Should Doctors Work 24 Hours Straight? 

I don't understand how hospitals think it's a good idea to let a doctor who has been working a 24-36 hour shift make important decisions regarding their patients' health.

I have never understood the “I suffered so you have to suffer too” mentality. People that suffered should have sympathy for those currently suffering. Just because you got exploited doesn’t mean others deserve to get exploited.

"Where is the next patient?" Doc, if you're not going to wake up to reality, the next patient will be the resident right in front of you.

As a patient and the mom of a med student, I firmly believe that 24 hour shifts should be eliminated.

As someone who has multiple sleep disorders I have been warned strongly and repeatedly by multiple specialists not to do ANYTHING that requires concentration or coordination when I'm sleep deprived. I've been educated on the effects of sleep deprivation and the possibly disastrous consequences that can follow. That said, I will NEVER understand how forcing doctors to fulfill their residency programs in such a taxing and dangerous way, possibly compromising their own or their patient's safety and health either makes sense or is legal. This is a "DUH" topic to me. My heart goes out to everyone forced to do this.

"I'd prefer you just suffer in silence" is the most true way to describe the elitism in healthcare that doesn't welcome change or improvement.

We have proof that long hours and irregular sleep cycles cause so much harm to the body and mind. The last person I want exhausted is the person deciding my treatment plan. Nurses are not allowed to work more than 16 hours and have to have 8 hours between shifts. A hospital I worked at restricted shifts to 6 days in a row (must have 1 day off at least). These are saftey because "you could kill someone if you're not getting enough rest." Doctors deserve the same protection. I hope you can influence change. This RN will stand with you.

Its like when i broke my wrist. I had to have surgery and had to wait in the hospital over 12 hours because the surgeon was currently in surgery. He came in after like "i just spent 18 hours on this last guy, i can do it now, but you REALLY want me to wait until morning."

Just imagine telling a patient the person they had looking after them was a trainee that hadn’t slept in 30 hours. I don’t know about y’all, but I’d be terrified if I was told that.

"I suffered so you should too" is a big unspoken motto that a lot of senior docs dont like to say Hate this culture, and it needs to change.

I’m a med surg nurse. I work 12hr shifts and by the end of shift I’m tired and while I’m still thinking clearly, I know I physically need rest. Making resident mds work 24 hour shifts seems down right dangerous.

In 1990 I was a 3rd year surgery resident. Medicare, which subsidized residency salaries, thought they were over paying us. We had to submit time cards every two weeks. We were on call every other night, so we worked 36 hrs on and 12 hrs, off (over and over, for 5 years). Therefore, we each turned in time on-call at 240 hrs per two week period. This comes to $4.64/hr. We did this for 1 month at which time they asked us to stop because they thought we all were lying. This was truly brutal and inhuman and cost many marriages and resulted in a lot of psychologic damage. However, there are 50-60 people who are alive after becoming critically ill or injured at very inopportune times, because I was "trained" to function under extreme stress and with very little sleep.

And then people wonder why so many docs are so ableist and ignore problems because they've become numb to the abuse they are put through and don't think it's actually a problem. Like maybe teaching prospective doctors to disregard their health is a bad idea?

The problem is that most "24 hour" shifts aren't really limited to 24 hours and are usually 30 hours and sometimes there are 48+ hours shifts. I think a step in the right direction would be to limit 24 hour shifts to real 24 hours and not a minute extra. No post call, no rounds no shit. Just hand on your patients the next day to your colleague and scram.

Don't forget how easy it is to make mistakes when you're that sleep deprived! You wouldn't let someone drive after 24h no sleep (pretty sure that's even illegal), let alone take care of patients 😅

I don't understand why factories have this figured out but hospitals can't, when the hospitals are supposed to have smart people at them. And who will pick up the extra shifts? Gee, I don't know, what if we reduce the bottlenecking that kicks people out of the field for no reason?

