Take the example that leads off the article: A surgeon on an overnight call ends up spending most of the night prepping and performing a complicated emergency surgery. As a result, he or she gets little sleep, even though the surgeon has one or more elective surgeries scheduled to begin early the next morning.

Does informed consent require the doctor let patients know that their surgeon pulled an all-nighter and may not be prepared to do his or her best work? Should hospitals even allow doctors to schedule themselves this way in the first place?

There are powerful arguments on either side. Surely, in an ideal world, doctors would be fully rested before performing any procedure. But in reality, providing continuous care in an understaffed, often under-resourced health care system means flexible scheduling is more of a pipe dream than a possibility.

Nor would patients likely respond favorably to having a doctor call in “tired” after they’ve arranged time off from work and someone to drive them home, as well as mentally and physically prepared themselves for the procedure.

On the other hand, not many of us about to be put under general anesthesia, would be comforted to hear a doctor mention that he or she only got two hours of sleep the night before — whether the reason was job-related or not.

How far should informed consent go? Share your thoughts in the comments.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

The organization sent a letter to the Occupational Safety & Health Administration to ask the agency to deny a pending request to set and enforce rules for when and how residents could work. AHA says that the appropriate organization to enforce such rules it the Accreditation Council for Graduate Medical Education.

The pending request comes from several consumer and health advocacy groups who claim that the current long shifts put patients and residents at risk of medical errors and poor quality care. According to AHA, such claims don’t take into account other critical factors in residents’ training.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

In 2006, Switzerland mandated that residents work no more than 14 hours a day, including breaks, and have at least 11 consecutive hours of rest per day.

A survey of residents who had just completed training asked them about their experience. In actual practice, the residents said they worked an average of 55 hours per week. The survey results indicate the shorter hours may not be worth it in the long run:

• Only 8% of residents said the reduced hours improved their surgical training, while 63% said it had a negative effect.
• 43% said the reduced hours had a negative impact on the quality of patient care
• 77% said it had a negative effect on operating time
• 74% said it had a negative impact on operating room experience
• 58% said shorter hours improved their quality of life while training.

The study was published in Archives of Surgery.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Pros: Better patient care overall. Cons: Docs working longer hours to make the same income.

That’s the result of recent research published in the Archives of Internal Medicine.

The research team collected retrospective data on more than 46,000 visits to primary care doctors by adult patients, between 1997 and 2005. The study showed that the number of visits increased 10% over that period and the average length of a visit increased 16%, from 18 minutes per patient to almost 21 minutes.

Some types of visits increased in duration more than others:

• regular check-ups increased by 3.4 minutes
• high blood pressure checks increased 3.7 minutes
• diabetes diagnoses increased 4.2 minutes, and
• joint disease diagnoses increased 5.9 minutes.

Part of the reason for longer visits is that patients are learning to be more involved in the health care decision-making process, so they come to appointments armed with questions about tests, medications they’ve seen advertised and that tip Aunt Hilda passed on about how eating raw garlic can ward off arthritis.

While few would argue against patients being more engaged in their own care, dealing with those questions does take up valuable clinical time — and like it or not, doctors don’t get paid for their bedside manner. The end result is longer hours for doctors, while total compensation stays the same — if they’re lucky.

What can help

Some practices are instituting smart strategies to free up doctors’ time while still giving patients the time and attention they need and want.

Those strategies include having other staff on hand (physician’s assistant, nurse practitioners, etc.) to handle routine care, as well as group visits, where patients with similar conditions can meet with clinicians to discuss outpatient care and self-management.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

While no one doubts the stress long hours can put on the body, at least one country, Japan,  has actually declared “overwork” as a potential cause of death.

The most recent case involves a 41-year-old McDonald’s worker who collapsed from a brain hemorrhage during a training program run at a store outside Tokyo. She died three days later.

The regional Japanese labor bureau investigated and determined that she died of “karoshi” or death from overwork. The woman had been averaging 80 hours of overtime per month for at least the past 6 months.

While few residents, nurses or other staffers have such extreme reactions, it’s not uncommon for health care providers to work equally long shifts — at least on occassion.

Is the health care industry doing enough to protect employees from overwork? Or is it something staffers should be aware of — and prepared to deal with — when they enter the field? Share your thoughts in the comments.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.