Tired doctors urged to beat fatigue with caffeine

I remember the first time a resident told me he couldn’t take call because the residency advocacy committee had decided that 24 hours was too long. I couldn’t believe what I was hearing. When I was a resident the immediate response would have been to show me the door. While I don’t believe in abusing a surgical resident I don’t think it is up to an “advocacy committee” to dictate resident training. The idea is to make a doctor not a union employee cranking bolts on a car. The most enduring lessons I ever learned were learned when I was under stress and nobody around to bail me out. Surgery is not a classroom acquired skill.

The idea is to make a doctor not a union employee cranking bolts on a car.

Coming to a hospital near you.....

I've seen the ethics, motivation and dedication deteriorate in the medical field over the past 25 years. There's alot to be said for newer technology and surgical techniques... but I still try to find the "old horse Dr." who's seen everything......for routine checkups. They can diagnose tonsilitis by looking at your toenails. (figuratively speaking of course) *chuckle*

With that said....I've always had respect for anyone who can stay awake and work for 24-36hrs, chugging 3-4 pots of coffee at a sitting... and still remember their own name. ;)

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.....

Actually, yours was a pretty good explanation. You must understand that sometimes these “conspiracy” theories are more entertainment than anything else.

However, I know how I get when I’m without sleep for 24 hours. Even with lots of caffine, I’m not hitting on all cylinders. Its hard for me to imagine going 2X that or more without sleep and being able to function effectively. Maybe you can do something rudimentary (like marching), but its hard to imagine being able to do something that’s mentally challenging—like diagnose a patient. I think I’m pretty typical in this respect, which is why most layman have a hard time understanding the nature of intern/resident training.

Of course, if a human being is trained right, they can do amazing things. If someone can hold up under these conditions, my hat is off to them. I can easily jog 5 miles at a time, but don’t think I’m tough enough to do that.

Actually it’s a nefarious way of forcing recent medical school graduates to provide below-cost care so that politicians can continue to buy people’s votes with various forms of free healthcare (Medicare, Medicaid, mandates to treat illegal aliens, and various other programs). The socialist hospital system in this country couldn’t possibly stay afloat without all this forced labor being provided at a tiny fraction of free-market cost.

And stumbling around a hospital in a sleep-deprived stupor for 4 years never made anybody a good doctor. Some manage to become good doctors anyway, but it’s in spite of, not because of the residencies. Plenty of solid medical research has shown the colossal negative effects of sleep deprivation on learning, reaction time, and physical and mental health. And a rather large study a couple of years back found that overworked residents were making a colossal number of potentially lethal errors each year, and that 90% of those errors were being caught by nurses before the patient was harmed. Funny how the nurses, with a tiny fraction of the “training” these doctors have, can detect so many doctors’ errors. Maybe its because most of them have gotten a healthy amount of sleep the night before.

I’ve been treated by so many utterly incompetent doctors over the years — all of whom had been through one of these purportedly wonderful, invaluable residency programs — that no one is ever going to convince me it serves any purpose but political vote buying with a side order of hazing. The long list of doctors — GPs, ER doctors, gastroenterologist — who spent TEN YEARS telling me and my mother that the intense and sudden pain I kept having right where the gall bladder is located (and that’s where I kept pointing, over and over and over again), often accompanied by vomiting, was 1) “just a little stomach bug — drink clear liquids and take some Tylenol”, 2) “a pre-ulcerous condition — just drink some Maalox every time it hurts” — that went on for years, as I downed literally gallons of Maalox, and 3) my favorite “honey, you just have a tummy-ache because your parents are fighting” — all went through these supposedly wonderful residencies. But somehow they still didn’t have an effing clue that sudden sharp pains, often accompanied by vomiting, that keep recurring in a patient who points right to her gall bladder every single time, just *might* be GALLSTONES. They finally figured it out when my common duct got completely blocked by stones, such that not a drop of bile could reach my stomach, causing it to back up from my liver into my bloodstream, turning me a lovely shade of yellow and rendering me unable to even keep down their favorite clear liquid, Gatorade. After my surgery (7 hours in surgery, 11 days in the hospital, because all the years of delay had made such a mess of things), the surgeon told me my liver had been in imminent danger of rupturing. In all likelihood, any nurse or first year medical student could have identified the problem as being in my gallbladder the first time I showed up in front of them and pointed at my gall bladder as I doubled over and winced in pain, especially after noting the lack of fever or any other symptoms and noting that my mother mentioned I’d vomited just before we arrived.

