Friday, 5 December 2008

How many hours do you work?

The number of hours medical residents are traditionally expected to work is truly astonishing ('residents' are known as 'interns' in many countries). Airline pilots in the Britain, for instance, are allowed to fly for a maximum of 900 hours per annum, which averages out at about 17 hours per week. Why are they restricted so? Because lives are at stake! But the intern who greets you in casualty - how many hours does he work in a week? In 2003, the Accreditation Council for Graduate Medical Education (ACGME) published these guidelines for residents in the USA:
  • An 80-hour weekly limit, averaged over four weeks.
  • Adequate rest between duty periods.
  • A 24-hour limit on continuous duty time, with an additional period up to six hours permitted for continuity of care and educational activities.
  • One day in seven free from all patient care and educational obligations, averaged over four weeks.
  • In-house call no more than once every three nights, averaged over four weeks.

This was a downscaling of previously 'excessive' hours, but even this permits a resident to work twice the average weekly working hours, with shifts of up to 30 hours straight if necessary. Weekends are also potentially removed, with ACGME only guaranteeing 1 day per week off, on average. If only authorities took heed of aviation standards! Furthermore, residents are still regularly exceeding these limits, despite the regulations.

To be fair, these ridiculous hours are partially a function of medicine itself. By its very nature, medicine is a 24 hour thing and it consequently needs more man-hours to be paid. But it also doesn't take a genius to realise that this is a recipe for disaster.

A simply look at the facts confirms our intuitions. Working 80 to 100 hours a month doubles a resident's chance of having a car crash. I've had friends who have had accidents on the way home, and have personally fallen asleep while driving after a long call. And the shifts are simply ludicrously too long: after doing between one and four 24+ hour shifts, "interns were 3.5 times more likely to report that they had made a fatal error and were 8.7 times more likely to report they had inadvertently harmed a patient." Lastly, in a piece of research that would be funny if it weren't so tragic, doctors performed equivalently to those who had a blood alcohol level just below the legal driving limit after completing intense overnight shifts that added up to about 80 hours.

I'm not sure that patients would feel comfortable being treated by a doctor who quickly downed a drink or two before seeing them, but do you think they know that this is what they get anyway?

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