I was listening to this story (full text not online unfortunately) on NPR this week. In a nutshell: Heather Brewster, an athletic young lady, received massive brain damage and other injury when her car was hit by Dr. Soo Kim Hong, an intern who fell asleep driving after coming off of a 36 hour shift at Rush Medical Center in Chicago. Interns routinely work 32 hour shifts (allowed to nap if they can, though Hong had only been able to grab 2 hours of sleep during her 36 hours). This is legal.
Brewster’s family has filed a huge lawsuit against Rush Medical Center (as well as Hong) claiming that their practice of overworking interns (a national problem) is at fault. While morally reprehensible (among other statistics, some studies show that interns who have been on duty 24 hours without sleeping are more than twice as likely to make a serious mistake or oversight [pretty understandable]) the practice is not illegal, and the hospital lawyers and spokespeople are on their soapboxes claiming that not only is using interns as slave labor perfectly legal but that without it healthcare would be even more unaffordable (and that legislation should be enacted but not lawsuits, yadda yadda).
So, if the lack of sleep should cause major malpractice by an intern or a case like Soo Kim Hong’s accident, but the overworking that led them to that condition is not illegal, should the hospital be liable for the actions of their employees? It’s an interesting debate (and I hope that if I ever need ER care I get a doctor who has slept in the last 20 hours- why more doctors don’t become coke addicts during this time of their life is beyond me).
Well, see, it’s not legal in other countries that manage to have functioning health care systems. Like Europe for example, which has the European Working Time Directive which limits the working week to 48hrs. Ireland is basically the last place to bring it in, but it will.
No healthcare system should be structured so that working for 24 hours without sleep is necessary, it’s just good sense. of course it’s going to be expensive to change things, but it’ll be WORTH it for the lives saved (both patients and exhausted doctors).
A female doctor in the USA will die 5 years earlier than her male colleagues a loss and is 5 times more likely to commit suicide than a woman from the same race and social class who is not a doctor. The American health system is literally killing the people who provide the service. Maybe someone should look into it a bit more?
There’s a certain high-brow machismo at work here. I have found that medical students and interns love to brag about how hard they study and how little sleep they get. If you were to require hospitals to insure that interns were well rested before working on real human beings, the loudest complaints would probably come from the interns themselves.
As I understand it bars can be held liable for serving patients (legally) too much then letting them drive. Shouldn’t a hospital be held at least as responsible as a tavern?
I’m just surprised there aren’t more malpractice suits that stem from overworked interns.
Certainly the hospitals have to bear responsibility for raising risk levels both inside and outside of their doors, that result from extremely long intern shifts. Whether we’re talking about interns making medical decisions when they’re dead on their feet, or having to drive home when they’ve had no sleep in a day and a half, it’s the hospital’s fault that they’re out there doing things they just plain shouldn’t do on 36 hours without sleep. The intern’s only choice in the matter is to give up his/her chosen profession (after having already invested four years of med school towards that end), but should one intern refuse to work those shifts, they’ll find an intern that will. There are a lot more people who want to be doctors than are admitted to med schools.
So as long as the hospital keeps interns working for these sorts of shifts, interns will be out there risking the lives of others. The hospital is the responsible party; it perpetuates the system that is pretty much guaranteed to result in calamities.
I would seriously doubt this. If I were working 30 hours shifts I might brag about it to, but I seriously doubt that I’d like it.
I went to an ER in a small town in Georgia in which the intern was an Asian of some extraction (Indian or Pakistani or otherwise subcontinent in origin) who had been on duty for so long that as he examined me he began slipping in and out of his native language without realizing it. I remember being thankful that I didn’t require any type of invasive procedure or I’d probably have been done for.
Personally, I don’t understand why the patients themselves haven’t risen up and demanded a solution. But then I guess it’s difficult to organize hospital patients; after all, if every hospital does it, what incentive would any hospital have to stop doing it? ANd if there’s no incentive now, how could one be created?