After a 24 hour call, my attending texted me to say he’d start the post intake ward round at 09:30 (the work day starts at 08:00). I can only assume that after getting 10 hours of uninterrupted sleep (I didn’t call him throughout the call), he was chilling in his house having a full English breakfast while I waited for him, suffering in silence 😢

And what patient wants the person holding their life in their hands to be sleep deprived and unable to think clearly? Oh yeah, none. We have limits for pilots, and drivers, why not for medical personnel? I really hate this "I suffered so you should have to suffer too" mentality.

I DO NOT want a doctor who has been working for 24 plus hours in a row. I want a doctor who has reasonable hours, is well rested.

Dr. Crazy Wig doesn't sugarcoat it, he just lays it all out there for you.

As an ancient, now retired nurse I did see the toll it took on residents. In all fairness, those grueling hours (this was before today's moderate restrictions on hours) did produce some great, think-on-your -(tired)feet physicians. But, on the other, it is clear that working such prolonged hours is inhumane and often dangerous to doctors and patients alike. While most docs in residency are on the younger side, they are still human with bodies that have limits which should be respected.

I remember in my house job/ internship that I worked 8am-3pm in one ward as morning duty , the off to call in another ward from 3pm-8am the next day. After that hectic call in which I barely got sleep and if I got 5 minutes of peace , seemed a miracle. After this ordeal, I got back to my morning duty till 3pm where a patient newly admitted for AKA had an MI. After managing that emergency, I had to shift him to the cardiac center after stabilising him. Totally regretted my fools paradise decision of getting into medicine that day and some other days

The exact reason why I have no desire to go to medical school.

You all need a union. Also, please call your representative and ask they regulate how many hours you can work in a row like truckers, I don't' think 24 hours should be mandatory.

I asked my department head when I was a newbie the same thing. It didn't go down well with him. 😢

24 hr shifts are dangerous in the end. Granted it was designed to put you under the pressure of a major trauma incident where everyone is working until the job is done, to teach you how to work under extreme stressful situations. However when you are done with that shift you still have to drive home - exhausted, which puts you at higher risk of an auto accident, falling asleep behind the wheel. Then where does that put you? Right back where you came from but on the other side as a patient. Now you lost a team member for that duration of recovery. Doctors aren't robots, let's stop treating them like they are

Unionize. Conditions in all work sectors except CEO have been growing exponentially worse in the last 10-15 years and people NEED to take a stand when it comes to health and safety.

One should not have to suffer in silence.

The only thing to change this system would be nation wide legislation, but keep in mind we already have burned out docs and a severe shortage of providers in our country, especially in rural areas

Ahh, the sensation of your brain starting to turn off, and when you look at your watch, the sensation of your brain realizing that you only made half the shift lmao

I am a now retired RN who did 41 years of full time night shift and I saw this first hand. A surgical resident came to our floor to check on his patients and write a few notes. Because it was night shift with the lights lowered and he was in the middle of his on-call 24 hour shift, he found a darkened, quiet corner and fell soundly asleep. We were alerted to it when we heard a beeper keep going off and very loud snoring. Nothing we did could wake him up - shaking him, calling his name, clapping our hands by his ear. He was out cold! He only awoke when he fell out of his chair and hit the floor. Luckily, he was unhurt.

We know the effects on a person who is up 24 hours. The idea taking care of you has not slept is frightening. They might as well be drunk

I’m not even a med student and I can completely say that anyone who said this doesn’t know how how hell double 12 hour shifts are

I just came out of 12h shift and no even 12h is not normal.patients were not even hard cases but first time i felt on the verge of crying.and medicine is almost only profession if not one and only where people r expected to work 24h or more.and no, its pointless.just night work is enough for human to be stress out, but off course nights must be worked at some jobs, not question about that part.i feel completely drained out after 15years and wished i had chosen other profession

I've always thought this way of 'training' doctors was criminal.