As a patient, I couldn’t believe what I was hearing some years ago, when I’d had a fever that was climbing a degree an hour, hit 103, and I decided to drive myself to the emergency room before I passed out (lived alone). So after an unreasonable delay in the dead quiet emergency room, while I’m hyperventilating harder and harder and can still feel my fever rising, I finally get stuck in a little room, a nurse takes my vitals, notes what I’m telling her about the onset of the fever only a few hours earlier, sticks an IV in my arm to try to hydrate and cool me, and sends for the doctor. It’s about 3:00 AM now, and this is definitely a resident. She looks at the chart, takes my temp again, listens to my chest with a stethoscope, and at least pretends to listen as I tell her the same thing I told the nurse — little bit of runny nose this afternoon, then started feeling feverish in the evening, started taking my temp, left for emergency room when it hit 103. “Okay, and your main complaint is the wheezing, right?” she says. Uh, wheezing? I didn’t say anything about wheezing, because I wasn’t wheezing. “No,” I say, I wasn’t aware of any wheezing; did you hear wheezing when you listened to my chest?”, I ask. “No,” she says. WTF???? I come into the ER with a fever of 103+ and PERFECTLY clear lungs, which I was demonstrating with deep and fast hyperventilation as my body tries desperately to cool itself, and this doctor imagines my “main complaint” is non-existent wheezing! And she continued to say and do things that didn’t make sense even after that.

No, doctors do NOT benefit from spending endless hours treating patients when they haven’t enough sleep for their brains to work properly. And patients end up bearing the brunt of this insanity, because they’re given no choice whatsoever in the matter. If the young doctors had a shred of decency left after their med school brainwashing, they’d simply go on strike until the system is brought to it knees (which would obviously take under 24 hours, since the system is so intensely dependent on this slave labor).

As a patient, I want to be diagnosed and treated by an intelligent rational human being whose brain is in working order. I’d much rather be treated by a nurse or physician assistant whose gotten 8 hours sleep in the last 24, than by a doctor who’s so sleep-deprived s/he can’t think.

Why drink coffee when you can write yourself a script for amphetamines? :-0

And stumbling around a hospital in a sleep-deprived stupor for 4 years never made anybody a good doctor.

really?

Cause I'd suspect that over 90% of the good doctors were sleep deprived during their training. Maybe even more.

Plenty of solid medical research has shown the colossal negative effects of sleep deprivation on learning, reaction time, and physical and mental health.

gee, ya rilly think? How 'bout this "study"

Hospitalwide adverse drug events before and after limiting weekly work hours of medical residents to 80make sure you read the RESULTS of the study!

Here's another "medical study" for ya... make sure you read the results...AGAIN!

and just for your real entertainment, here's a REVIEW article about all the recent studies of sleep deprivation and patient outcomes with regards to methodology and results

.... of course I'm only citing real articles and not just spouting off on anecdotal stuff that just sounds really, really, really... like medical, right?

You know what anecdotal versus blinded studies are and statistical differences... and stuff like ya know... Chi-Squared Test of Association, Independent Random Variables (important in these studies, huh?), or the probability-probability (P-P) plot that is constructed using the theoretical cumulative distribution function to test your optimal sleep duration model, right???

The long list of doctors — GPs, ER doctors, gastroenterologist — who spent TEN YEARS telling me and my mother that the intense and sudden pain I kept having right where the gall bladder is located (and that’s where I kept pointing, over and over and over again)....

well gee, right upper quadrant pain after eating and with possibly referred pain to the shoulder, flatus, fat, and with floating turds in the toilet..

ya, I might have ordered an ultrasound and if negative and ERCP... but that's just me and my GI doc and surgeon friends... who also trained at really benign sleepy time places like UT Southwestern Parkland, Duke, Brigham, MGH...

those residents get TONS of sleep.................. when they retire or die.

That's what they do.. they WORK their tails off to learn every single thing that they can.

If you think being a doctor is just reading a book 9-5, going to the golf course and banging nurses... you watch too much television.

you sound like you have got other "issues" with all doctors. my advice to you is to go to a nurse practitioner that gets tons of sleep or a Physicians assistant to get your medical care. It's still a free country and there are plenty of qualified nurse (as you pointed out) and PA's that get lots of sleep during their training in order to pay attention to your medical needs.

As for me and my family of 5.... well if they need surgery, they're going to a guy that busted his balls for 5 years in a general surgical program and can walk around a belly with a lap scope or crawl in their up to his elbow, cause he's seen a thousand operations in his life and had someone's life in his hands come rain or shine, day or night, Christmas or Ramadan for year upon year. ..... but that's just me.

You can have the guy that had a 40 hour work week, checked out when the big hand hit the 12 and is just a fresh daisy for his 5 year residency.... or if that's too long and too hard, maybe they can shorten it up to a 9 week online residency so he doesn't even have to get out of bed.

wow 2 near death experiences with doctors.... guess what?

your alive, so I guess either they did ok.... or you weren't that sick and you didn't really need those stupid doctors.

Either way, you are here and in good health, right?... thank God.

Trust me, boys and girls...that’s not a cure, that’s just postponing the inevitable.