Sleepless doctors losing caring


We deal with death and with pain

The job brings a whole lot of strain

The hours on call

Are the worst of it all

When your sleep goes right down the drain

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Sunday afternoon in the doctors’ lounge the faces show the strain.  We have worked too many hours too intensely.  The energy and the intelligence helps but 48 hours into the weekend call the pulmonolgist, the nephrologist, the hospitalist, the cardiologist and the family practitioners have all done too many admits in the context of not enough restful sleep.

As a med student and a resident I had times on call when I made the mistake of letting myself go all the way to sleep, and then I aroused only with difficulty.  Now amusing stories at the time carried frightful embarrassment.  Most docs had similar experiences, and we learned to doze rather than sleep fully.  I’ve asked other physicians, and about 15% say they can sleep well if they’re on call.  I fall into the other group. 

The muscles in my upper back and the base of my neck grow tender knots and then cramp up. 

With the geographic layout of our town’s two hospitals, walking from car to patient to car, a round trip of hospital-patient-hospital-patient comes to a little over a mile, and with admissions piling up at the average rate of 4 to a shift, physical fatigue adds itself to the list of emotional and intellectual weariness.

Even the brilliant, overachieving docs from other countries who work insane hours without complaining (the way I did as a resident) look tired.  While no one wants to be seen as a whiner, we commiserate and we wonder why this weekend, of all weekends, should be so hard.

My near participation in the pity party ends when my beeper for the other hospital goes off.

I can tell from his use of profanity that the ER specialist has passed his emotional elastic limit.  All his rant about the alcoholic’s manipulative behavior rests solidly on truth, and I recognize in my heart my own impatience with the self-defeating behaviors that brought the person in.  But the doc on the other end of the line goes on for minutes, communicating little about the patient’s medical condition and much about his own anger. 

Across town the patient’s blood alcohol level runs 224.  From experience I know that the interview process will yield little useful information.  Drunk patients want to appear clever and they want to talk and they have problems focusing, but as a physician I just want to collect the information and go home.  I don’t try very hard when it comes to my 140 question Review of Systems, where I ask the patient about every symptom possible.  I break off questioning at the first sarcastic remark, and I don’t try to fight the scrunched-up eyelids to examine the pupils.  My dictation uses the sentence, “could not be obtained because of patient intoxication” a lot.

Overworked docs with inadequate sleep may or may not provide the same quality of care as normally, but they definitely lose out on caring.

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