Are these really the people that should be required to work so much? Isn’t their job about handling life and death daily? Wouldn’t we want exactly these people to come fully rested to work every single day and be fully staffed?
I don’t know if there are jobs with similar stakes that are so carelessly staffed and disgustingly paid.
I’m disabled, have lived an entire year in the hospital such that they unofficially named a room after me on floor 5 and: this is the triple that I am okay with them working. Sitting in a chair, sleeping and making sure the psych/trauma surg patient doesn’t escape. That’s it. And honestly, it should be a hammock. I have this idea for a business hammock. Maybe I could sell hospital hammocks.
Doubles, I’m only good with them in emergencies. And having been the cause of a few emergency shift doubles in my day, I appreciate those of you willing to pull them. Those of you pulling triples, go to sleep. If your third shift isn’t one of the above sleeping shifts you’re intentionally taking unnecessary risks that are going to kill someone.
my gf is a nurse and it is absolutely bonkers how the healthcare system works at all, shit is very run down and society as a whole needs a lot of shifting for how taxation affects the health care system. tax the fucking rich and make them pay their fair share and siphon that into healthcare.
Most of them actually. Am a nurse and was once psychiatrically hospitalized alongside a train conductor and we really bonded over our ridiculous and yet supposedly “high reliability industry” jobs. She actually got hooked on speedballs because there’s some weird loophole in our state where the train conductors need to give something like 48–72h notice or something to take sick leave so most of them just show up for their 16h shifts fucked up on amphetamines to stay awake then benzos so the amphetamines don’t give them tachycardia and one of her managers actually basically gave her a pep talk on which doctors to go to and what to say to get them prescribed legally but given that they’re both extremely addictive substances her dosages spiraled wildly out of control extremely quickly such that she was only able to get effective doses extralegally. On the plus side though losing that job and getting shipped to the other end of the state just to find a bed got her away from both her dealer and her cartoonishly abusive ex (even a week into her stay the bruising was pretty wild). And then actually when I left the hospital my third time I met my now husband in partial although we lost touch for like a year until we ran into each other again and he helped me escape my much more subtly shitty relationship and actually graduate / get licensed (if you think nurse pay is shit I was getting paid $12.50 as a nursing assistant working with criminally insane men and that was after the promotion).
The best justification I’ve heard is that every time you change doctors or nurses at a shift change you introduce discontinuity of patient care. Meaning more opportunity for error. I’m not saying it’s a good justification, just the best I’ve heard.
we arnt, but its the NETWORKS, hospitals pushing them to do it. mostly as a way to solve the shortage and to cheap out on hiring more staff. PLUS EQUITY companies are buying doctors as well making it worst for the above.
at least from my insurance HMO, and other insurances, they MDs are pushed to only 20min/patients max, so they have to go through tons of patients in a day burning them out. a doctor which was my pcp havnt seen for more than a decade was visibly stressed from all those patients she had to see.
also lets not forget the MD industry is gatekept by the AMA, they limit how much licenses they will allow every year+ the immense amount of time fOR medical school+ costs, and then post school training.
The decision making center of your brain is the prefrontal cortex. It’s the really thinky bit. It is what does the explicit thought about novel situations. When something is done “instinctively” or out of habit, that’s usually handed off to the amygdala. It’s used more for stuff that you’ve done many many times before.
When you are tired, haven’t eaten well, and any number of other conditions that overworked and overstressed doctors face, your prefrontal cortex will do a lousy job. The amygdala will actually secrete chemicals that inhibit the performance of the PFC. As such, routine things are probably ok. something novel comes up? Bad times.
I’d prefer my doctor is well rested and in a good frame of mind to make quality decisions, thank you.
ITT: Everyone is exploited, but not as badly as my profession is. Stop crying.
Because one lunatic doctor had a cocaine addiction and could go days at a time without sleep, so he demanded the same from all his students who werent riding the white lightning, which inevitably left a deep cultural impact and expectation for everyone that followed to do the same, because “I suffered, so you suffer too”
Huh, I forgot about this bit of history. What was his name again?
William Halsted if my sleep deprived memory serves me.
Doctor disrespect
Because they’re such precious rare exceptional people, we just can’t have more of them.
If I recall, most medical mistakes take place over shift changes. Things like a patient getting a double dose of meds because they didn’t realize the prior shift already gave them. The idea is that minimizing the number of shift changes reduces the number of mistakes.
