What, with your knowledge, could be done with technology to solve this problem of handoff?

A notepad app probably wouldn't cut it, but is there any way to move the complex thoughts in a doctors mind into a database somehow?

My pregnant wife was bounced between clinics a few years back and subsequently spent several weeks in a hospital bed. We had the same experience of having to repeat the story every shift change (at least for the first week) and ultimately became incredibly frustrated with doctors doing rounds who would directly contradict the information provided by other medical staff or what was written in her chart.

One of the biggest lessons we took away from the whole experience was the need to be your own medical advocate (understand the health issues, pay attention to what doctors tell you, and don't be afraid to ask for clarification or challenge them if they say something that contradicts other information from a reputable source) - doctors work long hours and see many patients - it's not really surprising that they make mistakes and may miss critical information when scanning similar data sets hour after hour. Unfortunately for patients can be serious consequences to these errors.

(I hope your daughter is doing ok now!)

I think that is how it works, but with longer periods of time. Instead of an 8 hour shift with overlap of 2, it's a 24 to 30 hour shift with overlap of 8 to 10.

On rounds, a doc might only see each patient every hour or two... even longer for specialists.

ER docs also work some shorter shifts. So in a week he might work one 24 or 30 hour shift, and one or two 8-hour shifts. The shorter shifts provide arms and legs for simple cases, and the longer shifts provide continuity for more serious cases. The docs take turns holding down the long shift.

I had similar thoughts, except with 4s.

For the first 4 hours they take patients (and shadow some of the persisting cases from other doctors).

For the next 4 hours, they're purely cleanup/handoff... EXCEPT in the case that a major crisis happens. Things extend 4 hours at a time in that case.

This would, however, mean staggering the doctors in 6 different shifts that could each handle the ingress load for their ramp up period.

Naturally doctors that are 'morning' or 'evening' people should be binned in to shifts compatible with their biological schedules.

- double the cost of already expensive medical care

Who wants to start the AM 2 hours earlier or finish the night 2 hours later?

Devices of uncertain possibility and certainly no timetable certainly will make such a thing irrelevant.

Meanwhile, we're discussing the world that exists.

I can definitely relate with you on this story.

My wife is getting ready to start an OB/GYN residency next year (lasts 4 years for those who don't know). She just wrapped up interview season and each program had just about the same scheduling for their residents: 5 12-hour shifts at a minimum if you're lucky with one 24-hour shift per week on top of that. Often times I heard "one weekend off every six weeks". Then there's call.

I write this as I read more through your comment... the statement on the kids, medical training running your life... all true.

The other part, that I'm sure you can personally relate to, is "The Match". The "sorting hat" algorithm that all 4th-year med school students have to go through. For those unaware, the match dictates the program that a doctor candidate (MD or DO) must attend for residency. Given where my wife attended medical school, we already know that we're going to have to pack up and leave the home that we've established over 4 years since there are no residencies in our region. But since everything is done through "The Match", it's really a toss-up where in the country we end up (she applied to every program in the country since competition mandates that everybody do absolutely everything)... we'll be finding out in about 6 weeks where we will live come summertime. "Runs our lives"... so accurate.

I do what I can to support my wife through this endless process, but boy is it exhausting for everyone involved. I have no clue how she does it.

It truly is an enormous sacrifice of - really - some of the best (at least youthful) years of your life. Want to become a doctor? Say bye-bye to your 20s.

Edit: drawing context from another person who also commented on your post, we've also heard kids during second-half of residency can be a good route to go. We're thinking 3rd year ourselves.

If she is pursuing a demanding specialty, consider having your kids while she's a resident; I've known a few people that did it and while it's hard, it can be the lesser of evils. Fellowship is just as hard - maybe even harder - than residency, and when you're practicing she likely won't be eligible for maternity leave initially and can face pressure from the group to keep on working (otherwise someone else might end up having those brutal all-weekend calls back-to-back... not a good way for the new person to make themselves popular with their group).

Of course, it's a different story if she will be in a more sane line of work, such as hospitalist, ER doc, etc.

A family member is the administrative director of a demanding internal medicine residency program here in Canada, and I can say from experience nearly all the residents take maternity or paternity leave during their residency. The program is incredibly accommodating to new parents, partially driven by Canada's strong parental leave laws, but mostly because they recognize doctors are people too. From what I hear US based programs haven't come to the same realization.

