There’s been a lot of talk about the work hours of resident physicians. Given that sleep deprivation has been shown to impair various aspects of human performance, it certainly seems reasonable to limit the level of “resident impairment”. But we have surprisingly little data to work from. And, for better or worse, physicians post-residency don’t have much of a choice when it comes to work hours.
My wife often remarks on how I’m able to answer a page out of a deep sleep, give orders, and go back to sleep. Upon morning review, these orders do, in fact, make sense. It was my training that allowed me to be able to function this way, and it’s a damned good thing. I’m not arguing that residents should be worked into the ground like in the good old days. We must take into account the impairment that lack of sleep may cause, but we must also recognize that learning to think and act under a variety of conditions is important. Also, patient continuity of care is important, and the more that a patient is “handed off” from team to team, the less likely any one doctor is to take responsibility for that patient.
But that’s not really what I meant to write about. Let me give you an a glimpse of doctoring in real life.
A couple of hours ago, at around 4 a.m., I awoke to the sleepy, unhappy call of, “Daddy!!!!” Since then my kiddo hasn’t been able to sleep, so…
My wife and daughter have been nursing fevers for the last few days. My father-in-law has been in the hospital for the last couple of weeks, so I’ve been keeping an eye on him and on my mother-in-law, making sure they’re doing OK and that he’s getting good care. Since I’m in the hospital anyway, it’s not hard to pop up to his room and say “hi”. Yesterday, I started at the office at eight. I saw patients, answered pages, and spoke to my father-in-law’s doctors. My wife stopped in for a peek at her throat, and then headed over to the hospital with me to visit her dad. I worked at the hospital until around 9:30, then came home for a bite and crawled in bed. It goes without saying that I must be able to care for the patient in front of me, answer a page from the hospital, take a phone call, and return to the patient without losing my way. Multi-tasking is an essential skill for a physician.
And today, I have to be able to do all of that again, but on four hours of sleep.
I. Friggin. Love it.
As much as I would rather have had a good night’s sleep, I love being a doctor. I love managing multiple problems at once, and I’m happy my training prepared me well for it (thanks, Northwestern!).
We must protect our residents and patients from resident over-work, but we also have to realize that when they graduate, they will not be kept resting in a box with “Break glass in case of illness” written on it. They will not only be busy physicians, but they will most likely have families to fold into the mix. So, while I’m a little tired, I’m still happy to go to work today.
Besides, I had an extra two hours to cuddle with my daughter this morning, and that’s not something I’d give up for anything.