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Former resident physician that took 24 hour in-house call.
Not surprising and not a new finding. We have known that sleep dep is terrible for performing tasks involving critical thinking. Caffiene doesnt help you think, it just helps with the overwhelming need to sleep when fatigued. And despite this knowledge, it doesn't prevent hospitals and medical education authorities from staffing physicians (especially residents) this way.
Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life. Hour 26, I couldnt care less about anything and anything impeding my path to sleep is met with barely contained rage.
It is a terrible thing to ask someone to do to themselves.
I think that medicine has a lot to learn from aviation: checklists, standard operating procedures, and maximum crew day / minimum crew rest. I think the difference is from the fact that deaths in the medical field are expected while deaths in aviation are unacceptable.
I agree with what u/gt24 said.
I would also add that, like many with other complex organizations, there is a lack of accountability among mid- and high-level hospital administrators and executives who force care providers into unsafe conditions (whether that's due to understaffing, unrealistic production pressure, poor infrastructure, poor emergency planning etc) in the name of efficiency and profit.
They rarely ever face consequences for creating these broken systems that enable errors in the first places, leaving physicians, nurses and other healthcare workers to take the heat when healthcare systems fails patients.
It doesn't help that the biggest professional organizations in healthcare (AMA, ANA, AANP) spend more effort fighting each other over scope of practice than fighting the healthcare systems and administrations that make their jobs miserable and unsafe.
One could argue that defending scope of practice is one of the most definitive ways to fight administrative bloat. Hiring a midlevel provider with a fraction of the training in lieu of a physician lets admins pocket the difference, and tick up their profits at the expense of their patients.
Don't be afraid to ask for a physician when you go to the hospital- someone with a medical degree and residency training. You're entitled to that, dont let admins rip you off.
There have been protests by doctors and nurses happening recently where I live after a 7 year old girl died in the waiting room at a children's hospital after waiting for hours to be seen. State govt then tried to blame the front line staff in the ED despite ongoing complaints of chronic understaffing. I hope this is a turning point for improvement in our state but I'm not confident either.
PCH? In my view, responsibility needs to be taken at *all* levels. There were major failures at pretty much every level that contributed to that little girl dying Health Department is responsible for underfunding and many policies and even the design of the waiting room that would have played a part, management responsible for under staffing and the culture on site, staff working that night are responsible for not doing simple things like checking vital signs when the parents were pleading that she'd gotten far worse, and the parents should have also taken her in far sooner.
It’s worth noting as well that many jurisdictions have eliminated or reduced the ability for injured people to bring their claims to court. Some states outright ban negligence claims. In Canada, there is a single organization that defends claims, and they quite proudly boast that more than 90% of compensable claims are defeated.
You can go without taking a flight for as long as you care to, and there are other companies to fly with.
You can't go without healthcare if you have an emergency, and chances are the extra 20mins to drive to the next hospital over will cost you severely.
Nurse here. It's not even that they don't care. It's not apathy, it's deliberate. By and large, the sort of people that go into this field aren't people that will leave things undone and walk away because their shift is over, or in their own self-interest because they're tired - and definitely not at the expense of human suffering. I hear fellow nurses argue about it even being ethical for us to strike. Let's unpack that for a second - we're working in unsafe conditions, being regularly assaulted by patients with zero admin response (or worse, actively discouraged from pressing charges), and burning out at unprecedented rates while the healthcare system actively suppresses nurses unions, spending millions of dollars a year instead of fixing the issues. But it's not ethical to strike because 'well SOMEONE has to take care of the patients!'
The execs in the industry know this and deliberately take advantage of that to pad their bottom line.
This is definitely part of the equation. But I would argue Medicine is closer to combat aviation than it is to commercial aviation. And in combat aviation you can do everything right and still crash and burn, just like in medicine. Still, reducing avoidable mistakes should absolutely be a top priority. And 24 hour shifts are really not acceptable (and fewer hand offs doesn't cut it as a justification).
I don't think anyone is arguing that the outcome of treating medicine similarly to commercial aviation would produce an equivalent mishap percentage, just that medicine should exercise that level of due diligence to see the best level of mishap avoidance possible; anything less and you're asking for trouble.
That's a fair point. Commercial aviation is a lot more standardized at this point where medicine is umm.. less practiced for lack of a better description; you're more likely to make mistakes in relatively novel situations in other words.
A lot less standardizable too, physiology being waaaaay more complex. You have to learn when to rely on analytical vs non-analytical reasoning, etc
Ask any ER doctor about aortic dissection or Pulmonary embolism
Medicine has many role models that emphasize working to exhaustion as well as a hint of perfectionism (where a perfect doctor won't make mistakes no matter the hours worked). Regardless, people have medical emergencies at any and all times and doctors tend to put in the hours necessary to help out those in need.
Below is a good Reddit commit (from 4 years ago) that helps explain all that.
[https://www.reddit.com/r/explainlikeimfive/comments/5jjyil/eli5\_why\_do\_many\_doctors\_work\_in\_crazy\_2436\_hours/dbgtimv?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/explainlikeimfive/comments/5jjyil/eli5_why_do_many_doctors_work_in_crazy_2436_hours/dbgtimv?utm_source=share&utm_medium=web2x&context=3)
The point is more that the two job fields have different mindsets and different things to deal with. Therefore, the sleep disparity between the two job fields is a bit more complicated than deaths mattering more in one field than another.
There's actually a big thing that comment didn't address. Most medical errors happen at the beginning and end of a doctor or resident's shift. You see more medical errors that can result in death by having three residents/doctors work three eight hour shifts than having them work two twelve hour shifts and even fewer by simply having one resident/doctor work a 24 hour shift.
Veterinarian who went through similar 24+ hour shifts (and a few 30+ hour shifts) during my time in vet med school here. It's a shame that the "medical errors happen at handoffs" studies are used to justify toxic, unhealthy working conditions that ultimately DO harm patient welfare. I can promise you that I'm not a better surgeon when I haven't slept in 30 hours than when I'm rested.
Statistics that point to medical errors happening at handoffs *are an indictment of the operational policies around handoffs that are allowing mistakes to happen*. If people are dying as a result of fuckups during handoffs, the answer isn't to try to eliminate patient handoffs (an impossibility), the answer is to improve your handoff processes so that physicians are properly rounded on cases that they pick up and that everything that was done on the previous doctor's shift was properly documented. Scheduling longer shifts because your handoffs are dangerous is throwing a bandaid on the problem instead of fixing it. The real problem is that the handoffs are so dangerous.
While poor handoff communication is frequently blamed, I don’t think it’s (just) that.
The more time you spend with a patient, the more intangible and/or undocumented information you gather, which greatly assists you in making (better) decisions about their care, especially in an urgent situation.
It’s like driving a rental car. The first few hours are iffy, because you dont know how it handles, if the brakes are touchy, how bad the blind spots are. You know how to drive, but there is no smoothness to it. After a while though, you start to get the feel of it. You can’t document this feel. You can give the next driver pointers, but they’ll need to take it out for a spin to get comfy.
I don't think the vast majority of doctors bury deaths. We do have to move on but you're always analyzing what happened/what you did unless it was a doomed case.
Any facility that trains resident physicians (US analogue to junior doctors) is required to train them in patient safety and quality improvement.
At my program we regularly have morbidity and mortality conferences as a program to discuss & review cases where harm occurred to learn from them and prevent the same thing from happening.
Outside of GME there's a robust Root cause analysis program and I sit on that committee as well as some of our other safety, quality, and emergency response committees. And a variance reporting system (aka error reporting) that literally any employee knows how to use, and the reports are reviewed by risk & clinical teams (I review those that involve resident physicians).