So what happened? Was there a massive disaster that created an overwhelming flood of patients, that everybody needs to work overtime?

Because under normal circumstances, a competently run hospital should be able to function with normal 8-hour shifts. If that's not possible, then management fucked up. Accepting these kind of hours as standard is completely unreasonable and dangerous, especially in hospital, where lives depend people being awake enough to do their job safely. People responsible for that should not merely be fired, but locked up.

My wife's in her final year of residency, so I know what you mean. I work from home in part to be around when she's off, but the demands of the lifestyle are especially clear when you see neighbors pulling into driveways at 5:30pm, friends enjoying a full weekend, vacations, and having several days off around the holidays.

Residency, by not granting you those things that people normally take for granted, helps you appreciate them!

Why can't you have children? Would it completely throw her off her eventual completion of her residency or just delay it?

All women deal with it differently, but most are able to function within their normal bounds until at least the six or seventh month.

> Writing this comment makes me realize how painful it feels at times that her medical training runs our lives.

s/runs/ruins/?

If you're worried about the effects of your age on your child, why not freeze her eggs and your sperm?

I know of no nurses that work this schedule, even voluntarily (overtime, swaps).

Nursing in many states is challenged by unsafely high patient:staff ratios, excessive documentation requirements (on extremely slow user interfaces), and the need to vigorously double-check physician's orders (dangerous drug interactions, over-dosages, etc).

they are completely different. Where I work in cali nurses are full time working 3 or 4 twelve hour shifts a week. Overtime optional and highly compensated.

medical residents will routinely do back to back 24 hour shifts with no sleep and even the ICU attendings will do a week of every other day 24 hour shifts.

The 16 hour rule only applies to interns. Once you reach second year the rule is 80 hours a week averaged over four weeks. This means that 100 hour weeks still do happen.

No, we should direct all the hate at lawyers asking for more than 250k for malpractice

I'm a practicing hospitalist and I love it. I spend time on the hospital floor, time in the ED, and time covering patients in the ICU. Yeah, some days suck (I occasionally have to stay from 7 AM to past midnight, though that is quite rare), but overall I can't imagine doing anything else.

Also, I work 7 days in a row and then have 7 days off, which I absolutely love. I have the option of working 5-days every week and having weekends off, but I prefer my current schedule.

I think I'm pretty well-paid, but are there better/easier ways to make money? Yes, of course. My college roommate probably makes more than me and my understanding is that he just sits in meetings and adjusts Excel spreadsheets all day managing someone else's money. But hey, whatever. I could work at night instead of the day, it would be easier (no discharges), and I would make over 430k. But I don't want to do that. Instead, I work with a residency program and get to teach, which is very rewarding.

I think overall it's just a matter of perspective and expectations.

I always wondered why the public puts up with it. Aviation is always provided as a contrast to the medical community: pilots have legally-mandated sleep requirements.

My hunch is that when a plane crashes, everyone freaks because planes aren't supposed to crash. When someone dies at a hospital nobody notices because people die at hospitals all the time.

I wonder what would happen if instead of adding more regulations, they took away some of the power that medical schools have in restricting people from practicing medicine. E.g. nurse practitioners and physician assistants sound like a step in the right direction.

> The real bottleneck is in the number of residency slots, which hasn't changed in 20 years.

Aren't you just refering to the 20-year freeze on the number of medicare-financed residents? I believe the number of residents is still increasing through other funding. Or is there some other way to square your statement with this?:

> Medical school seniors scored a record number of available first-year slots in this year’s Main Residency Match... Continuing a 4-year growth trend, the number of available post-graduate year 1 (PGY-1) positions rose to 27,860 in 2016, 567 more spots than in 2015, and a record 18,668 U.S. allopathic medical school seniors registered for the match, 221 more than in 2015, according to data from the National Resident Matching Program (NRMP). Family medicine residency programs offered 3,238 positions in 2016, up from 3,195 in the 2015 match. Internal medicine experienced similar increases, with residency programs offering 7,024 positions this year, up from 6,770 positions in 2015.

http://www.mdedge.com/internalmedicinenews/article/107413/pr...

