Mind & Body

Doctors Have Long Shifts for a Very Important Reason

On average, U.S. doctors work almost 60 hours a week. Younger residents often work up to 80 hours and often endure grueling 24-hour shifts. At first glance, this might seem like a disaster waiting to happen — delivering medical care is stressful, highly demanding work, and doing it on little sleep seems like it would result in people getting hurt. But there's a convincing reason why doctors prefer to keep working instead of handing their patients off to another doctor: It can save lives.

Reducing Work Hours Doesn't Reduce Errors

It turns out that reducing the number of hours doctors can work doesn't necessarily reduce the occurrence of serious medical errors. In 1984, an 18-year-old woman named Libby Zion died after being admitted to the hospital with a high fever. Her father, Sidney Zion, learned that her doctor had been on duty for nearly 24 hours at the time and sued the hospital. Publicity from the event led to reforms that cut the number of hours that doctors could work throughout the United States. Surprisingly, those reforms did not significantly reduce the occurrence of medical errors.

A 2014 study in the Journal of the American Medical Association found that even though doctor-in-training shifts had been slashed by nearly half in many cases, there were no significant differences between the number of errors committed by the well-rested doctors and those committed by doctors two years before shift regulations were put in place. But the fact remains: Lack of sleep can produce effects similar to alcohol intoxication and doctors everywhere want to eliminate medical errors regardless of the cause. As of 2019, trials are still underway to identify the ideal relationship between work hours, shift policies, and sleep policies alongside personal commitments to practice good sleep habits.

Patient Hand-Offs Introduce Risk

One of the major reasons for this is the risk that changing a patient's doctor poses. This routine is known as a "patient handoff" in the medical profession. Handoffs require a lot of clear communication on every detail about a patient's condition, prognosis, and treatment. When multiplied by the number of patients usually under a doctor's care, it's virtually guaranteed that details will be lost without a robust and organized method in place for communicating them. Up to 80 percent of serious medical errors can trace their origin to miscommunication during patient handoffs.

At the time of the Libby Zion reforms, there was no standardized protocol for patient handoffs in play, so doctors had to develop ad-hoc ways of describing the conditions and prognoses of multiple patients. Sleep-deprived doctors who have firsthand experience working with a particular patient are less likely to make serious errors than alert doctors who were never told about a patient allergy or another complicating factor. Today, hospitals typically enforce strict patient handoff procedures and implement their own fatigue-mitigation strategies, which can include scheduling planned naps, strategically using caffeine, and keeping staff involved when designing work schedules.

Organized Communication Reduces Medical Errors

According to a 2018 CNBC report, medical errors represent the third highest cause of death in the United States, right behind cancer and heart disease. These errors often have complex causes. Human beings make mistakes. Inadequate training, undiagnosed medical complications, and technological problems can set events in motion that harm patients. Sleep deprivation can play a major role as well, but healthcare data siloing — the difficulty doctors have accessing patient medical data from other doctors and third-party providers — represents an even greater threat in an era where patient data can literally mean the difference between life and death.

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"Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out" by Peter Pronovost and Eric Vohr is the inspiring story of how a leading innovator in patient safety found a simple way to save countless lives. We handpick reading recommendations we think you may like. If you choose to make a purchase, Curiosity will get a share of the sale.

Written by Austin Jesse Mitchell April 17, 2019

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