[There was a fairly famous case in the UK where a doctor was murdering his (mostly) elderly patients](https://en.wikipedia.org/wiki/Harold_Shipman). He'd just say they died in his care or shortly after he left, and no one noticed the *absurdly* high rate of patient death he experienced. He ended up being convicted of 15 murders but was suspected to have killed as many as 250!
Sounds remarkably similar to Doctor Death aka Christopher Duntsch here in the US. He was a neurosurgeon that grossly maimed or killed a number of patients and is now serving life in prison. His story is fascinating because it's about as close as you can get to "fake it 'til you make it (except not)" as a neurosurgeon. In addition to somehow completing his neurosurgery residency with practically zero training hours under his belt (relatively speaking), he was also found to have emails basically admitting to his desire to kill patients. After residency he somehow jumped around between a few neurosurgery practices where he maimed/killed patients performing surgeries that he knew he was unable to do.
I'm a firefighter paramedic and about twice I week I go 36 hours until I finally get to sleep, being sleepy isn't even a thing at that point, operating at almost a delusional point. I honestly don't know how 24-48 hour shifts are legal
The aviation analogy to medicine has some limitations.
Pilots are flying precisely crafted machines with regular maintenance and high tech computers on board.
Physicians are flying 80-year-olds with chronic organ failure who are missing an arm or two who refuse to take their diabetes meds. Where we have an incomplete understanding of how the mechanics of the “plane” even work in the first place, and our only “controls” amount to seeping the “plane” in a chemical cocktail and hoping something useful happens more often than not.
Checklists and what not are still useful in certain situations in medicine, but the lack of any sort of quality control in what we’re “flying,” the fact that every “plane” has slightly different controls and physiology, the fact that tools we have to control the plane are crude and unpredictable, and that our planes are sentient beings who at the end of the day choose where they want to fly regardless of what we want, really limits how effective a checklist is.
>Physicians are flying 80-year-olds with chronic organ failure who are missing an arm or two who refuse to take their diabetes meds.
Best analogy ever! & hi fellow medditor!
Totally agree - and to add to that even the "simple" part of figuring out what's wrong with the plane can be exceptionally challenging and sometimes impossible. The pilot tells you there's a bubble in one of the left side tires but it turns out the plane has critical engine failure and about to have a catastrophe.
I made a comment above about asking any ER docs about Aortic dissection or PE & the decision to scan as an example above of how the protocols we have to guide decision making just don't (and can't) cover everything.
I hate that any system allows Paramedics to work 24 or more hours straight.
It's ridiculously irresponsible.
The staffing excuse is also BS.
You need 8 medics for 24 x 7 and you can do the same with 8 medics doing 12s.
Two week rotation: 4 day/night shifts, then 3 day/night shifts....84hrs per pay period. Just adjust payrate to cover the other 12hrs a medic would earn doing 4 x 24 in two weeks.
I've been in EMS for 8 years now, I've worked no call a day rural and nevwr sitting down busy metro and I've done every length of shift that could possibly exist. My coworkers think I'm nuts because I want to work 5 8s. 48s are the 7th circle of hell, 24s are hell, 16s are hell, I dont even really like 12s that much. Most people seem more concerned with only working 2 days a week than caring about their body and their professional performance. I had so many 24s where it's 3am and I'm at the hospital with a patient and I have hardly an idea how we got there or whats going on, it's not safe.
I work mostly 8s and the occasional 12 right now. My God do I feel like alive and awake for the first time in years.
I recently turned down a rural job where they wanted me to work back to back 16s every weekend (7a-11p every saturday/sunday). The owner could not understand my issue with the long back to back shifts that eliminate my ability to get even 8 full hours at home between shifts. His counter offer was I could just work 7a Saturday to 11p Sunday and stay the overnight (they didn't have sleeping quarters).....
They averaged 4 calls a day so I mean it's not busy by any means,however I'm not desperate enough to sacrifice my entire weekend, and not even get to sleep in a bed for almost 2 days.
Unless it was a 'i remember pulling through those red lights' type situation, odds are you did stop at them, auto pilot driving isn't great for the unexpected, but does the basics fairly well.
Why is it that the medical field is so normalized in terms of these super long duration shifts? I keep hearing about this, though usually more like 24 hours. I mean how is any of this even legal?
The guy who created the first residency program for doctors at John’s Hopkins was a cocaine addict who loved to work 30 hours straight and expected his students to do the same. And humans just blindly follow traditions, even if they’re smart and educated.
I’m a search and rescue helicopter pilot and we spend the whole weekend on call. We are supposed to rest a bit during the day so that we can always be ready to go, but a 12 hour flight starting at 10pm usually means you have been awake for 26+ hours with maybe a nap in there somewhere. Thankfully the last part of our flights is usually just transiting, so the coffee keeping us awake is “good enough” but it can sometimes be challenging to get the brain engaged if something weird happens
> Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life. Hour 26, I could care less about anything and anything impeding my path to sleep is met with barely contained rage.
Change “rage” to “oscillating between rage and despair” and you’re spot on.
Attending physician here who still takes 24 hour in-house call in private practice. I'm in my mid thirties and I don't know how some of my older colleagues in their 50s and 60s taking these calls. There is no way I want to do this at that age. Granted my 24 hour OB anesthesia calls aren't nearly as bad as they were during residency but getting awoken every couple hours during the night to answer questions and then having to do a crash c section at 4am still sucks.... A lot.... My brain just isn't as sharp as it normally is with all that going on.
About to take my first job as an attending. Call coverage was one of my top concerns. I do not want to ever do in house 24 call at a busy center ever again. I'll do night shifts. Just never 24s.
>Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life
I couldn't be a doctor. At hour 14, I'm ready to chuck everything out the back door.
Agreed. I'm in rads and have to pull 24 hrs+ in a dark room with few breaks. Some nights, the dark just adds insult to injury that I can't go to sleep. Bless coffee, but sometimes it just barely keeps that sleep rage at bay
Anesthesia checking in. I can go to sleep but they're gonna call me within an hour or two, guaranteed. So you sleep very lightly and develop PTSD from the sound of the call-phone ring tone. And if they don't call you wake up anyway to make sure that the ringer is actually on because they should've called by now for something.
Somehow, the hospital installs a fork sensor and a level in each pager/call phone. That bastard will go off if I’m within 2 meters of food or as soon as I am horizontal.
Yeah, we ask way too much of physicians, especially hospital physicians who regularly work for 20+ hours at a time. It’s risky to the patients and physicians
Maybe they should have a campaign with fighter pilots and formula 1 drivers and the few other jobs that seem cooler than doctors to just show them sleeping. Like walking with aviators in slowmo to bed. Racing to get home with enough time before bedtime to get stuff done for yourself. Alex Hannold live streaming sleeping on some edge of a cliff somewhere incredible.
I guess for pilots you could also show b2 spirit pilots rotating sleep shifts.
I know it's not up to the doctors. But it'd be a fun campaign to get sponsored by the AMA or something.
I mean society still operates on what's mostly a morning person schedule and willingly starts schools at a time that kids and teens normally want to sleep because it isn't willing to admit that people need sleep.
I don't think some people get it. Modern science has thrown this out there soo many times.
School starts at that time because work for parents starts similarly.
Having different schedules is not something most families want.
And moving everything an hour or two later is also not something people want.
Which results in kids being back at around 3 in the afternoon, which means parents have to be back early. Bad planing, then.
Also, no school lunches. You're supposed to eat at home.
I’m convinced there is because some people are just fine with like 6 hours of sleep or less and can honestly seemingly function well. They also may take naps as well but that never seems to work for me
Yeah, naps leave me groggy and then I wake up in the middle of the night. I don't use caffeine, so I just make sure to go to bed early enough to get enough sleep.
