A different consequence of 28-hour shifts

Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public Citizen, I chose to share a story that shows a different consequence of 28-hour shifts.

During my second year of residency, I was on a 28-hour shift, which we commonly call a “30-hour shift.” After this 30 hours is over we are supposed to have a day off, or what we refer to as a “post call day.” This post call day was my only day off for a very long time, and I had scheduled to see a geneticist on this day to do blood work. I was recently diagnosed with kidney cancer at 28 years old. This “day” actually began at 7 a.m. on the day prior and was supposed to end 28 hours later at 11 a.m. the next day. For example, if a 28-hour shift started on a Tuesday at 7 a.m. it would end on Wednesday at 11 a.m.

I had signed out my patients at 8 a.m. before I was about to leave but I was still working on some notes that morning. The more hours you work, the more work you have. I had informed the attending who had just arrived for the day that I had an appointment around noon. She told me that I was not to leave until all the orders, phone calls, transfer forms, and notes had been completed. Yes, she was aware that I had cancer. No, she did not care. Although she knows the ACGME rules, I informed her that 11 a.m. would be the appropriate time for me to leave as it would be my 28th hour. She proceeded to explain that because she was not here last night and I was, I was required to stay until everything was done for each new patient, no matter how long it took.

This issue is not only about the number of hours worked, it is also about the workload. I had not slept nor had I taken a bathroom break the whole night because I had ten new patients come into the ER. I had to do a history and physical on each. Then I had to interpret, and in some cases, order their lab work. I then had to diagnose them. I also had to attempt to locate their outpatient doctor/psychiatrist/case worker in the middle of the night so that I could get an accurate medical history on each.

Next, I had to do the admission or transfer paperwork for each patient. I had to put in orders for each into the computer. I had to call the relatives of each person and explain to them that their loved one was being admitted to the hospital. And when 8 a.m. rolled around I had to call each one of their pharmacies. All ten of them. This does not include the 17 psych floor patients I was responsible for all night or the 15 consult patients on other floors. I had gotten used to this workload which was fine; I knew what I signed up for when I became a doctor. I was busy, and I did not mind it. But I needed to go to my OWN doctor, so I had to put my foot down.

The patients were safe and the only thing left to do was paperwork, which the attending could easily do, however, she was not the type to “lower herself” to doing resident’s work. “I will come back to the hospital to finish the notes after I am done at my doctor’s appointment,” I told the attending. I arrived late to my appointment. The geneticist commented that I did not look well. I explained to her that I was a resident and immediately she understood.

“Well, I guess it is going to be hard to get you back here again so let’s hurry up and get some blood from you right now.”

But, no blood came out of me. I was so dehydrated that they couldn’t get a stick. The nurse, understandably, was taking a long time. Then I got a call. I couldn’t answer it as my arms had needles in them. Then the phone rang again, and again.

“Pardon me please.”

I looked at my phone and saw a text from the day resident informing me that the attending was gone and left a pile of work for her to do and instructed her to call me. The attending knew I was post call and getting a genetic workup, but she decided to tell the next resident to call me anyway? I told the other resident I was at a doctor’s appointment, but she said I needed to get back to the hospital immediately, or we would all be in trouble.

“You realize this is my post call day right? The ONLY day I have this week to get this genetic workup done?”

She told me that was my own problem and hung up the phone.

I ended up working 38 hours that day. I’ve worked 38 and even 40 hours straight before, but this instance really sticks out in my mind because it was a huge hindrance to my ability to care for myself. Other residents in this situation would probably not look out for their own well-being the way I did. Residents are self-sacrificing and aim to please. That is why I do not believe in increasing duty hours to 28 consecutive hours for interns. This is their introduction into life as a doctor. They are new and vulnerable. Others will take advantage of them. They will learn to believe that they are not deserving of time to themselves. They will become complacent with this type of treatment. They will accept that their needs come last and this attitude will continue indefinitely. If we don’t stand up for them, no one will.

Stephanie Waggel is a psychiatrist and can be reached at Improve Medical Culture.

Image credit: Shutterstock.com

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