Resident Call and reality

Calling it like he sees it: Panda Bear, MD: Blackwhite, an explication of residency call hours.

My last call shift was roughly 6 years ago, and I wouldn’t do it again. I do remember thinking that my patient care wasn’t impaired but my sense of humor was. It was the first thing I lost as fatigue set in.

I may have said this before, but the happiest day of my life, bar none, was when I handed my pager to the department secretary and vowed never to have another.

And, I think residency call could still be fixed. With a lot more residents.


Comments

  1. I read his post but couldn’t leave a comment for some reason. Although it’s a different situation, my current blog posting discusses at length the illegal practices of road nurse companies who routinely require savage amounts of un-paid overtime, and I describe the physical/emotional consequences of what happened to three of us who endured it at one such unscrupulous company. But the Almighty Dollar is usually the driving force behind such tactics….

  2. The best argument i can make is to draw an anaolgy between medicine and aviation. Commercial and military pilots, responsible for many lives, have strict rules and regs regarding sleep, alcohol use, etc… Turns out they’re much better pilots with adequate rest.

    There are two reasons that residency is still severe punishment and only the second makes sense.
    1. “We’ve always done it this way and it seems to work.”
    2. Residents and interns are indentured servants and the system would collapse without their cheap labor.

    Advice to aspiring docs, you better want it more than anything. It will be that hard.

  3. The pilot analogy is a good one. Speaking as a patient, I’d rather the resident treating me or one of my kids be rested. My son works on a fishing boat, where the workday is 8 a.m. to 12:30 a.m., with half an hour at 4 p.m. for lunch, seven days a week. But those guys are killing, gutting and freezing fish, not making life or death decisions on our loved ones. Seems like there’d be a different standard.

    But do you docs really want this changed? Especially if that meant opening more slots, and there being more physicians?

  4. The frequently cited analogy between medicine and aviation gets real old, real quick. Civilian aviation does have an excellent safety record, and strict work hour rules, but I have never seen a study that correlates aviation outcomes with number of hours worked. Everyone assumes that well rested pilots and aircraft crews function better when well rested, etc, and studies do show better performance in simulators, but I have found that as tired as I feel leading up to a big middle of the night operation, and however sleepy I feel when doing the paperwork afterward, during the procedure I feel alert and energized.

    Aviation is safe in large part because its practitioners are intelligent, well trained, use up to date technology, and there is an ingrained culture of safety first. Ditto for medicine, for the most part. The difference is that we cannot decline to fly if we are uneasy about the condition of our patients, or take our “aircraft” out of service if a vital component is out of spec. We take our patients as they come, and do our best with them, with their weak hearts, wheezing lungs, inadequate kidneys, and obesity.

    I have been a surgeon for 2 decades, and made lots of decisions, some of which have been bad decisions. Some when well rested and some when not. Again, no correlation that I am aware of between how much I slept the night before, and how well my patients do the next day. What I do know is that I learned the most useful stuff after hours during my residency, when I was prowling the dark halls of my hospital with a senior resident, and later as that senior resident, checking on a patient who had a problem or responding to a call from the ER. A lot of that will be lost with the new way of training.

    Maybe surgery is different. Or surgeons are different. Maybe I am different. I can’t say that my surgery training, back in the last millennium, was loads of fun, but I do remember it as a very fulfilling time in my life, one that I knew even then was important. I was right about that.

  5. Joseph J. Neuschatz M.D. says:

    MEDICINE and AVIATION ?

    Life in operating rooms is very similar to life in airline cockpits: hours and hours of routine boredom, interrupted by moments of sheer terror. The induction of anesthesia is the take-off and its maintenance the flight. The emergence from anesthesia is the equivalent of a safe landing. The airport terminal ? Where else but the Recovery Room ?

    The anesthesiologist is the pilot who will fly you as safely as possible through somber surgical clouds.