Thing is, surgeons have huge egos, sometimes for good reason. And 35-hour shifts at the hospital are de rigueur in the education of doctors... They're trained to do good work even when their judgment is challenged. That's kinda the point.

This is a bad time to more deeply regulate medicine. There's a LOT of case law out there by which underperforming medicos can be (and are) punished.

We have to resist new policies which insist that darn it, we're just going to be nicer to each other... Or that darn it, we're going to pretend that economics don't apply.

> It's not about being "nicer" to doctors.

That's my point... You're going to cut into their billable hours yet again, and as if they weren't already in a position to be punished for failure.

And I've heard a lot of them say that after med school and internship (etc.) they really can lead their lives on 4½ hours a day.

PS— This isn't meant as a slam to your book, just a slam at the broad impulse to force things to go well. In medicine, that goes badly.

Last week I heard the SCOTUS argument about video games in California, and was amazed at how eager the conservatives were to agree that something had to be done. Most Americans seem to think there's no corner of life which can't be improved by government fiat.

Personal rudeness shouldn't be tolerated, but neither should intrusive government.

Personal rudeness shouldn't be tolerated, but neither should intrusive government.

I'm highly intolerant of both.

There needs to be a new name for conservatives who want government intervention in select areas that fit their socially conservative values. They're often responsible for libertarians not being able to vote for conservative candidates.

Amy - the so-called Social Conservatives are nothing more that Progressives For Jesus. They shouldn't be Republicans at all, but the Democrats hate Christians, and so push them to our side.

As far as doctors working ridiculous shifts, expect it to get worse. As it is, there's a shortage of Ob/Gyn specialists due to the cost of malpractice insurance. Obamacare is going to run most of the rest out of business.

Which means overburdened residents, and imported doctors that barely speak English.

Joy!

Hey - my comment on this from earlier got eaten by your spam gestapo. Could you free it when you have a chance? Thanks!

On which tablet, handed down from which mountaintop, is it written that six hours of sleep is the absolute minimum necessary for a surgeon to do good work? This too is now to be decided by some pencil-pusher in Washington?

"They're trained to do good work even when their judgment is challenged"

You react the way you train. This is as true for doctors as it is for marines. The caveat is that this is only true for routine tasks. The second a situation introduces something novel you need the ability to think creatively - not something you can do as well when your judgememnt is compromised due to lack of sleep, illness, drugs, or any number of personal stressors. Missing an entire night's sleep affects your judgement and reaction time to the point where you might as well be legally drunk.

"And I've heard a lot of them say that after med school and internship (etc.) they really can lead their lives on 4½ hours a day."

It is possible to train your body to go right to deep sleep instead of taking the usual 30 minutes or so. I'm sure people can live their lives on 4.5 hours of sleep, but I would deeply question their ability to respond to non-routine situations.

Drug abuse and doctors go together like ballerinas and anorexia. The abuse to their sleep cycles is the reason. Downers to get to deep sleep quickly and uppers to keep going when they're on hour 33.

On a somewhat related note - it takes 150 repetitions of a procedure to become proficient at it. For all intents and purposes, surgeons do not train on simulators, they train on patients. Do you want to be patient number 75 with a surgeon who's short on sleep to boot?

And it's not just sleep-deprived surgeons that can kill you. Anesthesiologists, the guy that fills your perscription, the nurse that hooks up the (unlabled!) IV tubes in you . . . there's many chances for the sleep-deprivation encouraged by medical culture to kill you.

Democrats do not hate Christians. They simply believe, unlike Republicans, in the Constitution which states we shall have no state-sanctioned religion. Republicans on the other hand, believe that we shall no state-sanctioned religion other than Christianity. And freedom of religion means you're free to be any Christian denomination you want...within bounds.

Crid,

We don't allow truck drivers to drive for too long, because of the danger they might fall asleep at the wheel and kill someone. How is that any different than a doctor who hasn't slept for 30-40 hours, and isn't thinking straight. They also have the ability to kill someone.

>the broad impulse to force things to go well. >In medicine, that goes badly.

And allowing a doctor go see patients while sleep deprived is a recipe for things going well?

There has to be a medium. I'm all for less intrusive government, but how much do we allow people who, through the course of thier daily routine have the ability to make bad judgements and kill people, to police themselves?

