stuff too, especially at the bigger name medical centers and teaching hospitals.

    Working 80 hours a week is not all that far fetched either. When I was on my career fire department I knew guys who practically lived at the firehouse and would routinely work 72 hours straight. Like it has been said, fortunately they were not busy, but still, you run the risk of being overly tired and operating a 50 ton fire truck, or even a set of jaws.

    Last year there was a Paramedic in Ohio who died in a car wreck on his way home from work at a fire department because he was working so much. Sleep deprivation is a huge factor in a number of motor vehicle collisions as well.

    George:

    Dude, my wife is an ED nurse.
    Another shocker, a cop married to a nurse. What is up with that? WHy are cops and firefighters always marrying nurses?
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    Another shocker, a cop married to a nurse. What is up with that? WHy are cops and firefighters always marrying nurses?

    It shold be a law.

    They ony thing I can think of is that cops and nurses (especially ED nurses) basically deal, on a daily basis, with the dregs of society. They see the physical manifestations, as well as the emotional connsequences of traumatic accidents, violent crimesm abuse neglect and poor life choices. They experience the paradoxes in life. Such as how some of the finest people you will ever meet are in the ghetto, and some of the biggest pieces of crap God ever put on this earth are from affluent areas.

    These experiences breed at the same time a guarded cynicism and a special apprecation for life. There is also a defense mechanism characterized by sarcasm and humor.

    With nurses, I think there is a further explanation. Very rarely does a doctor save a life. Especially in the ED. It is the nurse, in close personal contact with the paitent for hours and hours, constantly making assessments, following the medical orders, intervening in a crisis and are actually the ones who make a difference in the patient outcome. The nurse holds the hand, laughs, cries and prays with the patient, and tends to the personal, often embarrasing needs of the patient. This is incredibly rewarding and gives many nurses a sense of pride, accomplishment and sort of a cocky swagger that you only see outside the hospital in cops.

    Just my opinion, with no intention of taking at the shot at the docs here.

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