Doctors Shouldn't Be Allowed To Work 28 Hour Shifts
I once pre-booked an Uber ride, and when the driver arrived he explained that he'd had to log off for 30 mins in the middle of the day in order to be allowed to take this ride in the evening, because the app has a maximum daily shift length of 12 hours before it locks the drivers out. Hey, safety first right? Driving can be dangerous, and tired drivers make more mistakes.
Meanwhile, your literal doctors are allowed to work 28 hours straight.
Here are some rules (apparently) from different professions for maximum shift lengths:
| Profession | Max Continuous Shift |
|---|---|
| Airline Pilots | 8–9 Hours (flying time) |
| Truck Drivers | 11–14 Hours |
| Doctors (Residents) | 28 Hours |
Three things should stand out to you here:
1) Doctors are allowed to work 28 continuous hours
2) But only the Residents
3) This is bananas
I'm currently reading a book called Sleep Groove (v good, recommended). Among many interesting and unexpected points, it makes the entirely predictable point that people perform worse on all kinds of tasks when they haven't slept enough. The decline is really, really sharp and the trough is really, really low.
Why are doctors allowed these shift-lengths? I have heard two opposite explanations, both of them bad:
- senior doctors treat junior doctors like fraternity pledges because they can. Medical residents technically count as students/apprentices rather than employees, and so are exempt from labor protection laws. At one point the residents tried to sue about this and then an unholy alliance of the medical establishment and Senator Ted Kennedy worked together to legally screw over medical residents for the rest of time so senior doctors could continue profiting.
- junior doctors actually WANT to work 28 hour shifts, because working 28 hours straight and then getting a five day weekend (or whatever) is more fun than working three 10-hour shifts spread across multiple days.
I just want to be clear that, whyever the current situation persists, I don't think it should be allowed to. We have both internal and external evidence that people make bad decisions when tired, and (crucially) that they don't know in the moment that they're making bad decisions when tired. We don't trust drunk people when they say "I'm totally fine, I can drive!" because the same thing that impairs their judgment is also impairing their meta-judgment about the impairdness of their judgment. Similarly, we shouldn't trust doctors who say that they're fine to work on limited sleep, no matter how much we love and appreciate doctors more generally.
The main argument used in favour of long shifts is "continuity of care", i.e. that it's better for a patient to see the same doctor continuously and prevent "handover errors", where something in the treatment goes wrong because information got lost when going from one doctor to the next.
I'm sorry, but this is the kind of process problem that the modern world is actually good at solving. I haven't worked at a hospital and I'm not saying the solution here is easy, but the solution is some version of "develop a procedure which standardizes the way that information about patients is handed over from one doctor to the next, minimizing error."
Of course, hospitals already have such procedures because shifts still end and handovers are still done; the only question is where to make the tradeoffs between "more handovers" and "sleepier doctors."
I am extremely grateful that doctors exist, they do a very difficult job and I celebrate them for doing it. But I fear we've got in a situation where the difficulty and importance of the job itself creates a taboo against other people having an opinion about it, which feels wrong. As mentioned, I'm not actually clear that the doctors who work 28 hour shifts even want to be doing that, or if it's enforced on them by a cartel of their elders who entirely control their job prospects, in which case it's extra-good for outsiders to speak up and help shift the equilibrium. But even if it's the case that doctors (overall) prefer to work fewer, longer shifts, that doesn't mean it's a good outcome. Patients – which, of course, ultimately includes doctors and their families too – shouldn't tolerate it.