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.
We aren’t. But it’s generally better for patient care. It’s the same nurse/doctor seeing through more of the care of a patient with less handovers.
Handovers are where minor details or context can be forgotten, dropped or misunderstood - especially after a really tough shift.
Patients also get to see the same faces more often, which makes them feel like they are being taken care of - as opposed to a part being made in a machine.
But it’s wrong. It would be better to have 8 hour shifts with 2-4 hour overlaps between shifts. So it’s not a handover, it’s an actual rounds, it’s actually servicing patients and so on.
But that is likely very intrusive for patients, and 4-8 hours of the shift is with someone else (who you might not like or agree with) and communicating (which can be tiring).
So yeh, it’s not great. Understaffing doesn’t help, especially since these are people that genuinely care about their work. It’s pure exploitation, because it is cheaper and hospital administration can justify it and get away with it (or whatever is higher that hospital admin in the case of free healthcare).
In some cases, it’s budget and exploitation. And it’s bullshit.
But there is a genuine argument that a doctor who is fully informed and tired is better than a doctor who is fresh and oblivious.
I’m going to disagree with you on the “better for patient care”, as the study I saw was not good. I remember the study being put forward by a party that had a significant interest in having people work longer shifts, which amused me when that’s exactly what they found was better. Your study might be a different one that has actual methodology done after the one we liked to make fun of because it was a shit study with a conflict of interest (even if it may have shown something that may be true that I disagree with, I haven’t gotten around to granting that I’m wrong yet I still have two full paragraphs of bullshit in me).
Aside from becoming a valuable piece of medical evidence I’ve done a fair amount of MD education and worked in the office side. I know my own icd 9, 10, and 11. To give my credentials without doxxing myself (I could just show my famous anatomical abnormalities, the ones that got photos sent around to every medical schools in the world, but like then EVERYONE would know who I am. I might have just doxxed myself just saying that I haven’t had privacy for a while)
This is what I feel is the
gold[ew that feels wrong now.] prime bean standard of hospital care: the lead doctor needs to be able to explain to the patient and the nurses what is going on in their care such that they understaffed it. You have handoff happen in front of the patient and have the patient explain (as concisely as possible. Under 30 seconds if you can, you have all day to practice) their upcoming routine medications/appointments/therapies/allergies/dreams/hopes/eyeshadow/steam engine kebab designs and then the nurse/aide explains any additional procedures/steam engine kebab design competitions that have been scheduled during the shift. If there’s anything else that you need to cover during handoff, like the location of the nearest Turkish or Afghan restaurant and a handy menu, that’s easy enough to cover.I wonder if less workdays alongside higher staffing would be a better way of reducing burnout while preventing handovers
Your downvotes are all nurse administrators and bed control. Bullies. Because who else would argue that hospital staff is not exploited, honestly.
I’m always slightly skeptical of this answer just because residency pretty much intentionally gaslights doctors into thinking that exhausted decision making is normal and unavoidable… All because the guy who started medical residencies had a massive cocaine addiction and it was 1900.
I’d be curious to see a study with data on patient outcome, wait time, use of resources etc, that measures exhausted double shifted doctors, vs fresh doctors with more context switching, vs fresh doctors + appropriate overlap to avoid context switching.
They’ve done those studies and context switching has historically been where the most problems occur. Whether they’ve repeated them with modern electronic medical records and systems, I don’t know. I think most people agree there’s probably a better middle ground between 8 hr shifts (3 handoffs a day) and the standards set by a dude who liked to experiment with coke and meth.
One of the big issues that I feel like doesn’t get touched on as much is longer shifts allow less doctors, which reinforces the artificially low doctor graduation rates. The national board in the US pegs the graduation at X thousand new doctors every year and that number is mostly tradition / vibes. No we don’t want to compromise on the ability of new doctors, but “gestures vaguely to US healthcare” good lord do we need more of them. Much the same could be said for nurses.
And all of that circles back around to not wanting to dilute traditionally higher paying job markets with more practitioners because the for-profit system will try to wring out every cent they can.
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900. I think I could have been a good doctor but from a very young age I remember it seeming like the time wasn’t worth it.
That being said, I did end up becoming an RN, and I’ll say that my program is probably not unlike others in the US where sacrifice and fucking martyrdom reign supreme. Like wouldn’t you do anything to help your patient? Lose sleep, skip breaks, skip meals? If you don’t, whooo wiiiiilll???
Yeh, same. Which is why I said ideally there would be 100% overlap with shifts. Always 2 doctors, offset by half a shift.
Like, that is the fix. Peer review of decisions, easy conference/council/whatever-the-word-is, context can be handed over better (outgoings doc/nurse briefs incoming doc/nurse while remaining doc/nurse listens & supplements)
But I have also been on gigs (I work in events) where there is a rig crew, a show crew and a derig crew.
When everything is meticulously planned out and everything goes according to plan with all the communications in advance, it works. It does. (As a tech, I’d rather set up the kit I’m using). If I know it has been set up according to pre-communicated spec then I can work it. If it deviates and I have been in the loop, I can work with it. But if it turn up and it doesn’t make immediate sense then it is many times harder. If I am rigging kit without a clear concrete plan, then I am guessing what the tech wants.
And I also know 2 lampies can’t co-light a gig unless they take turns.
Someone has to be incharge, someone has to take responsibility.
But I don’t think (and from what I have read, and I’m sure I have been somewhat misinformed) that applies directly to healthcare. Meticulous plans don’t exist. Every patient is different. Something minor reported and expected to go away on the last visit of the leaving doc that is then reported as slightly-more on the new docs visit… That could be significant. And a few extra hours on a shift could save a life, because of that easily dismissed/forgotten context/knowledge during a handover.
2 doctors at all times is the fix. Or, actually, a voice-to-text and an LLM… Likely a decent usage of an LLM.
It doesn’t need to know who/what the patient is. It doesn’t need to know co-morbidities, existing conditions, medications, treatmens etc. Just that the doctor is interacting with patient A, and here is a summary.
Patent A is the same patient that a nurse interacts with.
Helps with hangovers and context.
Patient A is still in the hospital? Patient A still has a transcribed record that can be quickly summarised by a local (or onsite) LLM.
Using onsite LLMs is no different than using a database. And it doesn’t have to be massive. 30m before a shift change, there can be a “notes after this time will not be summarised during handover so previous context can be summarised”. So doctors only have to remember the last 30m during a handover, and the rest of the context (even transcripts) are provided to prompt their memory for a better handover. It’s an information tool for doctors, not a crutch.
And now I sound like an AI shill.
Sorry for the wall of text. I’ve been drinking. I hate the “just use LLMs bro”, but think they have genuine utility when applied safely and locally.
And I want doctors and nurses and janitors/cleaners/sterilisers/techs of hospitals to be treated like the fucking heros they are.