THIS. Thank you, Doc Schmidt. I'm trying to push for the same in veterinary medicine. Just because we had to suffer doesn't mean those who follow should have to. We should always push to make things better.

It for sure boosts the level of medical errors. It's literally impossible that it wouldn't.

Shit, our chief does 24h shifts still too (smaller hospital to be fair) We just need a lot more personell or a complete structural shift.

As a chronically ill patient, nothing throws a wrench in the gears of my healthcare quite like a visibly exhausted medical staff. Shift-hazing (and medical hazing in general!) really needs to disappear. I'm sick of getting left in random rooms for hours because they were so tired they forgot to do whatever they moved me for, or that they moved me at all. Or they just perform random tests because they forgot which patient I was

i don’t want my healthcare providers, especially that MDs to be exhausted and overworked!

So true!!!! Doc S tells us as it is!! Much needed. Things change, and they should change for the better. Thank you bringing up this important topic

Fighting the good fight. Everyone would have to stand up before anything changes. Why won’t we?? Why does that have to be the status quo. I’m with ya!!

Since there's a shortage of physicians, it feels like making more residency spots would solve both problems. More physicians getting trained and fewer residents needing to work ridiculous hours with the increase in man power. I know it won't happen without other major shifts in the healthcare industry, but still

That claim helps any resident to tell their attending physician..

Next time im in the hospital, will be asking my resident when was the last time they slept. And asking for somone else if they are sleep deprived.

I wouldn't trust myself to perform my own job - which is neither time-critical nor does it have any potential to result in harm to anyone - for 24 hours straight. It's absolutely insane to expect doctors to do it.

Question for the group. Would you guys get on an airplane if you knew the pilot had been flying for 24 hours ?

Someone didn't do their resiliency modules after the 24h shift

I agree that many hours is bad. It should be changed. I also feel 12hr hospital shifts should be changed to 8hr.

Who wouldn't want to be treated by well-rested doctors who can access their full brain power to investigate obscure symptoms, rare medical conditions, as well as all the other "general" medical knowledge that may be needed along the way...

Maybe patients should insist on it.

Oooooh so that's why nurses are usually so rude and quick to tell me to shut up if I'm moaning in pain. They're jealous that i get to scream into the void.

Preach Dr. Schimdt!

I'll never understand the argument of, "Well, I suffered, so you should have to suffer, too!" Shouldn't we be trying to make things better?? Also, preaching to the choir here, but like, having medical professionals be THAT exhausted is detrimental, if not outright dangerous, to patients. I sure as hell don't want a doctor at the end of a 24-hour shift after an 80-hour week helping me in an emergency. But what choice do we have, when practically every hospital or program does this?? Are there any studies out there about, like, the number of mistakes doctors make at the beginning of a 24-hour shift versus at the end? I feel like that would be very illuminating...

Lead paint was also considered fine too… I think the older generations are more entitled than the generations that have come after. We have on average been more productive, working more hours and making less money and receiving less benefits year after year since the 1970’s. I think it’s about time the entitled generations pay it back. Work for free even if they think that’s what we should be doing.

During my intern year call was q3 with one day off a week which meant our schedule was 30 hour shift, 12 hour shift, 30 hour shift, etc until that one day off. A "golden weekend" was once a month when you got 2 days off. We got to trade schedules so long as one of us was there so we all worked hard to make sure that whoever had a golden weekend was post call the day before so they could leave right after noon conference the day before. My mental health suffered dreadfully from that schedule. And through that we were making emergency medical decisions, talking with families coping with end of life decisions, delivering babies, running codes (usually all on the same night). It meant we were all burned out before we even started our first "real" job. I remember one morning when I was in the clinic post call without any sleep and miserably sick (because that's also part of this...I couldn't take time off just because I was sick) and I just couldn't make myself care about my patients' problems. I realized at the moment that we were supposed to be so compassionate for everyone else but have zero compassion for ourselves. That hadn't occurred to me up to that point because it was just a given that that's what we did. So messed up.