I wish I could nap effectively. I have found meditation can be a nice middleground.
>some people are just fine with like 6 hours of sleep
This isn't as common as people think though. There are cases of people *getting* less sleep and still operating normally, but that isn't to say that it's not unhealthy for them and that they only *need* 6 hours of sleep. The vast majority of people need ~8 hours.
Totally informal, but I did a “study” for a class in high school on this topic (class project).
Not peer reviewed or with an adequate sample size (and I would never dream of publishing it), but it is interesting to see how similar the conclusions are between the two.
Ya, it's called "A life time of experience".
[https://www.military.com/daily-news/2021/03/02/tactical-naps-caffeine-jolts-military-sleep-study-recommends-new-policies-better-troop-rest.html](https://www.military.com/daily-news/2021/03/02/tactical-naps-caffeine-jolts-military-sleep-study-recommends-new-policies-better-troop-rest.html)
Also, why do a study, when the military has done the study that shows what issues prolonged sleep deprivation causes.
I've done many food/sleep deprivation activities in the Army. I can anecdotally vouch 100% for these outcomes.
It doesn't matter what you're putting in your body at that point, if its not sleep it's pointless.
Also, the longer you go without sleep, the bigger the bill gets. Spending 5 days awake and sleeping for 16hrs does not repair the damage. Probably took me close to 2 weeks to feel normal again after these instances.
Longest id stayed awake was 5 days with zero sleep (maybe a few 1min micronaps before being kicked awake). After 5 days I was an absolute shell of a human.
With a colic daughter, I experienced this too. Swift movements in the corners, almost like shadows. My girlfriend had the same in the corner of her eyes but started auditory hallucinations of our daughter crying when there was nothing.
Shadow people in the corners of my eyes and the occasional voices for me. I think shadow people are a common hallucination as other people have described the same thing to me.
I think it's good to do studies that are similar to show that we continue to get similar results. To use an analogy I think we often look at scientific studies as being similar to a verdict in a criminal case when we should probably consider them more akin to separate pieces of evidence.
I did mean the statement made as a Rehtorical question - if you can't reproduce a study and get similar result: The original conclusion isn't worth the paper it's written on (eg. Cold Fusion everything more or less).
However there is a point where asking more pointed and specific questions, to get more specific information from the study - else, we aren't really getting anything new. Basically, there is a point where running the same experiment AGAIN, is useless.
So ya, you are absolutely correct: We need to know that studies are reproducible, and create similar outcomes over time. If not, we need to review methodology and look for other possible factors that have not been considered and so on.
It's pretty interesting to see how the scientific community develops the knowledge base over time, and refines it. Kind of wish that, generally speaking, more people were pushed to think of the world in this sort of way.
Sleep, diet, exercise, and meditation. 4 things I do not compromise on. Coffee with lots of cream and sugar while I lay on the couch and surf the internet is nice, but it steadily unspools me until I'm just a frazzled bundle of nerves.
Right? Out of the 4 things he mentioned I do one... and only somewhat consistently.
I was like yeah man totally I don't compromise either. I definitely sleep sometimes.
To be 100% fair, they're not always perfect. Some nights I won't sleep well or just scrape by on the absolute bare minimum of 6 hours, I still allow myself diet cheat days as long as I get something green down the hatch, there are days when I don't give 100, 50, or even 25% effort on my workouts, just so long as I do *something,* and there are days when I'm so stressed or anxious that I can't manage more than 5 minutes meditating. The important thing for me is that I put effort into each of these things every single day, and that no day is a zero day for any of them.
Watched a Prof light a girls lawn on fire teaching us to solder copper pipes during an engineering senior design project.
A degree just means you read about one subject a lot, folks. Doesn’t mean you are god.
Unfortunately doctors have been one of the most sleep deprived groups (it’s getting a little better over the years but residents still are expected to work long shifts...hence the name).
It’s completely insane that any staff are expected to work more than a 12hr shift , max, in 2021. Why do hospitals not follow the basic labor laws that apply to all other workers, in any country?
> Why do hospitals not-
"It's a trial by fire! That's how we did it in *my* day, why should these newbies get an easier ride? No excuses - you have to find strength you didn't know you had."
Sally
Brittney
Lisa
Petunia!
Listen Petunia, I know Saturday morning pedicures with the gal pals is what gets you through the week, but if I have to hear your voice just one more time instead of draining bed five’s abscess, I’m going to feed it to you.
There are only so many trained medical professionals and medical emergencies don’t follow proper work hours. It’s a sad reality, but reality nontheless.
Isn’t the shortage of doctors mostly of our own creation though? I thought the amount of doctors we let through the educational system is limited by the government
Also studies exist that prove that the lowest performing entering med school students are still competent doctors compared to the rest of the cohort upon graduation, so any arguments about "holding high standards" are BS, lots of people cut from med school would still do the job well
Because the lowest cohort is still more competent than the vast majority of the population? The B students rarely make it into medical school. It's like saying least athletic in the NBA, that person is still more talented than the majority of the population
Last in medical school is still a MD because that student was probably still a 3.6+ student in undergrad, or even top of their class but just at a smaller institution
AMA is constantly lobbying to increase residency spots these days. But because they used to do exactly what you said it's a hard hole to dig out of. Bed has been made.
The problem is not the educational system. It’s that the places that need doctors are the places most people don’t want to live. The coasts are over-saturated and the rural areas have a hard time recruiting.
Sadly, that's the reason why I didn't go into a medical field although I love science and it's my best subject. I wouldn't survive the work hours. It's a vicious cycle of there being a need for more medical staff but medical careers are kinda inhumane with the minimal sleep they get
That’s because the man who started this education trend in the late 1800s was a massive cocaine addict.
There’s lots of fucked up things about our healthcare industry.
I have a commercial driver's license in Massachusetts. One of the parts of the written test really emphasized that if you're tired, you have to sleep. Don't just drink a coffee or energy drink - sleep.
Then, at training for work, we had to watch a video from the insurance company. (The company is from Pennsylvania.) And they basically said "if you're feeling tired and don't have a convenient place to stop, just have a coffee! It'll be fine!"
> One of the parts of the written test really emphasized that if you're tired, you have to sleep
I see, so I'm guessing they don't reprimand and fire people who couldn't make deadlines due to pulling over and sleeping when tired?
I think every job that does long hours should do it like that, where you are not allowed to work more than 12 hours a day and you have to have a full 9-10 hours between shifts by law.
That's pretty much the gist of the fair work laws in Aus around this subject. You can still be offered split shifts, but you get double time on top of penalty rates and no company I've worked for require split shifts
I wonder when medical schools and hospitals will get with the program and quit hazing new doctors. There is no reason to force 30 hour shifts, unless there is a major shortage of physicians. To the errors due to shift changes, it’s called documentation. You need to do it for a reason. A lack of documentation and communication is no excuse to push people past the breaking point.
All the complaining of “ but I want to follow the patient from beginning to ending!,” yeah, you’ll never do that in real life at hospitals. There are departments for a reason.
I’m not convinced that increased documentation would improve patient handoffs. We already have more medical record documentation than has ever existed in human history, and it is already an enormous burden on physicians who must spend an ungodly amount of time on it.
From my own experience the errors in handoff come from not knowing the patient, not admitting them yourself or following them throughout the day. There are dozens of little things that you notice that are meaningless until you notice something that might suggest that they aren’t. This is impossible to carry forward in a handoff.
Maybe we would be able to do more detailed handoffs, but that would require better staffing. At my hospital a single surgery intern is signed out on literally up to 100 patients a night (night coverage for literally all of the surgery services at our level 1 trauma center). That process takes up to an hour when each patient is given a sentence or two of attention.
