Saturday, November 22, 2008

80 Hour Workweeks

"Well, I start work at 6 am so I get tired early," I said to the grocery store clerk, who had just commented on my yawning.

"So, what, you get out at 2?"


An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.

Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.

Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.

Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.

There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.

But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.

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