As a (potential) patient, I prefer a well rested doctor rather than someone lacking sleep because of long shifts. Hope it changes. I'm not from the US but I think in Spain there are also 24 hour shifts.

Reminds me of the army. "Tradition"

Looking forward to finishing my studies next year................

Along with this, 12 hour shifts for nursing. Multiple studies have shown how this produces poor decision making from fatigue, yet 90% or more hospitals require this of staff. There are lots of nurses working two jobs who work 6 or 7 twelve hour shifts. Every week. This is especially true of night shift nurses. Then they also are interrupting sleep to attend family commitments. Not safe. But it persists because it's cheaper for staffing. And on top of this, night nurses have anywhere from 33% to 50% more patients that they are responsible for because no one wants nights.

Watching doctors on call and catching a few winks between pages helped me see why a doctor I'd see in the hallways looked odd. Socks and shoes not orderly, hair needing combing, and ...... 24 hours is too long.

I know a guy who fell asleep while on the toilet after a 48hr shift in neurosurgery. Brutal...

24 hours shift should not just be eliminated, they should be criminal for doctors. Here is my logic: they are basically treated as if it was criminal for commercial plane pilots. They are fines that are present. There are flight duty limitations. A commercial pilot can't work more than 36 hours a week, not more than 100 hours per 672 hours. They also can't do more than 1,000 hours of flight in 365 days - and in Europe, it's 900 hours. On top, they need to take fatigue management course Truckers also have legal limits on how many hours in a row they can drive.. And okay, they are difftence in risk. A plane crash in a major metropolitan area could kill thousands. A truck driver might kill a few hundred if he carry explosive material and something awful happens. Meanwhile a doctor tired choice such as forgetting a coma on a drug dose (0.1 mg and 1 mg might look so much the same, but it's not) could kill fewer persons directly. Probably that someone would look and go "pills of 50 mg of parenteral heroin? Yeah, you meant 5 mg, didn't you?" There is also the change if time zone that doesn't affect doctors as much because they are not traveling all the time. It does affect pilots and, to a lesser degree, truck drivers. However, it's still putting people at risks. I think doctors and nurses needs standards similar to pilots and truck drivers, with some adaptation to give a little bit more flexibility (so instead of 1000 hours, maybe 1200 hours per year max and no 24 hours shift).

Sleep Doctors: People needs about 8 hours of sleep each night. All other doctors: Residents are not people

I dare any RN or Doc to tell a patient or a family member that they are tired, stressed, whatever…patients and family are particularly awful to many of us. A few days agoI told someone I was going on vacation. A family member eas near by and said “ it must be nice! You go on vacation and all your patients get left alone”. I said nothing.

I also would like to not die becauee you are exhausted. Thanks

I worked more than 24 hours during a snowstorm. December 18, 2009. 😂 I couldn't do it again.

Getting rid of the 24 hour shift is great in theory. But people do have to be there to cover that time. And telling someone SURPRISE!!!! We changed the rules and even though you’re a senior resident or attending you now get to take up the slack for new residents is a recipe for even more people walking away from medicine. It will simply make a huge problem even worse. Im convinced the only real way to solve the issue is to make more docs and create more residency seats for them. Instead of increasing the work load on physicians that are already overworked and went through the insanity of the first year or two of a residency divide the workload among more junior residents.

HAHA 'Honestly I'd just prefer you suffer in silence'! Literally the most Boomer sentence every uttered! From 'You kids should be seen and not heard.' to 'Honestly I'd just prefer you suffer in silence'! Pure gold!

That’s how it is in nursing too when I would complain about poor staffing and high patient ratios. I was told that’s always how it’s been and how it will always be.