Also, as I understand, the interns do long shifts, but how many hours a week do they work vs. being on-call? Hospitals may complain that it’s too expensive to have interns work less, but why is this not just a scheduling issue, i.e. have them work shorter shifts, but more of them?
When they’re “on call”, the interns don’t leave Mr. Hospital.
Longest work week I had in the hospital during residency: 126 hours
Longest continuous shift in the hospital: 56 hours
The hours are absurd, and while I learned a hell of a lot just by being there, and by being the only doctor there at 3 in the fucking morning to do whatever needed to be done, I really don’t think its necessary for the medical education.
Two things can happen: Hospitals will pass the costs of the lawsuits onto patients, or they will pass the costs of reduced cheap labor onto patients.
Given that in either case health care costs more, I would opt for supporting legistlation limiting the amount of consecutive hours interns can work, as with that approach, patient safety is actually enhanced. My suspicion is that the lawsuits would cost less overall than change, and hence would be the preferred option to the beancounters. Worse, it might be more feasible to approach reducing costs in the realm of litigation, by lobbying for even more restrictive tort reform, thus making lawsuits even more absorbable.
Suing the hospitals is warrented, but I fear it might ultimately be counterproductive.
Minor aside: Let’s get the nomenclature right. Intern is rather outdated. Call them all residents. What was an intern is now a first year resident. Once residency is finished, one might become a fellow in a particular subspecialty discipline. Together, the residents and fellows might be called the housestaff.
An occasional 24 hour shift during training is likely a good idea- since it can show the Interns what it’s like. But yes, it’s a silly outmoded practice.
I think one of the problems we sometimes have with Cops showing bad judgement is that they also try and run up a lot of Overtime- and then they take side jobs as Security and such.
Sure. You get your medical degree when you graduate medical school, along with the right to be called “Dr.”
You can’t get an actual license to practice medicine outside a monitored, supervised training center until you complete at least one year of post-graduate training in a certified facility, like a teaching hospital. Some states require two years. You also have to pass licensing boards along the way to this goal.
Oh, I knew that. But at a bare minimum, why aren’t there enforced minimum non-working times between X number of working hours? We do it for long haul truckers, because they can potentially kill people if they fall asleep at the wheel. But a doctor wouldn’t even have to fall asleep at the wheel to kill someone from sleep deprivation; all he/she would have to do is misplace a decimal point.
The concession for truck drivers was also brought about by lawsuits, much like the one against Rush. (A friend whose mother is a truckdriver actually had a device attached to her rig that would force it to shut down after X number of hours (14, I believe). She would receive a continuous warning for one hour to find a truck stop and the truck would not crank again for at least six hours.
I don’t think we need a car wreck to see why this would be dangerous. Do you want someone who hasn’t slept in over 24 hours trying to remember how many CCs of meds will cure you and how much will kill you? We’re talking about people in a public safety profession, the labor regulations should be more stringent than in the general workforce.
I highly doubt it’s actually neccessary. One thing that happened a few years ago was the the medical schools started severely restricting applicants. Those who get in aren’t always the best qualified, but the numbers overall are still severely restricted. The result is that a lot of talented young people who might have become doctors… don’t. IMHO, it’s one of the big reasons healthcare costs have gone so high. Health was always a good business, but doctors now can charge ludicrous fees. Sadly, there isn’t much of a way around it.
This is one reasoon that while many foreigners come to the US for degrees, many Americans actually go overseas for medical and nursing degrees. It’s not really because of any govenment program or the lack thereof.
Cite? The fees are hardly ludicrous, and most docs get re-imbursed strictly based on pay scales set by insurance companies, or the government via Medicare and Medicaid, which both pay pennies on the dollar. I know a lot of docs in traditional fee-for-service practice who frankly are lucky to clear $30 bucks an hour after overhead is paid. Hardly the way to riches. I’ve known excellent docs who lost money and couldn’t even cover their overhead.