This is the explanation I’ve heard. It seems like someone should have thought of a better solution by now, though.
This is accurate. It has to do with minimizing handoff risk.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7539758/
Lots of uneducated responses in this thread that are pure conjecture and drivel.
That study doesn’t really address the issue here though. That study demonstrated hand-off risks. But as far as I can read, it didn’t address shift length at all. All the providers in question had 8 hour shifts.
Obviously hand-offs produce certain risks. But that’s a trivial question. Obviously changing shifts will have some negative effect as providers must get up to speed. But the right question to ask isn’t “do hand-offs produce risks?” The right question to ask is, “if long shifts are used, do the reduced medical mistakes from the shift change counteract the increased medical mistakes from fatigue and unreasonable shift length?”
Do you have any studies that show this? Otherwise the benefits of long shifts are pure conjecture and drivel.
When I worked as a nurse in CA, the standard for shifts was 8 hours, we had 3 shifts in 24h. Some travel nurses took 12h shifts, but staff RN had 8s. Not saying we never made mistakes, but it can be done with proper staffing (4 patients to hand off instead of say, 7) and a culture that respects the handoff time. We did it at the bedside in most cases so the patient could hear what was going on. In CA there are strong unions advocating for patient safety, and as a result, minimizing exploitive working conditions. We were still exploited to be sure, but not like if you’d dropped that hospital in any other state without those protections. Pay was outstanding as well.
Strong unions are the answer to this problem, at least for nurses/support staff. Idk about docs and residency but that is a big part of why becoming a doc never seemed attainable to me.
A combination of a few things.
First, the founder of modern medical teaching was a man who loved cocaine and created a fairly aggressive education program which fed into a profession without work-life balance. The profession hasn’t self-reformed while cases where skilled labor has massive overtime is generally more regulated.
Second, the cost of education is enormous. Medical training for a doctor costs north of half a million dollars, so there is a high cost to training an additional doctor. Because of that, it is more cost effective to add additional shifts to existing doctors and nurses.
Third, a lot of doctors have a god complex and don’t want to admit they are fallible people. Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”. There isn’t a push within the industry to study how people fail like there is in other industries.
Solid post. #2 stings extra, extra hard when you learn that in the USA doctors spend on average somewhere between a quarter and half their time (studies vary) with insurance nonsense. We could potentially DOUBLE (or, low end, increase by 1/3 which is still insane) the number of useful doctor hours tomorrow, but we don’t. U$A
Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”.
When I was an electronics technician in the Air Force, ‘tool accountability’ was huge. All toolboxes were arranged with individual foam cutouts for every individual tool, no matter how small, so it would be quickly and easily obvious from a mere glance if a tool was missing from the toolbox, leaving an empty cutout behind. (Like this.) Paperwork was required to check tools out of and into tool boxes. At the end of every job, the toolbox had to be checked – both the paperwork and visually – to ensure no tools were missing. (And if tools were missing, the job wasn’t done until those tools were found and accounted for.)
And that’s because aircraft in general – and jet engines in particular – really don’t like lost tools banging around loose inside. I didn’t even work on engines, or even on aircraft, but the Air Force had adopted these policies service-wide to prevent accidents resulting from lost tools left inside engines.
Which is why it baffles me that surgeons can sometimes accidentally leave a tool inside a patient. Working on a real human body is way more important than anything I worked on … and human bodies don’t like foreign objects left behind any more than jet engines do. Plus, those surgeons are getting paid so much more than I did, and they even have assistants in the room to handle the tools for them. How the fuck have they not managed to have a similar system of tool accountability, preventing them from leaving tools behind inside patients?
Surgeons are considered money makers in hospitals, literally “the talent.” If a surgeon punches a nurse, the nurse will be the one fired. If a surgeon sexually harasses a tech, even rapes a tech, the tech will be fired. If a surgeon makes life difficult for everyone in his department, they will work around him like a missing stair. If the surgeon comes in drunk or impaired, this “working around” gets tripled into direct coverup, where no one sees anything and no one knows anything. Reports are rote fabrications, as are incident reports; Joint Commission visits are scheduled in advance and prepared for (and their results kept non-public); when an incident occurs family members are routinely bullied; and god help you if you are an employee and you have a problem with any of this: whatever keeps the money coming.
