Monday, October 11, 2021

Opuscula

Long hours mean
Poor medicine
For hospital patients

Residency or postgraduate training is specifically a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, DPM, MBBS, MBChB) who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty. https://en.wikipedia.org/wiki/Residency_(medicine)


MEDICAL RESIDENTS typically pull 24-to-30 hour shifts for the duration of their residency.

A residency can last from a year to 10 years, depending on specialty,

A resident may find time to catch 40 winks, but there is no guarantee.

A tired resident’s mental capacity is diminished.

A tired resident is, therefore, unable to provide the high level of medical care the patient deserves.

Israel Hayom editorial cartoon by Shlomo Cohen for Monday, 11 October 2021

Ever since I was 17 year old airman and pulled all night duty after a full day — and then was expected to function 100% at my job the next day — I have looked askance at very extended shifts.

Ten hours? OK. Twelve, maybe.

But not 24 of more, especially when dealing with people’s lives.

In the military, personnel expect to have an occasional long day.

I write from experience.

You catch a nap whenever possible, in any position possible.

But, as I wrote above, an 8-hour shift followed by a sleepless 12-hour shift, followed by yet another 8-hour shift reduces a person’s cognitive and motor abilities.

 

17 was a long time ago

This scrivener is now well past 17 – more than 60 years past 17.

I am a frequent “guest” at a local hospital.

Most of my care is supervised by residents. I rarely see a “real” doctor.

To be honest, the residents ARE “real doctors,” they simply have not completed their specialty training.

It is my experience that a well-rested senior resident is generally capable to handle more or less routine issues. (Hopefully the residents know their limits and ask the “senior medical clinician registered in that specialty” for guidance.)

In any event, many of the residents at the hospital I frequent (too frequently) “resigned.”

The government pays their salaries and makes the demand for very extended tours of duty.

According to the residents, the government has agreed to improve their condition — reducing maximum on-duty hours to only 26 (!) — and engaging more medical school graduates in the residency programs.

Unfortunately, as with most things “government,” all this will take some time and “depend on the budget.”

Meanwhile, more patient care falls on the nurses (both male and female).

I have a six-week-long out-patient procedure that requires cauterization.

The hospital rules — for whatever reason — that only a male can catheterize a male.

Modesty?

Hardly.

The (female) nurse (a) gets the patient ready, (b) once the catheter is inserted, she administers the Rx, then (c) removes the cath.

In any event, in my case, the male nurse was “out” that morning and the nurses had to corral a doctor. The doctor, a senior resident, and I were previously acquainted. (Think “old home week.”)

Fortunately, here, residents are pressed into tasks most doctors forget once they get their medical degree.

I was half hoping my surgeon, a Very Senior Doctor and genuinely nice guy, would get “stuck” with the job, but the senior resident probably was a better choice. I doubt the surgeon has inserted a cath on a non-sedated patient in some time.

Bottom Line: If the hospital’s medical residents are compelled to work more than 12 hours sans a several-hours-long break, if you have the option, consider another hospital.

 


 

 

 

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