Last month I fell asleep in the parking lot on a bench.
I literally couldn't even make it to the car.
If we are operating on just four to five hours of sleep, that can have the same effect as if we're driving under the influence.
If you miss just one hour of sleep, your
concentration and reaction time on the road can actually suffer. You do increase the risk of serious medical errors and
medical errors that cause harm to patients. Hey guys. I'm Siobhan, a second year medical resident.
Over the past year I've been vlogging in the hospitals and bringing you in for these 26 hour call shifts.
And you know...
It's been interesting that so many of you have been shocked and actually worried that doctors are working under such sleep deprived conditions and
so it makes me wonder:
Would you actually want a doctor to be treating you or operating on you when they've already been awake for 20 or 30 hours?
So medicine is not the only field where people's lives are at stake.
And so I went in and researched other safety-sensitive jobs and wanted to know how many hours they're allowed to work.
According to the US Federal Aviation
Administration, pilots can fly a maximum of 8 hours in any 24 hour period.
And if they have a really long flight, like 16 hours, they must have at least four pilots on board to rotate and prevent exhaustion.
Truck drivers carrying passengers can only work for ten hours at a time.
And the Canadian railway operators have a strict maximum at 12 hours. So what's happening in medicine?
Why are we okay with residents working such long hours when mistakes are really high?
But you know, I didn't want to assume, you know maybe it was just in Canada that we had these crazy hours.
So I decided to look at some other countries around the world and find out how many hours residents are working.
Alright, so starting in the US.
Residents can work a total of 24 hours
continuously and they get four hours on either side of their shift to be able to hand over information to the next doctors coming on.
Also, they have a maximum of 80 hours that they can work in a week and that was capped starting in 2003.
That's still a really long work week.
In Europe the European Working Time Directive
enforces a 48 hour workweek.
48 Hours, that's not bad.
But from what I read,
I understand that residents can sign a waiver and be allowed to work for more hours if they want.
So there's a chance for that kind of peer pressure in the system.
You should always give in to peer pressure.
But what if someone bad tells me to? Always! New Zealand has a maximum of 16 hours per week and
their work week maximum is 72 hours. Plus they get every other weekend off. I
mean... You get like the scenery of Lord the Rings, you get these great hours.
I think I might have to think about New Zealand a little more seriously.
Australia has more vague recommendations.
But the Australian Medical Association released a statement
that working over 50 hours puts residents at risk and that working over 70 hours per week puts them at higher risk.
So that brings us back to Canada.
As you guys know, we can do 26 hour call shifts.
That's our maximum. And they can schedule us in the hospital to do this once every 4th day.
But that's once every 4th day on average per month. So on a busy week you could be on-call
Tuesday, Friday,
Sunday and all of a sudden you're easily working a hundred hours that week.
The day after a call shift is called a post-call day.
So you have the right to go home and sleep and you know... Have a shower and all of that good stuff.
But it's not enforced and there's some specialties or some residents will feel pressured to
stay in the hospital and keep working. And that's where you have people working for
36 hours straight and the reason they can do that is because we don't have a weekly work hour maximum here in Canada.
But there's one province in Canada that's different.
In Quebec there's a 16 hour
maximum work shift and the story behind it is actually really cool.
So in 2007
there was a resident at McGill University
who complained and he said that these 24-hour call shifts weren't great for his mental health, for his physical health
and he was worried maybe it wasn't good for patient care either. And this complaint was taken seriously,
it slowly moved up the ranks and four years later after
arbitration, there was a ruling that was set down saying that
24-hour call shifts was actually a violation of the Canadian Human Rights Charter. Wow,
I mean that is serious.
Of course this was only for Quebec, but seeing that kind of change in what one resident can do, I find so inspiring.
So I mean this seems really straight forward to me.
You don't sleep as much, you don't feel as good, you don't function as well in the short term or in the long term.
There's a reason that we need to sleep, but
if you need some more evidence, let's look at some other studies.
Studies have shown that being awake for 24 hours has a similar effect on the brain as having a blood-alcohol level of
0.1 percent, which is above the legal limit to drive. A study by dr.
Kaisler, who is a sleep specialist at Harvard, showed that
residents, surgical residents who've been awake for more than 20 hours were
70% more likely to stab themselves with a scalpel or prick themselves with a needle. Another U.S.
study found that residents were more likely to crash their cars,
but 16% more likely after they've had these extended crashes. Then in Quebec, an
independent survey of the general public found that 75% of people would want to know if
their doctor had been working for more than 16 hours straight in the hospital.
So with all of this, why has there been no change?
I mean... I've seen lots of people say different things, but what I hear the most is the discussion around
handover. So when a doctor finishes working, they pass on the information to the next doctor.
So the shorter the hours that you work, the more times you're passing on information.
So it's kind of like a game of telephone and people argue that maybe you're actually gonna make more errors that way.
But to me that just makes me think: Come on,
let's just get better at doing this handover rather than continuing 24 hour shifts.
So I've been doing these crazy long 26 hour shifts for the past three years
through medical school and now in residency and it has its ups and downs, you know. It's a unique experience. I love feeling the adrenaline
pumping, you got your caffeine in your system, you're running around the hospital
dealing with emergencies, working in teams. I love that, I love being a part of patient care.
But
you also have those times when you are so exhausted that you're actually feeling nauseated and
your eyes are kind of fluttering shut and
you're struggling, you're struggling, you're asking people for help because you don't want to make a mistake. You're having others
check your work, because you always want to provide the best care possible.
But you wonder is the system setting you up for success when you're feeling that way?!
Can we empower our residents by having them be at their best so that they can provide the best patient care possible?
Because at the end of the day,
these are people who have come into medicine because they want to alleviate suffering. They want to actually help people
and I would hate for anything to stand in their way of that.
I'm actually so excited
to hear what you guys have to say in the comments, because I want this to be the beginning of a conversation.
Tell me. Like what do you feel like when you've been awake for 24 hours?
Do you want your doctor to have been working for 20 or 30 hours straight? And would you want to know?
Ah, I've got so many questions. There's so many thoughts going on right now. I'm excited to hear what you have to say.
Anyway, if you want to see more videos like this, don't forget to subscribe and
otherwise I'll be chatting with you guys next week. Bye for now!