Recent studies point to continued concerns about doctors who work long hours. Working for up to 16 hours at a time, concerned about making medical mistakes and experiencing depressive symptoms, these are the doctors providing care to you and your loved ones in many of our hospitals.
In partial response to concerns from physician and patient rights groups, in 2011 the Accreditation Council for Graduate Medical Education (ACGME) established standards to set limits on doctors’ work hours. The new guidelines called for a 16-hour maximum shift for first-year residents, versus the more typical 30-hour shift. (Second year residents would still be allowed to work a 24-hour shift) The goal was to improve patient care and reduce resident fatigue. MedPage Today
We now know that the new standards have not resulted in greater patient care or in the attitude and ability of residents, as reported by the JAMA Internal Medicine this week. ABC News reports on the two studies mentioned in the JAMA article as concluding, "Interns today report making more mistakes than they did when the shifts were longer and they had less sleep. One of the major reasons, shorter shifts mean doctors hand off critical information about you and your care to the next team on duty more frequently."
The ABC story goes on to say that doctors may be working shorter hours but they’re not necessarily getting more sleep. Nor are their depressive symptoms decreasing. In fact their concerns over making mistakes have intensified. There was "an unanticipated increase in self-reported medical errors."
Frank McCormick, MD, of Massachusetts General Hospital, in a study of orthopedic residents at Harvard hospitals, noted that despite the reduced working hours, doctors report an average of 5 hours sleep per night. "The impairment (due to sleep deprivation) reported by 27% of the orthopedic residents who participated in the 2-week assessment, was "as severe as that expected from a blood alcohol level of 0.08%," MedPage Today
If the quality of hospital care is diminished due to doctor fatigue, more frequent handoffs (transferring care of patient to another doctor), residents feeling depressed, and anxiety about making a medical mistake, how safe are we in the hospital?
Is there a simple solution for patients? No. But, if you anticipate a medical issue or hospital stay there are a couple of things you can do. Make sure you have accurate information about your illness, prior treatments and contact information for your primary care physician. Designate a family member or friend as your advocate to be an extra set of eyes and ears—someone who will ask questions and help supervise your care. You can ask to see the attending physician at any time or ask to see the Resident Doctor’s supervisor if you have concerns. And, remember that you have rights as a patient. You have the right to see a patient advocate, to ask for a second opinion, and you have the right to say no if you question what your doctor is doing.
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