Doctors are trained to believe that sleep deprivation isn't something that affects good doctors. During their residency, doctors routinely work 24 hour shifts. This goes back to William Halsted, who for all intents and purposes invented modern medical training at Hopkins. Halsted managed his always-on work ethic with his cocaine addiction, and drove his residents to the same extremes.
> Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine.
It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.
I don't really agree about the manslaughter charge - if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient?
Personally, I don't think it's a doctor issue, I think it's a Medical Practice and Hospital Group issue. MD's don't really want to take call, but if they can take call for the entirety of one weekend and then have the next 3-5 off, they'd rather do that than take call for 12 hours 2 weekends in 4.
> if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient?
What lead to the systemic disaster that causes this situation to come up in the first place? The scenario is presumably a hospital in a major city in peacetime; doctors shouldn't be working those hours to begin with.
... because the rural hospital can't afford to hire enough surgeons to cover their shifts, because we don't train enough surgeons, because we overtrain surgeons, because everybody qualified to evaluate this has incentives to lobby for more training. Lack of training is a perfect scapegoat for any problem and increased training requirements create lucrative educational opportunities and decrease supply / increase prices of qualified professionals. We know this in general because we can evaluate results against other regulatory regimes, but if you drill down to specifics you run into the problem that everyone qualified to comment has perverse incentives.
Let's define "overtrained" to mean "we spent too much money on training" rather than "the training resulted in an excess of competence." I am sure the latter does happen occasionally, or even frequently, but I am also completely willing to believe that sometimes it... doesn't.
Why not? A pilot that works beyond their duty day will get a manslaughter charge if the flight results in the death of a passenger or person on the ground. Whats the difference?
It's an extremely unusual situation where if a person isn't flown immediately, they will die. It isn't that rare for people to need immediate medical attention.
https://www.nytimes.com/2011/08/07/magazine/the-phantom-mena...
> Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine.
It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.