Thats so messed up.... most residents (and attendings) work like 60-80% here so get more days off (or a full week every few weeks)...and idk 12h or so are the long long shifts i guess (or hope) But certainly not 24h

Agreed! As a potential patient I would strongly prefer a doctor who is well rested over someone who went to some prestigious med school. I do software and I've seen people do all kinds of stupid stuff when fatigued. Some people still work crazy hours, but I think it's more of a hustle flex than anything to do with real productivity. If anything it's counterproductive. My sister is a medical resident right now and it boggles my mind that the standard (and mandatory) practice in medicine is to keep them constantly exhausted and sleep deprived. That's not good for them or their patients.

Doctors encouraging patients to work along as they fix whatever is wrong with them, and still supports this kind of system is mindboggling to me at first. All this in the name of (or worse, in disguise of) beneficence, it's just despair inducing at this point.

I want better hours for doctors of all levels so I can trust their decision making. I also would like to fix the 'don't think zebra's ' Moto that's forced down their throats. Shouldn't it be more like "ready for the common but test for the less common". I'm in a relapse of a rare side effect to a rare side effect and it's taken only an MRI to adjust the course. In the meantime the antibiotics I've been on has mutated the infection. I could have MUCH less damage if they just did the MRI when I showed infection symptoms but insurance probably wouldn't have approved it.

I feel like this is about more than one thing. Also, no one should work 24 hours straight but ESPECIALLY not doctors or other care workers.

What if we stopped limiting the number of medical students. More medical students means more residents and more residents means we can spread the load. Current residence programs are an obvious health hazard to residents and their patients that no doctor ought to approve of.

Yeah yeah "don't reinvent the wheel" but sometimes the wheel needs work!

🚫⚕️👩‍🚒🚑👮‍♀️No one should work 24 hr shifts. Especially medical, fire & police! 👩‍🔬Hasn't it been scientifically proven a person makes mistakes they wouldn't if rested & refreshed? 👩‍🏫🤜⚖️Labor laws/unions protect other workers with limits - - a break every 2 hours. This is in effort to cut down on accidents. 💲he problem with doctors is the patient is the one that suffers & still has to pay a bill! I don't see protection for these that have jobs.… 🤕📊& than if severe enough is another adding to unemployment stats. ♻️Isn't that what is referred to as catch 22? 😴A tired doctor also gets grouchy bedside manner & doesn't listen or explains Instructions to the patient. … not what I pay for 🤷‍♀️ 🤹‍♂️ It's quite a wretched conundrum. 🕊 PEACE 💜 BLESSINGS 👼

Gonna be honest, something like this happened exactly to me some months ago, almos 112h/week and 1-2 36h+ shifts. While my senior residents obviously disliked it, they didn't want to talk to the attendees about it 'cause they would have retaliation against us and do some sort of punishment. Well let's just say that i tried to reach to some ppl in the hospital that could help us with our shifts, but the attendees were NOT happy about it, so much that i recieved insults and abuse for it, at a point that i had to retire of my program.

Me watching this as a start another 24hr shift in 5 hrs 💔

I'd love if you did a skit to bring attention to the under prescribing of pain medicine thanks to the DEA. People with cracked ribs and chronic intractable pain often can't get meds prescribed. DEA cuts production of the pills so patients can't fill prescriptions. Despite (or because of) these actions taken by the DEA, overdose deaths are increasing exponentially, and chronic pain patients are killing themselves - not because they are addicts, but because they are being tortured and their quality of life drops to zero. I know it's not the greatest material for a skit, but you're talented. This is an important issue because any of us can get critically injured and live the rest of our lives in chronic pain.

I wonder if opening more residency positions would help improve hours - more manpower and chiefs/seniors/attendings would not have to take on more hours. And decreases the bottleneck of many graduates that did not match .-.; … and provider shortage

Doctors more than anyone should know the importance of sleep. After enough sleep lost you just can't think straight. It's not a matter of skill or laziness or resolve, it's the brain needs sleep. Hell, hallucinations would start to be an issue with a schedule like that. Not to mention temors, lack of memory, irritability, increased errors massively slowed reaction time and more. And it doesn't just get better instantly. It can take days or weeks to fully recover after schedules like that. Maybe this is an acceptable thing in the most extreme and widespread disaster, but it's a sign of critical failure to resort to such extreme workloads otherwise.