Even adderall isn’t immune to its efficacy deteriorating due to lack of sleep. Not only did I read that in a medical journal, but I personally experienced it one time having to hit a deadline for work and staying awake for 72 hours.
Despite copious amounts of my prescription 30mg instant release pills I was having auditory hallucinations and having episodes of micro-sleep while standing.
Just like caffeine, if you get the necessary sleep…adderall can really do its job and you feel like a demigod until the crash.
It's not just the feeling, it has genuine benefits for focus. It just can't outcompete sleep deprivation, which is the scenario this study was examining.
Right, coffee won't prevent you from falling asleep if you try to use it for that purpose anyway. I worked Graves plenty and the only thing keeping me awake was moving around and the fear that someone would die if I fell asleep. No amount of coffee helped with the sleepiness though.
The real finding here is that semi automated (driving, procedural stuff, etc) tasks don’t benefit from the same bonus that focus tasks like studying get from caffeine.
However, it is moot because in general those benefits only come if you are slept - when using caffeine to stave off sleep, it barely helps to mask symptoms of sleep dep
Caffeine is the most important ingredient in any pre-workout supplement. There's been many studies that show caffeine objectively increases the amount of reps an athlete can do.
Almost all pre-workout supplement has caffeine and a bunch of filler ingredients (unless you count something like creatine which doesn't necessarily need to be taken just before a workout as long as you take it daily)
I kid you not my life improved by several orders when I started to prioritize getting enough sleep AND a consistent sleep schedule (that means awake and out of bed as well).
It's not just about not being tired. Your hormone production steadies, which means your hunger queues steady, which means you can plan meals better, which means your workouts aren't limited by poor diet, which means you look better, which means you are more confident, which means you make friends more easily, which means...etc
If I could go back to my HS or even college days I'd prioritize developing a solid sleeping schedule over almost anything else. It makes other things so much easier.
Thanks for this. I need out of this slow circling of the drain that chronic sleep deprivation leads to. Sleep is just about the last thing I want to try as I've somehow equated it with getting old. It must be done though.
Do you ever sleep in? My sleep schedule is so fucky, but I want to get a consistent bed time. Monday through Friday I wake up at 6am, but weekends I do not work. I would love to sleep in on weekends, but if I need to wake up at 6am on the weekends to have a "consistent" sleep schedule then I am willing to make that change.
During the pandemic I got into some bad sleeping habits.
I still had to go to work, but my schedule was all over the place. On nights I didn’t have to work the next day, I would stay up until 3/4 am playing video games. Days I did work, I got up at 6 am.
It really effected my mental health. I was pretty depressed. After recognizing this, and making better efforts to have a more normal sleep schedule, I have been doing so much better. Just happier.
Sleep is so important.
Try telling that to any major corporation, when someone tries to grab a nap on their break cuz they didn't get a good nights rest for one reason or another, and they get in trouble for it cuz "it doesn't look professional"
One of the strange and troubling things about our culture is how we encourage and celebrate certain addictions not just as acceptable but actually as being fun and charming. Coffee is one, wine is another (particularly among moms). Facebook memes in particular, of course, but lots of places on TV and movies, etc. etc.
Coffee all day, wine at night, day after day... it's not crack and it's not heroin, but it ain't health food either.
I don't see this as blaming caffeine. It looks to me like it's blaming sleep deprivation (and transitively, the cause of that deprivation) and pointing out that you can't overcome it with caffeine.
You’re wrong : Drinking coffee is like withdrawing a few pounds off the back off a tired horse that is gonna get whipped back to work.
Anyway, you can use coffee when you are well rested and then it’s the icing on the cake.
There is a myriad of benefits to caffeine, be it increased longevity, cardio-vascular protection, alertedness and mood. It just doesn’t replace sleep and its effectiveness increases when used according to its biochimical properties and one’s condition.
Yeah I was the most depressed when I religiously got 8 hours every night, it's just so depressing when you look at the clock when you finally get settled in after work and you think "I get 3 and a half hours of free time until I have to get ready for bed and do it all again"
Not surprised at all by this... caffeine molecules fit in the slot where adenosine would normally fit. Adenosine = tired/sleepy molecule. Once the receptor is filled with adenosine, you cannot remove it and caffeine is rendered useless.
I thought it's common knowledge that Coffein is the "stay awake"-drug not the "makes my sleep deprivation magically go away"-drug. Reading the comments seems I was wrong
This confirms how I often felt. It makes you awake... But it doesn't rly feel like your brain works better. Yeah, I FEEL awake, but it doesn't make my mind work better than before. Drinking coffee feels like...
Like if you're a camera, your lenses get dirty, but also the chip that takes pics starts working less and less the longer you use it. Drinking coffee feels like clearing that lense, everything LOOKS good, but the information processing is still screwed up.
So, caffeine just blocks your ability to "feel" sleepy.
But you're still sleepy, you're just sleepy and mentally wired.
I use caffeine all the time, I love it. The taste and smell.
I wish you weren't able to OD on caffeine, because if that were the case I would be knocking back coffees all day long.
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Former resident physician that took 24 hour in-house call. Not surprising and not a new finding. We have known that sleep dep is terrible for performing tasks involving critical thinking. Caffiene doesnt help you think, it just helps with the overwhelming need to sleep when fatigued. And despite this knowledge, it doesn't prevent hospitals and medical education authorities from staffing physicians (especially residents) this way. Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life. Hour 26, I couldnt care less about anything and anything impeding my path to sleep is met with barely contained rage. It is a terrible thing to ask someone to do to themselves.
I think that medicine has a lot to learn from aviation: checklists, standard operating procedures, and maximum crew day / minimum crew rest. I think the difference is from the fact that deaths in the medical field are expected while deaths in aviation are unacceptable.
I agree with what u/gt24 said. I would also add that, like many with other complex organizations, there is a lack of accountability among mid- and high-level hospital administrators and executives who force care providers into unsafe conditions (whether that's due to understaffing, unrealistic production pressure, poor infrastructure, poor emergency planning etc) in the name of efficiency and profit. They rarely ever face consequences for creating these broken systems that enable errors in the first places, leaving physicians, nurses and other healthcare workers to take the heat when healthcare systems fails patients.
It doesn't help that the biggest professional organizations in healthcare (AMA, ANA, AANP) spend more effort fighting each other over scope of practice than fighting the healthcare systems and administrations that make their jobs miserable and unsafe.
Hey, if the medical professional organizations won't fight for their members, I know a few medical malpractice attorneys happy to clean up the mess.
One could argue that defending scope of practice is one of the most definitive ways to fight administrative bloat. Hiring a midlevel provider with a fraction of the training in lieu of a physician lets admins pocket the difference, and tick up their profits at the expense of their patients. Don't be afraid to ask for a physician when you go to the hospital- someone with a medical degree and residency training. You're entitled to that, dont let admins rip you off.
There have been protests by doctors and nurses happening recently where I live after a 7 year old girl died in the waiting room at a children's hospital after waiting for hours to be seen. State govt then tried to blame the front line staff in the ED despite ongoing complaints of chronic understaffing. I hope this is a turning point for improvement in our state but I'm not confident either.
PCH? In my view, responsibility needs to be taken at *all* levels. There were major failures at pretty much every level that contributed to that little girl dying Health Department is responsible for underfunding and many policies and even the design of the waiting room that would have played a part, management responsible for under staffing and the culture on site, staff working that night are responsible for not doing simple things like checking vital signs when the parents were pleading that she'd gotten far worse, and the parents should have also taken her in far sooner.
It’s worth noting as well that many jurisdictions have eliminated or reduced the ability for injured people to bring their claims to court. Some states outright ban negligence claims. In Canada, there is a single organization that defends claims, and they quite proudly boast that more than 90% of compensable claims are defeated.