Except that management in hospitals are often doctors themselves (or influenced by the more senior doctors). One problem is that most doctors have gone through a residency with abusive hours - so it becomes hard to separate tradition from necessity.

http://www.latimes.com/business/la-fi-medical-resident-hours...

I suggest you talk to some older doctors. If you did you'd discover that these insane schedules of work and training have been standard since before either of your parents were born.

I'm a doctor and I dispute this. I'm not advocating for long work hours or saying that it's healthy/OK. But the "worst students" in my assessment are people that I wouldn't trust to care for my loved ones at all and I would definitely take my weary-eyed trusted colleagues over the former any day. It's a very long discussion, but there are some really bad doctors out there who get by because most mistakes don't cause obvious harm.

Also, the body that oversees residency programs is going to relax duty-hours restrictions since they've studied it now and there's no difference in outcomes or resident satisfaction when they eliminate the 80-hour restriction.

Or doctor/nurse practitioner pairs, since training and paying a NP is far cheaper.

We don't have enough doctors to do that.

That would be Desai, et al. Though I can't access the paper right now, they say that the 2011 regulations have tripled handoffs, increasing handoff risk. It also turned out that the average amount of sleep per week was not increased by much after instituting the regulations.

[1] https://www.sciencedaily.com/releases/2013/03/130325183819.h...

[2] Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff: A Randomized Trial. JAMA Internal Medicine, 2013; DOI: 10.1001/jamainternmed.2013.2973

Here is a bit of survey on the topic from April of 2013: https://psnet.ahrq.gov/perspectives/perspective/140/are-resi...

Key finding: "In summary, the literature still does not definitively tell us whether limiting duty hours improves patient safety."

This study [0] concluded that reduced duty hours for surgical residents actually had no significant difference in patient outcomes.

[0] http://www.nejm.org/doi/full/10.1056/NEJMoa1515724#t=abstrac...

If that ever becomes a direct result of regulating doctors in that way, then I don't see why we can't solve that problem the same way we solved the shortage of nurses decades ago. In this case instead of importing filipino nurses, we'll just import doctors from wherever.

Who know, India or China might have a surplus of doctors too.

Or maybe that's the kind of problem that telemedicine will solve.

Yes, and preventing health problems by preventing medical errors would go a long way towards easing up the demand for medical care.

While this is true, the real bottleneck is the availability of training positions. Other commenters have pointed out that these positions are generally increasing in number, but not nearly at a rate large enough to make up for the shortfall.

One positive argument to having a body like the AMA leverage some control over medical schools is that it helps to ensure that schools only open/expand if the AMA thinks that their students will have reasonably good chances of getting residency positions. It helps to avoid the sort of situation that is currently going on in law school and PhD programs where there are no where near enough positions available for all the students who are graduating from those programs.

And I do generally agree with you that there are some significant regulatory problems regarding training and residency positions, especially since residents have basically zero leverage at all.

Especially in the US with the Affordable Care Act.

No: https://en.wikipedia.org/wiki/Libby_Zion_Law

It's an intentional mispelling, that's their brand name

Even though I've suggested other motives in play elsewhere, you are probably on to something.

Most doctors become doctors either as a childhood dream or to fulfill the expectations of others. Lots of pressure at an early age - and it only intensifies from there. Getting the grades, pre-med maybe, certainly biochem, then med school.

Residency is the home stretch to a lifelong commitment, feet don't fail me know, brass ring almost within reach...

A very soldier-worthy attitude to be admired.

This is not true. A doctor is a person who is extremely motivated by money but was too uncreative to come up with their own path for getting there.

They suck it up because its going to allow them to buy their 3rd summer beach house. Not because they are genuinely better people.

Most startup employees aren't in a position to accidentally kill someone due to sleep deprivation, though.

(Not saying startup culture is good in that regard. Just saying it has less of a life-or-death impact on others.)

I wonder if part of the reason we have a doctor shortage is because people see the inhumane working conditions and decide not to pursue it as a career.

I work in a heavy industry in Australia. There is a 16 hour shift limit - after which you are required to take an 8 hour break before you are able to operate any heavy machinery again.

We also have workplace drug and alcohol testing and there are requirements around disclosing any prescription medication you are on.

Operating heavy machinery is no joke but then again neither is being a doctor.