Posted on 09/07/2009 5:18:26 PM PDT by Nachum
SIX cups of coffee - that's the State Government antidote to sleep-deprived doctors killing and harming their patients in a haze of exhaustion.
The astonishing remedy forms part of Queensland Health's new doctor fatigue policy, currently being rolled out in public hospitals.
The Courier-Mail yesterday reported the confessions of junior surgeons and medics whose exhaustion-induced errors had killed or hurt patients during "on-call" shifts of 30 to 80 hours.
But a guidelines document underpinning QH's Fatigue Risk Management System claims "solutions such as 'we need more staff' might not be achievable or effective in managing a fatigue risk."
(Excerpt) Read more at news.com.au ...
Of course, isn’t that what OUR interns all do when they get “broken in?”
Real confidence builder too :)
Or Modafinil...
what... no RedBull in Oz???
You couldn’t even get away with proposing that for truckers in the US. The NTSB and law enforcement would go nuts.
This sort of insane and unconstitutional “training” for doctors has been government-mandated for many decades in the US. If you need any kind of medical care that can’t be provided at a small community hospital, you have only one option in the US and that’s a “teaching” hospital, staffed with recent med school graduates who are up to their ears in debt, and being paid a pittance to work dangerous and unhealthy hours in the hospital which the government-mandated match system assigned them too.
Huh? You don’t seem to be very familiar with the government-mandated residency system in the US. No one can get a US medical license without going through 4 years of this. Patients are routinely killed by doctors who haven’t been allowed to get enough sleep. Plenty of them are using much stronger drugs than caffeine to keep going, and nobody in charge of their “training” is discouraging this.
I’ve often wondered what the reason is for this. On the surface it seems dangerous and just plain dumb. Only thing I can think of its a form of hazing to weed out the weak candidates. The other (darker) possibility is that under these conditions, the interns routinely (and inevitably) screw up. So, the senior Doctors have something to hold over their heads in the future—just in case they get out of line.
Well, the studies show that caffeine is one the best performance enhancing drugs available....
I've heard of 36-48 hours here in the US. 80 hours? That seems a bit much.
Ah, No Doz. That was all the rage on campus when I was a freshman college boy many years ago.
I know I (illegally) put in 96-hours last week. And that was chump change compared to what those who went before me put in.
There are three lines of thought.
1. A physician must be relied upon to make good decissions day or night rested or not. Internship and residency is a time to teach young doctors to think even when physically, they are at the end of their rope. I can vouch that they do teach skills that are valuable when practicing medicine for prolonged hours or while suffering with the flu.
2. There are so many hours to teach a resident before they are out on their own. Sleep is wasting valuable teaching and learning time. The more patients seen, the more learning opportunities.
3. The staff physicians went through the same torment, there is no reason why the kids should get off easy. This is pretty close to the reasoning behind hazing, and the hardest to justify.
Nobody wants to see someone hurt, the resident nor the staff physician. The staff physician has plenty to hold over a residents head. They are god of the call schedule, all-mighty ruler of patient load and can ruin a residents future at a whim if they so desire. I could tell you horror stories about a psychotic staff gynecologist who to the dismay of generations of resident worked until he was 80.
It’s not really a weeding out. Most of that happened long ago. What it boils down to is that somebody has to take care of patients overnight. Someone has to admit them, as well.
The single best time to get to know a patient is when you first admit them. You spend by far more time getting to know all the intricacies of a pt’s medical and personal history this way. So you develop a strategy to address their problems in the middle of the night, collapse after you’ve set it in place, and come back the next day knowing the patient. You’re getting attending feedback in the morning, as well. It’s supposed to be a learning opportunity. How well this works when you’re falling asleep in the middle of a conversation at noon the next day is up for debate...
A lot of these longer hours could be served with nightfloat systmes or more days off, but that requires hiring more residents and more hands in the pot.
I’ve figured it out. Right now I’m working for about $10 per hour.
You see if you're tired you get an excuse to screw up and make mistakes. Cause if you worked only 40 hours a week then the quality goes up and doctors that work for years 60 hour work weeks and trained at every other night on call for 5-7 year residencies sucked.
Like Debakey, Thal, Denton Cooley, Sabiston, Rockwood and Green... what a bunch of cr#p.
they're trying to make doctors "shift workers" or employees and not professionals that sometimes have to dedicate themselves to their patients.
I've seen the type, they want the big bucks but not the "hassle" of seeing a "bunch of clinic" patients. In training your check off to the higher level doctor, if he's lazy and irresponsible then you're screwed either way... cause medicine is an art and a science practiced by professionals. The pencil pushers and bureaucrats are just trying to get their finger in the money pie.
The case here in the states that supposedly was the trigger for residency time limits was because of a LAZY intern/resident not wanting to tap a sick patient.... and a lazy and incompetent upper level resident not busting some balls and making the intern finish a workup. So the "I'm sleepy" excuse takes hold and a patient dies. Well if there are no doctors "available" after midnight then I guess you're going to die anyway.. so you might as well have a tired doctor than no doctor.
Preach on, brother
First of all, you need to see as much pathology as you can. Actually see the disease process from start to finish in the ER/Clinic.
Secondly, I think it dispels the myth of the "part time" doctor. The guy/gal who like to say, "I'm a doctor" but isn't dedicated to the time consuming review of organ systems, pathology, biochemistry and multiple other diagnostic and treatment modalities that are currently being used and future developments.
Thirdly I think that being in a hospital for hour upon hour makes you comfortable in your work environment and desensitizes you to some of the most awful things you can imagine. It helps you learn how to cope and in some respects how you don't cope with having someone's life in your hands. LITERALLY...
Every time a mother brings her child in with an astma attack, grandma comes in with chest pain, dad hit his head and is not waking up, Chato and Willy come in with sucking chest wounds and guts hanging out.... young girls come in from car wrecks or just drunk kids puking their toe nails up... you have to prioritize what you've seen hundreds and maybe several hundred times to what your presented with...
only after hours and hours of sick kids over years will you get the weird "feeling" of a real sick kid.... or If you've ever heard REAL "whooping" cough, you know the difference between that and a croupy cough, or a partially obstructed airway from a peanut from a sick kid with epiglottitis.... and which ones make your sphincter tighten up no matter how little sleep you've had.
The hardest residencies aren't necessarily the ones with the least sleep, but they generally have the busiest hospitals and the more upper level residents busting the balls of the lower level residents in order for them to explain the presentation, differential diagnosis and current workup, treatment and statistics ... also to describe down to the biochemical level the disease process... otherwise any old joe could get a book out of the library and "fake" being a doctor as several have done in the past...
Heck even actors know all the right "words" but have no idea about the biochemistry behind the pathology and treatment. THAT's what medical school and residency do. You KNOW what to do and why you're doing it.
Of course I could be wrong and it just could be a way of killing people so that other doctors have a corpse in your closet or some other nefarious scheme to get a bunch of drug addicted speed freaks into medicine in order to kill people.....
This is from Australia but what next? Government classes for farmers recommending fertilizer for crop production?
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