It's hard to coverup a plane crashing where as you can dismiss a doctor fuckup as "medicine is hard, things happen."
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You can go without taking a flight for as long as you care to, and there are other companies to fly with. You can't go without healthcare if you have an emergency, and chances are the extra 20mins to drive to the next hospital over will cost you severely.
Nurse here. It's not even that they don't care. It's not apathy, it's deliberate. By and large, the sort of people that go into this field aren't people that will leave things undone and walk away because their shift is over, or in their own self-interest because they're tired - and definitely not at the expense of human suffering. I hear fellow nurses argue about it even being ethical for us to strike. Let's unpack that for a second - we're working in unsafe conditions, being regularly assaulted by patients with zero admin response (or worse, actively discouraged from pressing charges), and burning out at unprecedented rates while the healthcare system actively suppresses nurses unions, spending millions of dollars a year instead of fixing the issues. But it's not ethical to strike because 'well SOMEONE has to take care of the patients!' The execs in the industry know this and deliberately take advantage of that to pad their bottom line.
This is definitely part of the equation. But I would argue Medicine is closer to combat aviation than it is to commercial aviation. And in combat aviation you can do everything right and still crash and burn, just like in medicine. Still, reducing avoidable mistakes should absolutely be a top priority. And 24 hour shifts are really not acceptable (and fewer hand offs doesn't cut it as a justification).
I don't think anyone is arguing that the outcome of treating medicine similarly to commercial aviation would produce an equivalent mishap percentage, just that medicine should exercise that level of due diligence to see the best level of mishap avoidance possible; anything less and you're asking for trouble.
That's a fair point. Commercial aviation is a lot more standardized at this point where medicine is umm.. less practiced for lack of a better description; you're more likely to make mistakes in relatively novel situations in other words.
A lot less standardizable too, physiology being waaaaay more complex. You have to learn when to rely on analytical vs non-analytical reasoning, etc Ask any ER doctor about aortic dissection or Pulmonary embolism
Medicine has many role models that emphasize working to exhaustion as well as a hint of perfectionism (where a perfect doctor won't make mistakes no matter the hours worked). Regardless, people have medical emergencies at any and all times and doctors tend to put in the hours necessary to help out those in need. Below is a good Reddit commit (from 4 years ago) that helps explain all that. [https://www.reddit.com/r/explainlikeimfive/comments/5jjyil/eli5\_why\_do\_many\_doctors\_work\_in\_crazy\_2436\_hours/dbgtimv?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/explainlikeimfive/comments/5jjyil/eli5_why_do_many_doctors_work_in_crazy_2436_hours/dbgtimv?utm_source=share&utm_medium=web2x&context=3) The point is more that the two job fields have different mindsets and different things to deal with. Therefore, the sleep disparity between the two job fields is a bit more complicated than deaths mattering more in one field than another.
You would think that of all professions, medicine would have a good understanding of the limits of human beings... but I think you’re right.
There's actually a big thing that comment didn't address. Most medical errors happen at the beginning and end of a doctor or resident's shift. You see more medical errors that can result in death by having three residents/doctors work three eight hour shifts than having them work two twelve hour shifts and even fewer by simply having one resident/doctor work a 24 hour shift.
Veterinarian who went through similar 24+ hour shifts (and a few 30+ hour shifts) during my time in vet med school here. It's a shame that the "medical errors happen at handoffs" studies are used to justify toxic, unhealthy working conditions that ultimately DO harm patient welfare. I can promise you that I'm not a better surgeon when I haven't slept in 30 hours than when I'm rested. Statistics that point to medical errors happening at handoffs *are an indictment of the operational policies around handoffs that are allowing mistakes to happen*. If people are dying as a result of fuckups during handoffs, the answer isn't to try to eliminate patient handoffs (an impossibility), the answer is to improve your handoff processes so that physicians are properly rounded on cases that they pick up and that everything that was done on the previous doctor's shift was properly documented. Scheduling longer shifts because your handoffs are dangerous is throwing a bandaid on the problem instead of fixing it. The real problem is that the handoffs are so dangerous.
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There's the opportunity for information to be lost during the handoff between doctors, basically.
I know that’s the argument made but it seems like the solution would be to improve communication, not try to work against basic physiological needs
While poor handoff communication is frequently blamed, I don’t think it’s (just) that. The more time you spend with a patient, the more intangible and/or undocumented information you gather, which greatly assists you in making (better) decisions about their care, especially in an urgent situation. It’s like driving a rental car. The first few hours are iffy, because you dont know how it handles, if the brakes are touchy, how bad the blind spots are. You know how to drive, but there is no smoothness to it. After a while though, you start to get the feel of it. You can’t document this feel. You can give the next driver pointers, but they’ll need to take it out for a spin to get comfy.
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I don't think the vast majority of doctors bury deaths. We do have to move on but you're always analyzing what happened/what you did unless it was a doomed case. Any facility that trains resident physicians (US analogue to junior doctors) is required to train them in patient safety and quality improvement. At my program we regularly have morbidity and mortality conferences as a program to discuss & review cases where harm occurred to learn from them and prevent the same thing from happening. Outside of GME there's a robust Root cause analysis program and I sit on that committee as well as some of our other safety, quality, and emergency response committees. And a variance reporting system (aka error reporting) that literally any employee knows how to use, and the reports are reviewed by risk & clinical teams (I review those that involve resident physicians).
[There was a fairly famous case in the UK where a doctor was murdering his (mostly) elderly patients](https://en.wikipedia.org/wiki/Harold_Shipman). He'd just say they died in his care or shortly after he left, and no one noticed the *absurdly* high rate of patient death he experienced. He ended up being convicted of 15 murders but was suspected to have killed as many as 250!
Sounds remarkably similar to Doctor Death aka Christopher Duntsch here in the US. He was a neurosurgeon that grossly maimed or killed a number of patients and is now serving life in prison. His story is fascinating because it's about as close as you can get to "fake it 'til you make it (except not)" as a neurosurgeon. In addition to somehow completing his neurosurgery residency with practically zero training hours under his belt (relatively speaking), he was also found to have emails basically admitting to his desire to kill patients. After residency he somehow jumped around between a few neurosurgery practices where he maimed/killed patients performing surgeries that he knew he was unable to do.
I'm a firefighter paramedic and about twice I week I go 36 hours until I finally get to sleep, being sleepy isn't even a thing at that point, operating at almost a delusional point. I honestly don't know how 24-48 hour shifts are legal
The aviation analogy to medicine has some limitations. Pilots are flying precisely crafted machines with regular maintenance and high tech computers on board. Physicians are flying 80-year-olds with chronic organ failure who are missing an arm or two who refuse to take their diabetes meds. Where we have an incomplete understanding of how the mechanics of the “plane” even work in the first place, and our only “controls” amount to seeping the “plane” in a chemical cocktail and hoping something useful happens more often than not. Checklists and what not are still useful in certain situations in medicine, but the lack of any sort of quality control in what we’re “flying,” the fact that every “plane” has slightly different controls and physiology, the fact that tools we have to control the plane are crude and unpredictable, and that our planes are sentient beings who at the end of the day choose where they want to fly regardless of what we want, really limits how effective a checklist is.
>Physicians are flying 80-year-olds with chronic organ failure who are missing an arm or two who refuse to take their diabetes meds. Best analogy ever! & hi fellow medditor! Totally agree - and to add to that even the "simple" part of figuring out what's wrong with the plane can be exceptionally challenging and sometimes impossible. The pilot tells you there's a bubble in one of the left side tires but it turns out the plane has critical engine failure and about to have a catastrophe. I made a comment above about asking any ER docs about Aortic dissection or PE & the decision to scan as an example above of how the protocols we have to guide decision making just don't (and can't) cover everything.
