"Eat When You Can, Sleep When You Can."

One of the very FEW things I like about driving is listening to NPR, something I normally would not make time for nowdays. Aside from getting a good survey of what's going on in the world, I get to hear a lot of interesting stories and reports, one of which I heard this morning and I'll elaborate on it later. First, a gripe about commuting! I was lucky enough to work a half day today as attending was busy doing resident interviews. I was happily driving home after lunch...but who gets stuck in traffic at 1:30 in the afternoon??? I was inching along for the longest time and wishing I hadn't finshed my bottle of water out of boredom as my kidneys work super fast. The highway was totally shut off for what reason I don't know. I had to call hubby to get alternate road directions. Thank goodness he was so helpful and I got home without incident albeit it took me 3 times longer!

Here's what I heard on NPR this morning: another study, this from Harvard, showing dangers of excessive medical resident work hours. Well, I copied and pasted an article that sums it all up:

http://www.ama-assn.org/amednews/2006/10/02/prsd1002.htm
~~~~~~~~~~~~~~~~~~~~~~~~
Study finds widespread resident work-hour violations. The Accreditation Council for Graduate Medical Education disputes these results, stating that the majority of residencies are in compliance.

By Myrle Croasdale, AMNews staff.

Some 43% of medical interns are working more than 80 hours a week in violation of Accreditation Council for Graduate Medical Education standards, according to researchers with the Harvard Work Hours, Health and Safety Group.
The study was conducted the first year duty-hour limits were imposed, but researchers said current data suggest further noncompliance.
These data, published in the Sept. 6 Journal of the American Medical Association, contradict results reported by the ACGME, which found only 5%of residencies in violation of its standards in 2003-04.
The study is the latest from the Harvard group of sleep experts that has called into question ACGME standards intended to curb resident fatigue and limit errors.
In the same issue of JAMA, a second Harvard study found that interns were at a higher risk of needlesticks during extended shifts. Previous studies from the Harvard team documented fatigue-related medical errors during the 80-hour schedule with 30-hour call shifts and found a link between residents, 30-hour shifts and car crashes.
"In the face of this evidence, it's ethically imperative that we change the system," said lead researcher and study author Christopher Landrigan, MD, MPH, of Brigham and Women's Hospital in Boston. "The standards that we have right now are not evidence-based, and it's becoming increasingly evident that residents are not safe."
~~~~~~~~~~~~~~~~~~~~~~~~~

As for myself, I have experienced sleep deprivation in the name of medical education. I don't want to be around myself after I've been on overnight call, much less providing good patient care to someone's loved ones. I remember having to stop and park in parking lots to take a nap in middle of my driving home after being on call. (Do I need another reason to hate long drives?) I never got to the point where I actually fell asleep on a patient's chest as I listened to the heart with the stethscope, this happened to a resident I heard and the patient was not very happy. But I have felt my knees buckling and body swaying while just standing around after going without sleep for 30 hours. I've learned just how important sleep is to me, eight hours per night is really optimal for me. That makes me feel like a time-wasting hedonist or 6-yr. old child sometimes, but it's just the biological truth! Without adequate sleep, I can nod off like crazy if I'm allowed to sit for even a minute, and perceptibly, I feel the slowing of my mind. I'm apt to forget the easiest things and when I talk, I get this weird out-of-the-body experience as if I'm hearing someone else talk. I have often thought this must be what my brain is like on drugs, without the euphoria, of course.

This issue of lack of sleep and excessive work hours is the biggest concern I have as a resident-to-be. Early on in medical school, I was very elated when I found out about the 80-hour work week limit and I thought I won't have to suffer as much by the time I become responsible for patient care. It is disheartening to hear about the rampant violations. However, I am happy to say that I'm going into a speciality that is kinder to residents in terms of sane work hours. My worst year will be the intern year. I've come to terms with not being the most healthy person to my body for a year. I will give myself the freedom to gain weight, that's what the expansible drawstrings on scrub pants are for! So, like the intern mantra of survival says, "eat when you can, sleep when you can!"