Blog | Friday, August 12, 2011

Being a doctor is a lot like being a parent: You can't tap out


The American College of Graduate Medical Education has enacted further restrictions on resident work hours. No more than 80 hours per week of work for resident physicians, averaged over one month. And no more than 16 hours of continuous work for first year residents (24 after that), which includes patient care, academic lectures, etc.

Whenever they do this sort of thing, everyone seems excited that it will make everyone safer. After all, residents won't be working as much, so they'll be more rested and make much better decisions. It's all win-win, as physicians in training and patients alike are safer.

I guess. The problem of course is that after training, work hours aren't restricted. There is no set limit on the amount of work a physician can be expected to do, especially in small solo practices, or practices in busy community hospitals.

I understand the imperative to let them rest. I understand that fatigue leads to mistakes. I get it! But does the ACGME get it? If physicians don't learn to work with fatigue, don't learn to make decisions and do procedures when they're weary, then they won't be able to do it later when they are completely and totally accountable for the patients in their charge.

Have I ever been fatigued and made a mistake? Probably. But for the most part, I have learned that some of medicine is a kind of wonderful auto-pilot learned by hard repetition. In an age of checklists, it's a kind of innate, well-practiced algorithm that kicks in when sleeplessness limits our creativity. The fact that it isn't printed on a chart or embedded in a computer program does not change what it is.

And it can only be learned by practice, kind of like parenting. As a parent, there are no work-hour restrictions. When your darling child is sick, you simply get up. And when they vomit all night, you clean them, comfort them and if necessary drag yourself to work wondering when you'll get your turn at the toilet.

When your kids are tired you carry them to bed and when they need help completing assignments you stay up. When they have to be fed as infants you feed them and when they have to be transported as teens, you take them. You can't tap out.

Medicine is a lot like that. Once you're out, seeing patients, and accountable, once residency is over, you can't tap out.

I'll make a prediction here. Physicians are already ditching call responsibilities left and right. But when new physicians realize just how hard it is to change from restricted work hours to unrestricted work hours, they'll give up on call responsibilities so fast you won't be able to say "circadian rhythm."

You see, sometimes, life just makes you tired. And in order to do what needs to be done, whether it's surgery or raising children, you just have to deal with it. And be tired.

This post by Edwin Leap, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.