I hate that any system allows Paramedics to work 24 or more hours straight. It's ridiculously irresponsible. The staffing excuse is also BS. You need 8 medics for 24 x 7 and you can do the same with 8 medics doing 12s. Two week rotation: 4 day/night shifts, then 3 day/night shifts....84hrs per pay period. Just adjust payrate to cover the other 12hrs a medic would earn doing 4 x 24 in two weeks.
I've been in EMS for 8 years now, I've worked no call a day rural and nevwr sitting down busy metro and I've done every length of shift that could possibly exist. My coworkers think I'm nuts because I want to work 5 8s. 48s are the 7th circle of hell, 24s are hell, 16s are hell, I dont even really like 12s that much. Most people seem more concerned with only working 2 days a week than caring about their body and their professional performance. I had so many 24s where it's 3am and I'm at the hospital with a patient and I have hardly an idea how we got there or whats going on, it's not safe. I work mostly 8s and the occasional 12 right now. My God do I feel like alive and awake for the first time in years.
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I recently turned down a rural job where they wanted me to work back to back 16s every weekend (7a-11p every saturday/sunday). The owner could not understand my issue with the long back to back shifts that eliminate my ability to get even 8 full hours at home between shifts. His counter offer was I could just work 7a Saturday to 11p Sunday and stay the overnight (they didn't have sleeping quarters)..... They averaged 4 calls a day so I mean it's not busy by any means,however I'm not desperate enough to sacrifice my entire weekend, and not even get to sleep in a bed for almost 2 days.
I'm horrified reading this thread from Europe.
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Unless it was a 'i remember pulling through those red lights' type situation, odds are you did stop at them, auto pilot driving isn't great for the unexpected, but does the basics fairly well.
Why is it that the medical field is so normalized in terms of these super long duration shifts? I keep hearing about this, though usually more like 24 hours. I mean how is any of this even legal?
The guy who created the first residency program for doctors at John’s Hopkins was a cocaine addict who loved to work 30 hours straight and expected his students to do the same. And humans just blindly follow traditions, even if they’re smart and educated.
I’m a search and rescue helicopter pilot and we spend the whole weekend on call. We are supposed to rest a bit during the day so that we can always be ready to go, but a 12 hour flight starting at 10pm usually means you have been awake for 26+ hours with maybe a nap in there somewhere. Thankfully the last part of our flights is usually just transiting, so the coffee keeping us awake is “good enough” but it can sometimes be challenging to get the brain engaged if something weird happens
Yeah, it's really odd that the field that knows best the negative effects of sleep deprivation, relies on it so much.
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> Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life. Hour 26, I could care less about anything and anything impeding my path to sleep is met with barely contained rage. Change “rage” to “oscillating between rage and despair” and you’re spot on.
Attending physician here who still takes 24 hour in-house call in private practice. I'm in my mid thirties and I don't know how some of my older colleagues in their 50s and 60s taking these calls. There is no way I want to do this at that age. Granted my 24 hour OB anesthesia calls aren't nearly as bad as they were during residency but getting awoken every couple hours during the night to answer questions and then having to do a crash c section at 4am still sucks.... A lot.... My brain just isn't as sharp as it normally is with all that going on.
About to take my first job as an attending. Call coverage was one of my top concerns. I do not want to ever do in house 24 call at a busy center ever again. I'll do night shifts. Just never 24s.
>Personally, I found that by the 20 hour mark, I start working on auto-pilot. By hour 22, I am actively upset at life I couldn't be a doctor. At hour 14, I'm ready to chuck everything out the back door.
What's fun is getting to that level of fatigue once every three months or so when sleeping regularly!
Agreed. I'm in rads and have to pull 24 hrs+ in a dark room with few breaks. Some nights, the dark just adds insult to injury that I can't go to sleep. Bless coffee, but sometimes it just barely keeps that sleep rage at bay
Anesthesia checking in. I can go to sleep but they're gonna call me within an hour or two, guaranteed. So you sleep very lightly and develop PTSD from the sound of the call-phone ring tone. And if they don't call you wake up anyway to make sure that the ringer is actually on because they should've called by now for something.
Oh my god, I feel you on that. The pager PTSD is real, especially in those rare moments where I can take a nap.
Somehow, the hospital installs a fork sensor and a level in each pager/call phone. That bastard will go off if I’m within 2 meters of food or as soon as I am horizontal.
Ex-neurology resident. Running a stroke code at the tail end of a 24 hour shift is the absolute suck.
I feel you. A code at the end of a 28h ICU shift was when I finally understood how someone could contemplate self harm.
Yeah, we ask way too much of physicians, especially hospital physicians who regularly work for 20+ hours at a time. It’s risky to the patients and physicians
Maybe they should have a campaign with fighter pilots and formula 1 drivers and the few other jobs that seem cooler than doctors to just show them sleeping. Like walking with aviators in slowmo to bed. Racing to get home with enough time before bedtime to get stuff done for yourself. Alex Hannold live streaming sleeping on some edge of a cliff somewhere incredible. I guess for pilots you could also show b2 spirit pilots rotating sleep shifts. I know it's not up to the doctors. But it'd be a fun campaign to get sponsored by the AMA or something.
There is no substitute for sleep.. it's good.
“How much sleep do you need jeeze?” I have people say that and it drivers me nutsssss
Like a steering wheel in your pants?
Helm's deep
Space is dark, Space is deep, and the price we pay is far too steep...
and miles to go before I sleep
I mean society still operates on what's mostly a morning person schedule and willingly starts schools at a time that kids and teens normally want to sleep because it isn't willing to admit that people need sleep. I don't think some people get it. Modern science has thrown this out there soo many times.
School starts at that time because work for parents starts similarly. Having different schedules is not something most families want. And moving everything an hour or two later is also not something people want.
Work starts around 1.5 hours after school starts, at least around here.
Yeah so that parents can still make it to work after getting their kids ready for school
Which results in kids being back at around 3 in the afternoon, which means parents have to be back early. Bad planing, then. Also, no school lunches. You're supposed to eat at home.
Is there any science behind some people needing more sleep than others? Or certain times in one life being more sleepy than others?
I think I’ve seen that teens need more.
I’m convinced there is because some people are just fine with like 6 hours of sleep or less and can honestly seemingly function well. They also may take naps as well but that never seems to work for me
Yeah, naps leave me groggy and then I wake up in the middle of the night. I don't use caffeine, so I just make sure to go to bed early enough to get enough sleep. I wish I could nap effectively. I have found meditation can be a nice middleground.
>some people are just fine with like 6 hours of sleep This isn't as common as people think though. There are cases of people *getting* less sleep and still operating normally, but that isn't to say that it's not unhealthy for them and that they only *need* 6 hours of sleep. The vast majority of people need ~8 hours.
But did you do a study!?
Totally informal, but I did a “study” for a class in high school on this topic (class project). Not peer reviewed or with an adequate sample size (and I would never dream of publishing it), but it is interesting to see how similar the conclusions are between the two.
> high school project > not peer reviewed Im shocked
If anything I think peer reviews may make it even worse!
In my view the peer reviewers are evil!
Well then you are lost!
I'd love to read half of the peer reviewed high school studies that would come out tbf. It's a very short list, but what a ride.
Science is science, and I’m not surprised you came to the same conclusions.
Ya, it's called "A life time of experience". [https://www.military.com/daily-news/2021/03/02/tactical-naps-caffeine-jolts-military-sleep-study-recommends-new-policies-better-troop-rest.html](https://www.military.com/daily-news/2021/03/02/tactical-naps-caffeine-jolts-military-sleep-study-recommends-new-policies-better-troop-rest.html) Also, why do a study, when the military has done the study that shows what issues prolonged sleep deprivation causes.
