washingtonpost.com
Millennials in medicine take healthier approach to work hours

By Robert McCartney
Sunday, March 21, 2010; C01

We learned last week that the older generation of doctors is looking down its nose at the new crop coming out of medical school because it's resisting working 30-hour shifts and 80-hour weeks in local hospitals.

Those young people. Such slackers. They've sure got a lot of nerve suggesting that maybe, just maybe, it's not in patients' best interest to be treated by physicians struggling to keep their eyelids up and their minds alert at the end of an all-nighter. What gall!

I'm a baby boomer, but my sympathies are entirely with the millennials on this one. In fact, I applaud them for pressing the medical establishment to reform work schedules that have violated common sense and ignored scientific research for decades.

Moreover, I think the millennials, those in their early 30s or younger, are trying to accomplish another goal that we boomers said was important to us when we were young -- and then mostly dropped. They want a healthier balance between work and personal life. They say that society's institutions, like hospitals, ought to find ways to offer that.

This boomer says: Right on.

The issue arose in a story in Thursday's Post by my colleague Ian Shapira. He reported that older physicians are worried that residents just out of medical school aren't getting enough hands-on training because national guidelines say they're supposed to work "only" 80 hours a week. The limit on individual shifts is for 24 consecutive hours of patient care, plus six for patient handoff and educational work.

The veterans expressed frustration that the new generation didn't want to learn medicine the same way they did in the 1970s and 1980s. That's when residents worked 36-hour shifts and 120-hour workweeks, rules that officially were changed in 2003.

The older folks should study some of the scientific literature on sleep deprivation. It establishes -- what a surprise! -- that people have trouble learning and remembering things when they've been up for 24 hours straight.

That means the veterans shouldn't wring their hands when residents go home rather than stay beyond their shifts to observe one more procedure. The youngsters' brains aren't in any shape to absorb the material, anyway.

"If you are deprived of sleep [for one night], your ability to actually learn new facts is significantly compromised by about 40 percent," said Matthew Walker, an assistant professor of psychology and neuroscience at the University of California at Berkley.

He added, tartly, "I don't know of any evidence that medical residents are immune to these effects." Walker has 10 years' experience in sleep research.

Then there's the risk to patients. There's abundant research showing that sleep-deprived doctors are more likely to make errors, including fatal ones.

According to a 2006 study by a research group affiliated with Harvard Medical School, one out of five first-year resident physicians acknowledged making a fatigue-related error that harmed a patient. One out of 20 admitted making such a mistake that led to a patient's death.

A separate 2006 study, also by the Harvard Work Hours Health and Safety Group, found that doctors who'd worked more than 20 hours were 73 percent more likely to injure themselves with a needle or scalpel than those who'd worked 12 hours. The group found widespread violations of the 2003 ceilings on hours.

"After 24 hours without sleep, performance impairment is comparable to being legally drunk," Charles Czeisler, a Harvard medical professor and director of the group, said in testimony to the Medicare Payment Advisory Commission on March 10.

It's nice to have all this medical data to prove the point, but it's kind of unnecessary. Do we really need Harvard studies to show us that we're not going to get optimal care from a doctor who's upright only because of two triple lattes in the past hour?

The medical establishment doesn't need such evidence, either, and that points to the real scandal in all of this. The people we've entrusted with our health have been willing to put it at risk for the sake of practices that are absurd.

Why, then, are the long hours in place? Doctors' pride is partly to blame. The older generation is saying, in effect: We had to suffer and prove we were tough enough, and now so do you.

However, a bigger reason apparently is dollars and cents. Hospitals have a strong financial incentive to squeeze as much work as possible out of young, relatively low-paid residents.

I've got no problem asking doctors or other professionals to work around the clock for days or weeks at a time when there's a genuine emergency. Lawyers do that when a major brief is due. Journalists do that when planes crash into the World Trade Center and the Pentagon.

But I object when the regular routine provides for people making life-and-death choices to be awake for 24 hours at a time. Although it's too late for us boomers, I'd love to see our children's generation succeed in making it easier to have successful careers as well as adequate time for family and other personal pursuits.

http://mccartneyr@washpost.com

Post a Comment


Comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions. You are fully responsible for the content that you post.

© 2010 The Washington Post Company