Did They Really Learn More?

I call ’em ‘When I was…’ stories.

Any time an old-school doc starts a sentence with ‘When I was….’ they quickly see I have totally lost interest. Invariably, s/he is going to wax reminiscent about the days when docs worked 36 hour shifts routinely. And, frankly, those stories – unlike those ‘walked to school uphill both ways’ stories – are true. 36 hours was TYPICAL and happened ever 3rd or 4th night. It really was brutal and I have to wonder what kind of care those doctors provided. But I still don’t care. That was then. Scorn me if you want, but that ain’t now.

I’m not the only one who scorns anyone who works that much. As most of you know, there are work hour regulations in place these days. Some residency programs still mess with those hours and have ways of making their residents work more than what the regulation permits. But for the most part, a good majority of residencies are very serious about being compliant…and they are getting closer and closer to compliance with the rules.

What are the rules? Can’t work more than 80 hours in 1 week. Yeah. DOUBLE the federal qualification of full-time. And for the same salary – around 40k/yr – that most entry-level 40hr/week jobs pay for your average college educated graduate. It’s ok if a given week exceeds 80 hrs, however, it has to balance out over the course of 2-4 weeks. So, we can still put in weeks of 100 hours and nobody’s going to get in trouble. Residents also can’t be on for more than 30 hours straight at a time – although they can do paperwork beyond that (just not patient care). And they have to have at least 10 hours off between shifts.

So, things are better. Those rules may seem pretty lax, but they’re WORLDS better than it used to be. Even so, I HATE the ‘When I was…’ stories. Every older doc has them. They wear their workaholism around like a badge of honor. Honor…by the way. That IS how this whole system sustained itself, in case you didn’t know. There was a deep sense of accomplishment to stay up for days and days and still be in control of everything. Residents competed – tacitly or occasionally in the open – to see who was tougher. When they were finished with their training programs, they each felt as though they had endured a trial of fire. Each of them were willed with a fierce pride that you see in few other places besides special ops and Marines Corps.

For years, do you know what the excuse was to continue the inhumane training programs? “It’s the way it was for me.” Honestly, that was the first answer of most doctors. Stupid, I think. Reminds me of the Roast Story: Daughter sees her mom cutting the end off of a roast before she puts it in a pan and cooks it. When she asks her mom why she does this, the mother replies, “I don’t know. My mom always did that. It’s just how we prepare roasts.” Later the daughter calls her grandmother and gets the same answer. So the girl calls her great-great-grandmother and asks the same question. Great-grannie’s answer, “Pan was too short.”

One other reason to justify looong work shifts is that many typical disease processes traject along an arc that lasts, coincidentally, about 36 hours. From the time of admission, a person is either stable, discharged, discharged or dead within about the first 36 hours. So, a shift that long provides excellent learning opportunities.

That’s another stupid one, I say, unless they line up all the sick people who will need to come into the hospital and don’t let them in until the oncoming resident can evaluate them. Then we can tell them, “Good thing you’re getting in right when the resident starts his shift! By the time he leaves tomorrow – too tired to know his name – you’ll either be going home, still sitting here and sick…or just completely dead. Have fun! Thanks for waiting.

I guess I’ll never know if the docs of old were smarter at my stage of training than I am. Well, I’m sure some of them were smarter in 5th grade than I am now. But you get my meaning. I do know that I admitted a patient this past Saturday at about 3pm. Since I was on call that whole night, I saw her again the following morning. In days past, I might have hung around all day Sunday too before I went home. But since this is a new day, my shift was only 26 hours of sleeplessness, and I was out of the hospital by 10 am on Sunday. Nice. But this patient I admitted had overdosed on SSRI’s, something I’d never seen. The result can be catastrophic. Called serotonin syndrome. And I don’t know if this happened to her or not. She was looking pretty good when I left.

But then again, as I read about serotonin syndrome last night, I was intrigued to see that the symptoms of this life-threatening syndrome frequently don’t show up for…oh, about 34-38 hours.

Touche, Old Guard.

One thought on “Did They Really Learn More?

  1. mysteryshrink

    Loved your look at the “hours.” I’m a psychologist with a diplomate in psychopharmacology whose been around a while. Those SSRI possibilities are SO much better than the OD’s on tricyclics or Tylenol. I’ve had two people take loads of Tylenol and survive with lifetime liver complications.

    Enjoyed looking over your shoulder.


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