Tuesday, March 22, 2016

A Hard Day's Night

There are all sorts of worker protection now in place for medical residents. Residency program directors have to abide by very stringent work hour rules and allowable number of calls. That's great progress for resident well being but what happens when these coddled physicians finish training and go out into the real world?

As somebody in private practice, I work hours that would make most residents blanch in disbelief. Multiple calls in one week? Check. Multiple 16 hour work days back to back? Check. Five hours of sleep per night for a week at a time? You betcha.

In Anesthesiology News, there is a study on how sleep deprivation can affect an anesthesiologist's temperament. Not surprisingly, it isn't very pleasant. Twenty-one pediatric anesthesiologists at the Nationwide Children's Hospital in Columbus, OH participated in the survey. They were asked to rate their moods on several criteria at 7:00 AM on a non call day and again at 7:00 AM after a 17 hour call shift. As you can imagine, being post call SUCKS.

When post call, the anesthesiologists were more likely to experience significantly more anger and fatigue and have much less vigor. They also showed increased tension, depression, and confusion though not to a statistically significant extent. These changes did not seem related to age as all age groups were affected.

Now this is based on the perceptions after a 17 hours call shift. Most of us do 24 hour call shift as private attendings. Our anesthesia group tries to give us the day off after a call. Sometimes though that is just not possible due to staff shortages so like good soldiers we trudge on for another 8-10 hour day shift. That is when I usually get into trouble with the hospital staff as I get quite snippy and impatient with people. It doesn't even matter if it was a busy call night or not. The same feeling of fatigue happens either way because a good night's sleep just isn't possible when one expects to get called for a case at any minute. Then that's when I get hauled to the Chairman's office for a little one on one intervention. After some dressing down, I'm sent back out into the trenches, ready to take on my next 24 hour shift.

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