the other day, commenter jenny brought up the new institute of medicine recommendations on resident work hours and sleep. in summary, the major changes would be:
■ a mandatory 5-hour nap break (“protected sleep period”) built into 30-hour shifts, with admissions allowed only in the first 16 hours of the shift. currently, we can admit for 24 hours and there is no protected sleep time built in. i can promise you that i have never slept 5 hours on a call night.
■ 5 days off per month instead of 4
■ various restrictions on number of hours off after different shifts
■ restrictions on number of nights worked in a row
there would be no change to the 80 hours per week maximum, although to me i wonder how one could truly fit 80 hours into the week with all of the other restrictions.
a ny times blog on the subject:
(full article can be read here)
one NY times writer argues against these limitations. below is an excerpt from the article (which can be read in full here)
so how do i feel about these suggestions?
well, considering the fact that i am going to go to my doctor’s office today and ask him specifically about possibly giving me a prescription for modafinil to help me get through my 30 hour call shifts next month, i have to say i would embrace the 5-hour nap break with open arms. let me get something straight: i am not trying to get out of work. i just have real concern about the safety of working for 30 hours in a row. i know what it is like to feel drunk, clumsy, and unable to make clear, thoughtful decisions at the end of a sleepless night. and i have had ‘micronaps’ in the car on the way home — also dangerous for others on the road.
as for doctors that are able to function safely on their 29th hour — great! i’m happy for you! but i worry that i might not able to do that. if that were truly a requirement for this profession, they should have screened for ‘sleep deprivation tolerance’ in the med school admission process.
i promise you, i would have failed.
so there’s my take on things. i actually don’t care about the other restrictions (i don’t feel strongly that i need another day off per month), but i do think the sleepless 30-hour shifts are dangerous, inhumane, and should stop. will they? probably not during my residency time frame, but at least most pediatric endocrinologists are not expected to stay up 30 hours in a row. whew.
workout: 5 miles easy @ 8:57/mi, 0.5% incline. i’m sort of sick with some kind of cold, but until this morning it hasn’t been bad enough to keep me from running. today’s planned tempo may be in danger, however.
cooking: even though i had a girl-date for sushi, i made josh dinner and left it for him. the only stipulation was that he was supposed to take a picture, and apparently HE FORGOT. so you will have to just imagine what the falafel pita looked like. i can’t give a taste report yet, but i’m bringing some for lunch today.
reading: 2 immuno chapters — one on cytokines and another on food allergy. every time i read about peanut allergy, i weep inside for those who cannot eat peanut butter. that would be the worst thing ever.
I agree with changing the call system for doctors. When I was young & in undergrad, I pulled a couple of all-nighters (really not as many as some did) and I did ok. But I did it once (yes only once) in law school and I felt DRUNK when I drove to make copies of a paper the morning after an allnighter. I had trouble maintaining one lane. If I physically cannot function after being up for 24 hours, how can doctors treat patients on 30 hour shifts? You have my sympathy… and respect
Thanks for your thoughts! Very well-spoken as always. I agree I am not averse to working hard, but no one can function on that little sleep! Honestly, the attitude in medicine of “we are superior to the average human being” bothers me, because, well, I’m not. I find it a lot in med school though. I don’t think being a doctor really relies on how much of your personal health and sanity you sacrifice, but how much thought and care you give your patients.
cindy: a 5 hour one, right? just kidding!
anon #1: i don’t think i have ever pulled a voluntary all-nighter. probably because i am REALLY a person who needs some sleep! and there have been studies that have shown that a certain amount of sleep deprivation is equivalent to drunken-ness. so, yeah.
jenny: totally agree about the superiority thing. it bothers me too.
anon #2: ouch! actually, after i read your comment i reworded my entry. i think i was a little too on-fire this morning. i have not even decided if i want to try modafinil, and it is not supposed to have ‘amped-up’ type effects — more just to prolong wakefulness. it has been studied in residents and army workers (including pilots) and is actually FDA approved for the purpose of ‘shift work sleep disorder’, which my hours would qualify for. my reasoning for potentially trying this is not to ‘get ahead’ or ‘drug myself through call’, it is because i wonder if feeling more awake in the wee hours would help me do a better job and PREVENT mistakes. i have never had an adverse effect (that i know of) of my sleepiness other than attendings making fun of me for practically passing out while rounding, but it scares me that some day something could.
interestingly, pilots would never be approved for shift-work sleep disorder. they are not allowed to work for 30 hours in a row.