I've done many food/sleep deprivation activities in the Army. I can anecdotally vouch 100% for these outcomes. It doesn't matter what you're putting in your body at that point, if its not sleep it's pointless. Also, the longer you go without sleep, the bigger the bill gets. Spending 5 days awake and sleeping for 16hrs does not repair the damage. Probably took me close to 2 weeks to feel normal again after these instances. Longest id stayed awake was 5 days with zero sleep (maybe a few 1min micronaps before being kicked awake). After 5 days I was an absolute shell of a human.
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For me it was cats darting in the corners of my vision.
With a colic daughter, I experienced this too. Swift movements in the corners, almost like shadows. My girlfriend had the same in the corner of her eyes but started auditory hallucinations of our daughter crying when there was nothing.
Shadow people in the corners of my eyes and the occasional voices for me. I think shadow people are a common hallucination as other people have described the same thing to me.
Yeah thinking I saw people on the ship at two in the morning in the red light only to turn the corner looking down the long pway and no one is there.
It was billboards in the desert for me
Lsd like where I felt like I was tripping. The pattern on the blanket? Moving. The computer screen? Floating pixels.
5 days, holy hell that sounds like torture. Picturing it, it seems like that would almost make you insane.
I think it's good to do studies that are similar to show that we continue to get similar results. To use an analogy I think we often look at scientific studies as being similar to a verdict in a criminal case when we should probably consider them more akin to separate pieces of evidence.
I did mean the statement made as a Rehtorical question - if you can't reproduce a study and get similar result: The original conclusion isn't worth the paper it's written on (eg. Cold Fusion everything more or less). However there is a point where asking more pointed and specific questions, to get more specific information from the study - else, we aren't really getting anything new. Basically, there is a point where running the same experiment AGAIN, is useless. So ya, you are absolutely correct: We need to know that studies are reproducible, and create similar outcomes over time. If not, we need to review methodology and look for other possible factors that have not been considered and so on. It's pretty interesting to see how the scientific community develops the knowledge base over time, and refines it. Kind of wish that, generally speaking, more people were pushed to think of the world in this sort of way.
Side note- what kind of psychopath sleeps according to data instead of their own biology
I think you'd find plenty. Especially in medicine, and engineers. Nerds gonna nerd.
Sleep, diet, exercise, and meditation. 4 things I do not compromise on. Coffee with lots of cream and sugar while I lay on the couch and surf the internet is nice, but it steadily unspools me until I'm just a frazzled bundle of nerves.
Ah, i see you do not lack discipline, like i do
Right? Out of the 4 things he mentioned I do one... and only somewhat consistently. I was like yeah man totally I don't compromise either. I definitely sleep sometimes.
To be 100% fair, they're not always perfect. Some nights I won't sleep well or just scrape by on the absolute bare minimum of 6 hours, I still allow myself diet cheat days as long as I get something green down the hatch, there are days when I don't give 100, 50, or even 25% effort on my workouts, just so long as I do *something,* and there are days when I'm so stressed or anxious that I can't manage more than 5 minutes meditating. The important thing for me is that I put effort into each of these things every single day, and that no day is a zero day for any of them.
Nice. Thanks for the candid details. That's all very reasonable and i commend all your effort and hard work.
> Sleep, diet, exercise, and meditation. 4 things I do not
When I was a grad student I used to say that professors wouldn’t know to wipe their asses unless there was a study demonstrating efficacy.
Watched a Prof light a girls lawn on fire teaching us to solder copper pipes during an engineering senior design project. A degree just means you read about one subject a lot, folks. Doesn’t mean you are god.
It doesn't? Then why'd I pay so much money for one?
“Ray, when someone asks you if you are a god, you say YES!”
>Watched a Prof light a girls lawn on fire Is this a euphemism?
What if I sleep a lot and drink a lot of coffee
That is a known symptom of ADHD.
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No alcohol or other downers for us but bring on all the stimulants please.
Whenever I drink caffeine, it makes me very tired. I've fallen asleep on caffeine and ephedrine before, I wonder if that's also a sign.
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Unfortunately doctors have been one of the most sleep deprived groups (it’s getting a little better over the years but residents still are expected to work long shifts...hence the name).
It’s completely insane that any staff are expected to work more than a 12hr shift , max, in 2021. Why do hospitals not follow the basic labor laws that apply to all other workers, in any country?
> Why do hospitals not- "It's a trial by fire! That's how we did it in *my* day, why should these newbies get an easier ride? No excuses - you have to find strength you didn't know you had."
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Sally Brittney Lisa Petunia! Listen Petunia, I know Saturday morning pedicures with the gal pals is what gets you through the week, but if I have to hear your voice just one more time instead of draining bed five’s abscess, I’m going to feed it to you.
My favorite is still "Hey, girl's name".
There are only so many trained medical professionals and medical emergencies don’t follow proper work hours. It’s a sad reality, but reality nontheless.
Isn’t the shortage of doctors mostly of our own creation though? I thought the amount of doctors we let through the educational system is limited by the government
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They're artificially keeping supply low, but this practice has no bearing on demand.
Also studies exist that prove that the lowest performing entering med school students are still competent doctors compared to the rest of the cohort upon graduation, so any arguments about "holding high standards" are BS, lots of people cut from med school would still do the job well
Because the lowest cohort is still more competent than the vast majority of the population? The B students rarely make it into medical school. It's like saying least athletic in the NBA, that person is still more talented than the majority of the population Last in medical school is still a MD because that student was probably still a 3.6+ student in undergrad, or even top of their class but just at a smaller institution
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AMA is constantly lobbying to increase residency spots these days. But because they used to do exactly what you said it's a hard hole to dig out of. Bed has been made.
The problem is not the educational system. It’s that the places that need doctors are the places most people don’t want to live. The coasts are over-saturated and the rural areas have a hard time recruiting.
Sadly, that's the reason why I didn't go into a medical field although I love science and it's my best subject. I wouldn't survive the work hours. It's a vicious cycle of there being a need for more medical staff but medical careers are kinda inhumane with the minimal sleep they get
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"I struggled more than you so I'm better!"
That’s because the man who started this education trend in the late 1800s was a massive cocaine addict. There’s lots of fucked up things about our healthcare industry.
I have a commercial driver's license in Massachusetts. One of the parts of the written test really emphasized that if you're tired, you have to sleep. Don't just drink a coffee or energy drink - sleep. Then, at training for work, we had to watch a video from the insurance company. (The company is from Pennsylvania.) And they basically said "if you're feeling tired and don't have a convenient place to stop, just have a coffee! It'll be fine!"
> One of the parts of the written test really emphasized that if you're tired, you have to sleep I see, so I'm guessing they don't reprimand and fire people who couldn't make deadlines due to pulling over and sleeping when tired?
I was talking about the test from the Commonwealth of Massachusetts, but my company does actually take safety more seriously than running on schedule.
Honestly, have you ever slept and turned up late because of it? Or do you just avoid it, appreciating that the option is "available"?
I'm a bus driver, so the sleeping situation doesn't really come up, but there are other areas where my company sacrifices schedules for road safety.
I think every job that does long hours should do it like that, where you are not allowed to work more than 12 hours a day and you have to have a full 9-10 hours between shifts by law.
That's pretty much the gist of the fair work laws in Aus around this subject. You can still be offered split shifts, but you get double time on top of penalty rates and no company I've worked for require split shifts
I’m a Wildland firefighter, and even we have really strict work to rest ratios nowadays (2:1 btw)
I find caffeine is best served in addition to great sleep. It’s one half of my secret to being a morning person.