I would be very upset if my doctor had been working more than 12 hours when they tried to do ANYTHING for my healthcare. Even read a chart.

First year residents driving in cars “poses significant safety risks for [them]” This study does quantify the extra risk, it just says it is significant, however if you remember the mythbusters episode where they tested sleep deprivation vs drunk driving and do a shitty meta analysis we can quantify the increased risk. During their controls both kari and tory made no mistakes. They then drank enough to get to .08%bac Kari made 7 mistakes in the city test, then veered out of her lane 104 times (58 seconds altogether) whilst tory made 2 mistakes in the city test and crossed the lines 4 times (1 second altogether) during the highway test. Can you tell who drives drunk more often? Lol Anyways back to the point, they then waited a day and deprived themselves of sleep in a controlled environment for a full 30 hours to do the sleep deprived test Kari had 6 mistakes on the city course and went out of the lines 210 times (332 seconds) on the highway course. Tory had 5 mistakes on the city course and went out the lines 110 times (77 seconds) on the highway course. So .08%bac is a conservative 2x risk factor based on torys control having no mistakes, and his drunk test having 2. Whereas sleep deprived for 30hrs is a very conservative risk factor of 16x baseline at very minimum. So while sleep deprived for 30 hours you can expect to see a minimum of 16x your normal amount of careless mistakes. www.ncbi.nlm.nih.gov/pmc/articles/PMC6684113/ mythresults.com/arrow-machine-gun

It wasn't fine for him or his patients and to think that is literally insanity

It’s abuse !!!

Yeah absolutely not. 24 hour shifts lead to mistakes being made. Mistakes that could end or ruin someone's life. Mistakes that are preventable by giving doctors proper breaks. Here is a thought also- get two residents for a previously one resident slot?? If it's the same hours and same level of doctor then it is the same paycheck the hospital would have to write, just split between two people working much more reasonable shifts.

My first 28 hr shift next week as a PGY1 in FM LOL yay

I think everyone prefers that everyone else just suffer in silence. Lol

What I don't understand is why this is not a regulated issue, because it absolutely creates a risk to the patients when health care workers are expected -- as a matter of course and not only in emergency situations -- to stress their minds and bodies with inhumane work hours/conditions. Once upon a time, truck drivers' on-road hours were not regulated, but by instituting regulations for maximum daily limits on hours driving, it improves public safety. Contracts bedamned, this is a public safety issue.

Humans are only efficient, productive, and fully functional for about 12 hours of the day at most. Our peak capability is only about 6 hours long. It's really weird to expect an overgrown primate wearing pants to do difficult labor for 24 hours effectively.

My longest shift call has been 42 hrs straight with only 2hrs of sleep ..

I've heard about this before. I thought it was comical and dangerous. When a client calls for me legal advice--I work quite late--and I've just woken up, I tell him I'll call him back later. Most legal actions can be reversed. And I won't give legal instruction when I'm tired--let alone a sleep-deprived physician. That is remarkably irresponsible.

People used this argument against student loan forgiveness, as well. I hate people who think like that. How is anything ever supposed to change for the better if everyone says that everyone in the future should have to go through what they went through.

I wonder if patients were able to help this cause by asking their doctors how long into their shift they are and if its too long we ask to see someone else

Imagine the irony of a sleep medicine doctor having to do those long hours with irregular shifts

If you put in earplugs the patients will also suffer in silence...

24hr shifts are like docusate... it's not effective and there's way better options, but it's still part of the culture so we do it anyway...

Hi Doc. Schmidt; could you make a video about the Blakemore baloon? Did you read the positive comments to the video where you made a clever ad of a balm? I think it's to block bad smells.