Hospital HR departments are set up to maintain exactly this situation, to the point that even the internal complaint process is rigged, for example in a situation where per the employee handbook you as an employee must submit ALL your evidence up front, and no evidence added later will be considered. You might think, “Well, that’s harmless enough, right?” No. What this does is game any complaint from the start: you as an employee generally can’t sue successfully unless you have tried internal solutions first, and this way the hospital gets to see everything you have upfront, create a defense and/or coverup tailored to your proof, and then counter-accuse you with bullshit you cannot rebut because you never saw it coming and are not allowed to submit anything further. So you either have to sue, or accept being fired at some point, if you’re not fired outright with whatever fabricated misconduct you get charged with as a result of bringing the complaint. Or you can just drop it and try to get on with your career somewhere else.
I have more, but you get the idea. These true experiences come straight from a very large hospital in the southeast US, one that would be considered “award-winning” in a major combined metropolitan area and is considered a “great place to work” based on salary rates. But inside those walls, people who work there usually and very quietly go to the smaller hospital across town when they need their own surgical healthcare. There are many, many great people that work there who are every bit people you would want on your own healthcare team should you need it. But in many departments, the ones that demonstrably aren’t great are not the ones who get fired.
I’m sure other hospitals are better, but many are even worse. The very rare surgeon who does lose their job for cause anywhere in the US is out only because after a years-long road of internal complaints and related witness/complainant firings and employee harassment, one person, at great cost to their own career, doesn’t back down, OR by a stroke of circumstance a patient who is harmed has the right connections to make some kind of justice happen, and then the surgeon moves to another hospital in another state. But that’s rare.
And it’s all about the money: surgeons bring in lots of cash, like oncologists and cardiologists do, and elective surgeries bring in even more. Who pays for all that cushy hospital administration? Surgeons, specifically, among others. You’re 100% right that surgical mistakes can be eliminated, but not in a healthcare system that prioritizes profit over all else. If that surgeon has a pulse and can get to the hospital without getting arrested for DUI, guess who’s doing your surgery? Hospital HR departments protect “the talent,” simple as, and state licensing boards aren’t any guarantee either: they’re staffed with MDs who all went to the same schools as the people whose professional conduct they are entrusted with overseeing.
on the third point the it was the anesthiesa professional group which made the push for the much more rigorous process that greatly improved outcomes. So there is some precedence for the profession realizing it needs to improve processes.
Yes, and it is important that those doctors advocated for better patient care and that the desire to develop procedures are somewhat there. However, the medical profession as a whole seems to be less focused on procedures than others.
We’re not.
We’re just powerless to change it outside of our local jurisdiction.
No we’re not. But generally governments everywhere want to starve the medical industry to make it generate profit for the wealthy. The US is their role model.
Glares at Doug Ford
they kinda are doing that, by UNDERSTAFFING everywhere, replacing expensive MDs for NP/ or even nurses, and PAs. PAs are useful if they can spend time with your medical history like 30min+, anything less than that they are only slighty better than NP/nurses.
Honestly, I don’t think it’s even about profit everywhere.
I obviously don’t know what it’s like in Canada, but in my country, we also have socialized healthcare (like Canada), we have a shortage of some specialty doctors because they’re expensive to train and expensive to hire, and many go to other, richer countries instead (Finland in particular, as it’s close by). But nobody works huge amounts of overtime usually. Nurses work double or triple shifts, but mostly overtime is voluntary, and the only reason they work 16 or 24 hours in a row is because of stupid traditions and the slight risk of information going missing with the shift change.
The one upside is that they get a bunch of days off after each shift since you only need 2 shifts a week, and actually get to skip one shift every now and then if you don’t want to do overtime.
Glares at Tim Houston
Tries to glare at Tim Hortons but it is not available in my region
I mean they deserve it too…
Right in the Tim bits.
ಠ_ಠ
Because the alternative is the rich paying more in taxes, and we can’t have that obviously.
the rich hospital admins, they skimp out on hiring more mds to rotate the burnouts.
Not really.
Universal healthcare could be more than paid for just with what we pay in insurance.
It’s still money, but in this case it’s that profit healthcare is tied to employment causing employers across all industries to want less employees, which means a lot of overtime.
The real solution was shortening the work week to spread the labor around while keeping salaries high.
I agree. Same thing with truckers driving to long. Part of it is the culture. The worst is when they get out of medical with residency and such. Its that frat type of. I had to do it so so should they.