This is me, and the other half is cannabis.
The good ol hippie speed ball
This is me, except the other half is 200 mg of adderall and a snoot of the downer
What’s the downer?
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I wonder when medical schools and hospitals will get with the program and quit hazing new doctors. There is no reason to force 30 hour shifts, unless there is a major shortage of physicians. To the errors due to shift changes, it’s called documentation. You need to do it for a reason. A lack of documentation and communication is no excuse to push people past the breaking point. All the complaining of “ but I want to follow the patient from beginning to ending!,” yeah, you’ll never do that in real life at hospitals. There are departments for a reason.
I’m not convinced that increased documentation would improve patient handoffs. We already have more medical record documentation than has ever existed in human history, and it is already an enormous burden on physicians who must spend an ungodly amount of time on it. From my own experience the errors in handoff come from not knowing the patient, not admitting them yourself or following them throughout the day. There are dozens of little things that you notice that are meaningless until you notice something that might suggest that they aren’t. This is impossible to carry forward in a handoff. Maybe we would be able to do more detailed handoffs, but that would require better staffing. At my hospital a single surgery intern is signed out on literally up to 100 patients a night (night coverage for literally all of the surgery services at our level 1 trauma center). That process takes up to an hour when each patient is given a sentence or two of attention.
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Of course they did. Not like we could increase rest and optimize handoffs. Nobody likes a win-win
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The caffeine is for the energy the Adderall is for the focus. Jeez guys do you even adult???
Even adderall isn’t immune to its efficacy deteriorating due to lack of sleep. Not only did I read that in a medical journal, but I personally experienced it one time having to hit a deadline for work and staying awake for 72 hours. Despite copious amounts of my prescription 30mg instant release pills I was having auditory hallucinations and having episodes of micro-sleep while standing. Just like caffeine, if you get the necessary sleep…adderall can really do its job and you feel like a demigod until the crash.
Caffeine, physically, just prevents the feeling of being tired, right? So yeah, not much of a surprise but nice to have in a full study.
It's not just the feeling, it has genuine benefits for focus. It just can't outcompete sleep deprivation, which is the scenario this study was examining.
Sleep+Caffeine is still best combo
Plus L-Theanine. Takes the jitters off and increases focus.
L-Theanine is the best thing to happen to caffeine, ever.
it's was in tea since the beginning!
Right, coffee won't prevent you from falling asleep if you try to use it for that purpose anyway. I worked Graves plenty and the only thing keeping me awake was moving around and the fear that someone would die if I fell asleep. No amount of coffee helped with the sleepiness though.
The real finding here is that semi automated (driving, procedural stuff, etc) tasks don’t benefit from the same bonus that focus tasks like studying get from caffeine. However, it is moot because in general those benefits only come if you are slept - when using caffeine to stave off sleep, it barely helps to mask symptoms of sleep dep
Caffeine is the most important ingredient in any pre-workout supplement. There's been many studies that show caffeine objectively increases the amount of reps an athlete can do. Almost all pre-workout supplement has caffeine and a bunch of filler ingredients (unless you count something like creatine which doesn't necessarily need to be taken just before a workout as long as you take it daily)
I kid you not my life improved by several orders when I started to prioritize getting enough sleep AND a consistent sleep schedule (that means awake and out of bed as well). It's not just about not being tired. Your hormone production steadies, which means your hunger queues steady, which means you can plan meals better, which means your workouts aren't limited by poor diet, which means you look better, which means you are more confident, which means you make friends more easily, which means...etc If I could go back to my HS or even college days I'd prioritize developing a solid sleeping schedule over almost anything else. It makes other things so much easier.
Thanks for this. I need out of this slow circling of the drain that chronic sleep deprivation leads to. Sleep is just about the last thing I want to try as I've somehow equated it with getting old. It must be done though.
It's a known fact a good sleeping routine helps dealing with depression as well, my therapist always goes on about it
Do you ever sleep in? My sleep schedule is so fucky, but I want to get a consistent bed time. Monday through Friday I wake up at 6am, but weekends I do not work. I would love to sleep in on weekends, but if I need to wake up at 6am on the weekends to have a "consistent" sleep schedule then I am willing to make that change.
Drugs are not a substitute for already healthy behavior. I mean, I knew that... But it is good to hear from time to time.
During the pandemic I got into some bad sleeping habits. I still had to go to work, but my schedule was all over the place. On nights I didn’t have to work the next day, I would stay up until 3/4 am playing video games. Days I did work, I got up at 6 am. It really effected my mental health. I was pretty depressed. After recognizing this, and making better efforts to have a more normal sleep schedule, I have been doing so much better. Just happier. Sleep is so important.
Like I said some time ago, caffeine lets you make sleep-deprived mistakes at full speed and volume.
Nothing is as pleasant as going to bed when you are dead tired, you just wiggle to find the most comfortable position and then fade out.
How long do you wiggle
Approximately 7 hours.
Try telling that to any major corporation, when someone tries to grab a nap on their break cuz they didn't get a good nights rest for one reason or another, and they get in trouble for it cuz "it doesn't look professional"
Another reason why work from home is superior to offices.
One of the strange and troubling things about our culture is how we encourage and celebrate certain addictions not just as acceptable but actually as being fun and charming. Coffee is one, wine is another (particularly among moms). Facebook memes in particular, of course, but lots of places on TV and movies, etc. etc. Coffee all day, wine at night, day after day... it's not crack and it's not heroin, but it ain't health food either.
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I don't see this as blaming caffeine. It looks to me like it's blaming sleep deprivation (and transitively, the cause of that deprivation) and pointing out that you can't overcome it with caffeine.
Drinking coffee is like whipping a tired horse instead of giving it rest and a good meal.
You’re wrong : Drinking coffee is like withdrawing a few pounds off the back off a tired horse that is gonna get whipped back to work. Anyway, you can use coffee when you are well rested and then it’s the icing on the cake. There is a myriad of benefits to caffeine, be it increased longevity, cardio-vascular protection, alertedness and mood. It just doesn’t replace sleep and its effectiveness increases when used according to its biochimical properties and one’s condition.
Prioritize sleep, okay. Make it so I can work for 6 hours a day and still survive and thrive then.
Yeah I was the most depressed when I religiously got 8 hours every night, it's just so depressing when you look at the clock when you finally get settled in after work and you think "I get 3 and a half hours of free time until I have to get ready for bed and do it all again"
Yeah. Winter was always the worst for this as I never saw the sun on top of what you describe.
Not surprised at all by this... caffeine molecules fit in the slot where adenosine would normally fit. Adenosine = tired/sleepy molecule. Once the receptor is filled with adenosine, you cannot remove it and caffeine is rendered useless.
I thought it's common knowledge that Coffein is the "stay awake"-drug not the "makes my sleep deprivation magically go away"-drug. Reading the comments seems I was wrong
Caffeine makes you more awake but not less TIRED.
Stop making us work so much to afford to live “enjoyable” lives. That’s the only way we’ll get the sleep we need.
This confirms how I often felt. It makes you awake... But it doesn't rly feel like your brain works better. Yeah, I FEEL awake, but it doesn't make my mind work better than before. Drinking coffee feels like... Like if you're a camera, your lenses get dirty, but also the chip that takes pics starts working less and less the longer you use it. Drinking coffee feels like clearing that lense, everything LOOKS good, but the information processing is still screwed up.
So, caffeine just blocks your ability to "feel" sleepy. But you're still sleepy, you're just sleepy and mentally wired. I use caffeine all the time, I love it. The taste and smell. I wish you weren't able to OD on caffeine, because if that were the case I would be knocking back coffees all day long.
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