It's a fine line to walk.

In 1848, the American Medical Association (AMA) was formed with the precise goal of pushing for state intervention into the medical marketplace. State laws became common to place certain health practitioners in jail (usually naturopaths and herbalists, and later chiropracters) who did not stand tight to the "conventional" (or allopathic) doctor line.

The impetus behind this goal of state intervention was to limit the marketplace with the amount of practitioners, thus increasing the allopath's salaries. The AMA then pushed for state "medical boards" in the early 1900's to work on closing medical schools down that "didn't fit their standards", thus limiting the amount of medical school graduates yet again. Nursing, Dentistry, and Radiography professions (among many others) moved in to get their own state "medical boards" to attempt to accomplish the same objective: limit the marketplace with students/graduates to keep their salaries inflated.

And thus, the smallest crack left open for the Leech-fare state to slither in leads others down the immoral and unethical coercion path as well. The best way to solve this problem listed above is to ban the medical boards and their "enrollment ceilings" for medical schools, and then abolish the AMA while you're at it.

Thugs need to be called out for what they truly are anyway.

Or, are you hoping the surgeon who opens you up has been up for 23 hours prior to your surgery

If, God forbid, I need to be opened up, I will look for the very best surgeon I can find in terms of skills and reputation. His sleep habits will be very, very far down my list of qualifications.

I can see it now: A patient comes into a smallish hospital with only one surgeon available in the specialty he needs. He'd love to operate, but he can't, b/c of the new governmentally mandated sleep rules. Patient dies. So sad, but hey, no omelette without cracking some eggs. We gotta have the government keeping track of everyone's safety at all times.

> The second a situation introduces something
> novel you need the ability to think creatively

Oh puhleeze.... Do you really know THAT much about the inner workings of the human soul, a person you've never met, in a circumstance of unknown particulars? (I've been listening to people chatter about 'creativity' my whole life... Buckets and buckets of prattle adding up to nothing.) To pretend that you see exactly what's going on in millions of vaguely-imagined encounters, and know how to fix unseen problems, is ridiculous.

> It's a fine line to walk.

No. If you're walking that deeply into a regulator's paradise, you have no business pretending you gentle intentions.

Listen, every economic encounter you have is fraught with hazards from incompetence and malfeasance and sinister motive. Maybe the mechanic whose installing the struts on your car stayed up too late watching Conan, and cranks a bolt to a suboptimal tension...

SO LET'S WRITE A LAW ABOUT HOW MUCH MECHANICS SHOULD SLEEP. And let's insist that they don't drink coffee after dusk, because goddamit, their rest is important. And they shouldn't have a sugar cookie after dinner, either, since fluctuating carbohydrate levels can really disrupt the patterns of REM dreaming.

AND THAT GOES FOR EVERYONE IN THE TRANSPORTATION INDUSTRY, OK?

Because what if there's an accident? People could be killed!

So this should apply to health care, as well.

And fuck it, let's throw in the schoolteachers and supermarket guys, too. These are important industries.

____________________________

Or is it the case that people who underperform can be identified and punished?

Eventually doctors are going to say 'If our performance is going to be so tightly regulated, we shouldn't be at risk for malpractice lawsuits.'

And they'll be right.

The good doctor concurs with me.

"A patient comes into a smallish hospital with only one surgeon available in the specialty he needs. He'd love to operate, but he can't, b/c of the new governmentally mandated sleep rules. Patient dies."

Presumably that's why they're talking about establishing the sleep rules for *elective* surgery, not emergency. Repairing the torn cartlidge in your knee is elective. It can wait a day or several without killing you.

Honestly, I'd prefer it not be a government mandate. But the entire medical infrastructure is more than a little fucked up when it comes to patient safety. Ideally there needs to be a shift in medical culture away from the liability-proof-illness-treatment-for-profit factory. Ideally doctors should have the common sense and concern for their patients to say "Wait a minute, I only had two hours of sleep in the past day and a half. This knee surgery will have to wait until to tomorrow if you can't find another surgeon."

But as long as we're talking "ideally" then I'd like a unicron that poops jellybeans/

Presumably that's why they're talking about establishing the sleep rules for *elective* surgery, not emergency.

And that's where you think it will end, huh? That'll go over well. The doctors doing elective surgery need to be rested, but the guys treating the poor shmucks in the emergency room - it's okay if they're falling off their feet. Sure.

