Tuesday, May 10, 2011

The Shifting Continues

One of our local hospitals recently added laborists to their OB/GYN staff. This will now allow them to handle vaginal births after cesarean sections. I had never heard of laborists before but it makes sense. Laborists are obstetricians who only work in a hospital setting, similar to the concept of hospitalists for internists and family practitioners. The idea is the patient will have all her prenatal care by her personal OB. Once the patient goes into labor she is admitted to the hospital and the laborist takes over her care. This can really help the poor nursing staff who were frequently the only medically trained personnel in the labor ward who was helping the patient with her contractions. The OB doc usually didn't want to be called until the patient was dilated up to seven or eight centimeters either because he didn't want his office schedule disrupted or it was in the middle of the night. Frequently that meant the doctor would get to the hospital too late and it was the nurse who delivered the baby. From my personal experience, our OB doc didn't show up at my wife's bedside until she had been in labor for over 24 hours on a weekend. After about ten minutes he determined she should have a C-section instead. Gee thanks for showing up doc. I hope you made it to your golf game later that afternoon.

This continues the trend of more doctors embracing shift work into the daily schedule. Anesthesiologists have long been derided as not being "real" doctors because we frequently work in shifts, handing off patients to the on call person at the end of the day. But patients are becoming more comfortable with the idea of having a doctor in house all the time who they can talk to even if it's somebody they've never met before. Who wants to wait until the end of office hours before they can see their doctor? And usually that doctor will be tired and impatient, with little time for the myriad of questions one has accumulated during the day waiting for him to show up. As the experience of anesthesiologists, hospitalists, laborists, emergency physicians, and many other fields shows, doctors working in shifts do not decrease the quality of patient care. In fact I would bet that the care is better as the physician is not as tired or grumpy. He won't be burdened by what happened at the office earlier in the day. And the patient will have more access to his doctor. It's a win-win for everyone.

Not surprisingly, the last holdouts on shift work are probably the general surgeons. There is a machismo involved in that field that derides anyone who doesn't have the temerity to work at least 24 hours straight. Even now the surgical attendings belittle the work ethic of their own residents for not being allowed to work more than 80 hours a week and being given at least one weekend off a month. With attitudes like that it's not surprising how unpopular general surgery residency has become with current medical school graduates.

As more doctors are repulsed by the idea of working for days on end like the previous generation of doctors, maybe we'll have a more pleasant and well rounded generation of physicians. Who wants a doctor who admonishes a patient for poor eating and exercising habits when they themselves don't follow the same rules? Who wants a robot doctor who only knows work but doesn't even know the name of his own son's favorite baseball player or his daughter's best friend? I think shift work will bring humanity back into medicine.

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