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An ignorant doctor can always do what the one in the article did and aquire more information and make a correct descision. A tired doctor could have all of the information and make an incorrect descision. The main problem there is a lack of communication between the doctors, not having the “floating doctor”.

with all due respect some of the hours doctors and nurses work are truely ungodly! it might be time to start placing some limits on shifts

And, conversely, an ignorant doctor can think they know what to do and make an incorrect decision…while a tired doctor might realize they’re not performing optimally and consult others for a second opinion. An unfortunate truth is that people’s conditions can change drastically while in the hospital, and the primary doctor might not have encountered the condition in this patient and therefore would have no information to share. It again gets back to the question…in an emergency would you rather have a tired doctor with years of experience, or an inexperienced doctor fresh on their shift?

Old surgical adage about residency training. The resident who is on call every-other night gets half the training and experience.

The limits on hours for house staff are a very good idea. I practically grew up in a hospital, and I certainly do not want to be treated by someone who has been up for thirty hours. The point to take away from this article is that the system has not yet adapted and is doing a poor job of transmitting information from one shift to the next. Relying on comments at handoff is idiotic. The information should be in the chart. With the advent of computer systems, charts should be easily searchable and the old problems of sheets going astray and illegible handwriting should disappear. A major part of the problem is the attitude of many physicians, who think that practicing on no sleep is a rite of passage that everyone should go through because they went through it.

“in an emergency would you rather have a tired doctor with years of experience, or an inexperienced doctor fresh on their shift?”

I don’t think you’re usually going to get an experienced doctor at night either way. In an old-style residency system, the tired doctor working all day and all night is likely to be a resident who is only a couple of years out of med school.

As an intern 40 years ago on a general surgical service, we faced this problem routinely. A weekend shift started at 8am Friday with an elective surgical schedule, and continued until all patients received during that first 24 hours were treated and stable. With auto accidents and the “knife and gun club” at work, it was common to operate continuously, one patient after another, until sometime Sunday. At one point, errors attributed to errors of judgment induced by sleep deprivation led to a change. At the end of 24 hours, patients remaining untreated were transferred to the next crew. Errors increased due to unfamiliarity with the patients and this unfamiliarity was not helped by verbal hand-off. This was not a scientific study, but after some months, the institution went back to the old method.

I look back on my five years of post-medical school training, which involved many a sleepless night, with fondness. It was a rite of passage, and a validation of how “tough” I was. But I agree a better method is needed. The availability of electronic records should permit development of a check-list type of hand off form that will reduce the risk of errors as described in the post.

One other factor to consider is the role of nurses. Nurses usually have a very good idea of what has been going on. It is important to stagger nursing shifts and physician shifts so that a physician coming on encounters a nurse who has been on the floor for some time. It is also necessary for the physicians to pay attention to the nurses, which all too many do not.