There's no way a government regulation like this will remain restricted to a certain class of surgeons. It's naive to think so.

Shanna, they bought their tickets, they knew what they were getting into. I say, let 'em crash.

It seems that a surgeon can be severely sleep deprived while operating.

I believe that a surgeon is forbidden from drinking alcohol within 24 hours of operating. Any use of other drugs (cocaine, meth, etc) is always forbidden, regardless of when last used.

Simple disclosure would be better than regulation. Surgeons could make representations about their sleep and alcohol use, then let the patients decide. A patient could have a sleep deprived surgeon in an emergency, and independently opt for a rested orthopedist for hip surgery.

Let the doctors and hospitals make their case for excellence from real data, always with the requirement that they serve their patients according to their wishes.

The push for change here means you are answering a choice:

"Would you rather see a sleepy doctor, or no doctor at all?"

Hint: You're answering "no doctor".

Doctors work these punishing hours because they have no choice. Their profession is not simple, it is not attained by many, it bears a huge cost not only in dollars, but in its toll on the person's mental health, to watch people die day after day, to treat complicated problems and difficult people who expect you to be God and then sue you when you aren't. When a patient needs to be treated at 0400 in the morning for a crisis, do you tell them, "No, you can't be treated now, the doctor can't operate unless he's had another four hours of sleep."

The fact is that the medical push you're talking about in this case Miss Alkon, means a push for medical malpractice because it will mandate doing nothing.

We're not talking about people coming in at twenty past midnight for a nose job, we're talking about sudden heart attacks, gunshot wounds, drug overdoses, car accidents, the unplanned for occurences that need treatment now, not after a nap...NOW.

And when you need that treatment, whatever it may be, you're not asking if he's had enough sleep when he gets to you, you're thanking the god you don't believe in that he's there with the knowledge to save your life and the willingness to sacrifice his own comfort and well being to do it. Is he at 100%? Maybe not, but life isn't perfect in such a convenient way that there is always a well rested hand on the scalpal. Sometimes you just have to settle for the tired expert at 90% in the present instead of the hypothetical well rested expert at 100Z% the following day.

Welcome to the cold cruel grip of our uncaring reality. I'm not sorry that this isn't common knowledge amongst people, because then more well meaning fucking idiots would be passing laws and regulations and filing lawsuits that keep doctors away from patients in dire need, and more people will die, and all those same fucking idiots that sued to keep the weary docs out, will be suing again when their relatives die waiting for critical care.
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The difference steve, is that nobody dies if the truck doesn't arrive on time. But people DO die if the doctor isn't there when he has to be. We're not talking nose jobs at 0300 after 30 hours work, you're talking critical procedures with a time limit. It may not be perfect, but it beats nothing, and THAT is what you're talking about, nothing until to late.

Answer: ban the AMA, ban the state licensing boards from limiting the number of licenses they issue. Get rid of the forced artificial scarcity and the market will sort it out.

Oh, and Happy New Year from the East Coast.

The Goddess Writes: Know any doctors? My ex-boyfriend is on an elite liver transplant team. I know about the hours from him.

As I recall from my stint working in a hospital, there's also huge incentives to work those long hours. 92 hour work weeks were not uncommmon for me. In addition to time and a half overtime, they would also tack on a few extra dollars per hour for working another unscheduled shift.

So, it might be also that these people are voluntarily subjecting themselves to sleep-deprived conditions and why you won't hear them complaining about it. With all the extra perks for extra hours, they can effectively write their own paycheck.

Let's see, we've got all kinds of warnings that 'not enough sleep causes 'X' and contributes to 'Y', if you've ever been awake for 24 hours and still had to work you know what it does to your judgement, but they let- from what I've seen in resident programs require- docs stay awake for those kinds of hours and then treat people?

Don't know about a law, but definitely seem to need a change in the medical culture.

They're trained to do good work even when their judgment is challenged. That's kinda the point.

Written by someone who has clearly never tried to function under extreme fatigue.

Commercial pilots are subject to very stringent rest requirements, because the odds of error, no matter the training, skyrocket in the face of sleep deprivation.

The only reason doctors don't have the same requirements is because their mistakes only kill patients one at a time, instead of stacking the bodies by the cord.