YOU’RE GETTING SLEEEEEEPY

Megan McArdle over at http://www.instapundit.com makes a great point that I agree with:

YOU’RE GETTING SLEEEEEEPY: A new study shows that tired interns are making mistakes.

D’uh! I have no patience with the way hospitals work their interns and residents. I’ve never heard a good explanation for why we want our junior medicos, who provide a lot of our front-line care, in a state of perpetual exhaustion; most revolve around the utterly unconvincing idea that they somehow need to learn to work under pressure, as if they were all going to be disaster-relief doctors. After a few weeks, older doctors assure me, they learn how to cope.

Hogwash. I’ve worked those kinds of ours as a technology consultant many times, and while you do get better at coping with exhaustion, there are limits. And I don’t care who you are or how many times you’ve done it before, when you’ve been up for 36 hours: you. are. stupid. Your reaction times slow waaaay down (or speed up disastrously, as you short circuit past critical steps), you’re over-emotional, and you’re prone to cut corners as your body and brain cry out desperately, desperately for sleep.

Sure, I’ve done it. But at the end of the day, I was working on a box of bolts. It would be a VERY BAD THING if one of my clients, say, couldn’t trade on Monday morning — but they’d all still be breathing when they came in on Tuesday. Also, I rarely had to make split-second, irreversible decisions about caring for my boxes; they were unlikely to flatline while I took a few minutes to think things over.

The system endangers patients. I recall when a friend of mine, an intern, had to go to work despite the fact that he was suffering from terrible influenza. Why? He had to make his hours. How ridiculous is it to have a system that puts sick doctors out on the floor where they can infect patients? And what kind of decisions do you think a flu-ridden intern makes?

Even worse than that, the doctors know it endangers patients–they don’t want themselves, or their families, in the care of residents. Some of that is because we all naturally want the most experienced doctor for our families, of course. But some of it is because they know that exhausted doctors make for bad care.

(Why can’t they just let them work shorter hours? Say it with me, folks: the reason is green, and it folds. Fewer hours for residents mean more hours for attending physicians, who, unlike residents, would have to be paid for it.)