A system to identify doctors who’ve been working too many hours

My shift had finally ended.  As a second-year resident, I was driving home after 30 hours awake straight.  The busy call included delivering several babies, two Cesarean sections, circumcisions, rounding, triaging new patients, and teaching medical students.  Never during that 30 hours was a 5-minute nap possible; clinical load would not permit this.

I couldn’t wait to get home at the end of the shift as I was completely exhausted.  So, I buckled up and prepared to drive the 20 minutes home on interstate 95 so that I could finally get some rest.

I could feel my eyelids drooping intermittently as I was driving, like a weight I couldn’t control was pulling them down.  I turned the radio up loud, drank a big gulp of my hot coffee, and rolled down the window.   I had done this many times previously after these long shifts and had figured out all the tricks to make it home safely, or so I thought.

I must not have been able to fight off my increasingly heavy eyelids, because I woke up suddenly to the jarring bumps on the side of the road: intelligently placed to wake up drivers such as myself who may be drifting out of the lane.  Startled, I turned the wheel hard to get back on the road.  However, I overcompensated, confused from no sleep, and spun around 180 degrees so that I was facing the opposite direction of traffic on the interstate.  I slammed into the wall of an overpass, and my car came to a sudden and jolting standstill.

My heart was racing, my hands were shaking, and I tried to get my bearings to understand if I hit someone, or if I was still in danger and needed to get out of my car.  I quickly got out, unbelievably unharmed (and miraculously no one else either) and called my husband with trembling hands.  I was only 5 minutes from home.

My car was totaled.  I walked away fine, without a scratch, but with a new understanding of the dangers of prolonged sleepless working shifts unique to the medical profession.

Ultimately, I believe patients have the right to know if they are receiving care in optimal situations that promote safety and decrease preventable medical errors.  Physicians have an incredibly important and powerful ally in our quest for humane working conditions- our patients.

They likely don’t want their obstetrician to be on their 30th hour awake and about to deliver their child, or for the doctor admitting their father with congestive heart failure and writing detailed medication orders to be without sleep for over 24 hours.

There is a way to promote transparency with patients.  Physicians can wear rubber wristbands (handed out to them by their residency program director or employer) signifying how many hours straight they have been responsible for patient care without a break.

Green: 12 to 24 hours
Yellow: 24 to 30 hours
Red: 30+ hours

Think this could never work, or that nobody would do this?  Guess what, its already been done.  Please see how the South African Medical Association came to bring this project to fruition in their country: “The SAMA campaign makes it easier to identify doctors who have worked longer hours. It is also a visible reminder that South Africa should employ more doctors to manage their workload.”

Physicians want working conditions that promote safety, but it is complicated for a profession such as ours.  We have been told it is illegal to form a union.  We are threatened that going on strike puts patients at risk.  We can’t just all walk out of an ER at the same time, and therefore we don’t, out of respect for our patients and concern for their well-being.  However, this puts us in a trap of beneficence where “do no harm” compels us to continue working in unsafe conditions not only for our patients but for ourselves.

A physician can wear their wristband and not have to fear retribution from an employer or worry about being labeled a “troublemaker.”  If the bands become standard, hospitals who are employing safe practices can use this as a bragging tool that their physicians are well rested and rightfully claim to be advocates for their patients.  It can be a silent tool of protest for physicians who will continue working without going on physical strike and allow our patients to do the fighting.  In the end, it is the collective voice of our patients that carries the most promise for change to a dysfunctional health system.

The trajectory of medicine now has more physicians employed through a hospital or HMO, as opposed to private practice.  The loss of autonomy in these positions does not allow a practicing physician to dictate the amount of time on call thought to be “reasonable” or “safe.”  While typically thought to be a problem for physicians in training, many attending physicians work much longer hours.

Currently, residency programs are simply trying to meet patient needs with the limited number of physicians employed to fulfill the demand.  Addressing this concern would require increasing the number of residency positions.  This means there needs to be increased funding for residency positions from the government to meet patient need.

Perhaps if the public knew and could see first-hand, the types of hours the doctors caring for their sick family members were working, they would demand change.  It would no longer be an abstract concept.

We can seek meaningful change in our profession without going on “strike.”  Patients will see wristbands turn from green to orange, and ultimately red.  Patients will begin to speak up.  Not only out of concern for themselves/family members, but out of care for their physicians.  We remain a team, with health and healing at the core of our mission.  With enough help from our patients, I do believe we can see a change in the culture of medicine.

Valerie A. Jones is a obstetrician-gynecologist who blogs at OB Doctor Mom.

Image credit: Shutterstock.com

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