CBC Forum: How can doctors' shifts change to best serve patients?

CBC's Marketplace reports that many of Canada's 12,000 resident doctors may be working shifts that last longer than an entire day. Fatigue can lead to more mistakes, but shortening shifts and changing nothing else means that doctors have to hand off patients' cases more often, which also increases the risks of something going wrong. What do you think? How can doctors' shifts change to best serve patients?

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    Comment ()
    Good afternoon. Welcome to today's CBC Forum.
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    CBC's Marketplace reports that many of Canada's 12,000 resident doctors may be working shifts that last longer than an entire day.

    Fatigue from such shifts may lead to mistakes. But shortening shifts means that doctors have to hand off patients' cases more often, which also increases the risks of something going wrong.

    A steering committee with the Royal College of Physicians and Surgeons of Canada looked at the problem three years ago and found that strategies such as managing the risk of fatigue are a better solution than limiting shift lengths.

    What do you think? How can doctors' shifts change to best serve patients?
    Comment ()

    Is your doctor too tired? Marketplace investigates lengthy shifts

    Sleep deprivation can impair the brain as much as being drunk. So why are doctors allowed to work lengthy hours?
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    It is an interesting dilemma. I suppose it's a basic cost vs. benefit analysis though. Are the costs of mistakes higher in cases where doctors were tired or in cases where they had handed patients over? I would assume by the amount of reporting and documenting that it would be easier for a doc to be caught up on a patient’s history than it would for them to function cognitively after 20+ hours straight. The thing about emergency medical care is that everything can change in a moment. It’s easy to say, “Okay, work for 12 hours and then go home” but there’s no way to anticipate who will be coming into the hospital, what care is going to be needed, or how long a patient might need care. What we do know is that it is unsafe for medical professionals to be working for these marathon shifts. It costs everyone in the long run. Docs, patients, the medical system, the government…
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    I think Canada just needs more doctors.
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    Many times topics are presented as if they required lengthy discussion. I submit that this is not one of those. This fits into the 'no brainer' category which coincidentally matches the mental state of someone required to work so long. Surely there has been data collected by those other countries to show the patient benefit so lets stop talking and get moving instead,
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    It has a lot more to do with seeing if the resident (student) can operate under pressure and fatigue without making mistakes.

    Residents do have a level of supervision over them from doctors who have completed their training. I have absolutely no problem with grinding the prospective physicians in order to see if they can withstand the pressure.
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    Illness and health concerns do not adhere to a Mon-Fri, 9-5 clock -- neither should healthcare. ERs and walk-in clinics are not the right model to fit the needs of our 24hour society.
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    We need to stop clogging our emergency departments with complaints that can be dealt by family doctors. And of course family doctors need to have access to their clinics in after hours and must be able to handle walk in clients too. The whole system needs a shake up so that everyone gets value for money spent.
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    The other important aspect of this, beyond the extent of medical errors due to either sleep deprivation or increased patient handovers, is the effect on the residents' health. It's no secret that physicians have a very high rate of mental health issues, and suicides. This has an overall negative impact on patient care and on our health care system as a whole.
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    We need more long term care facilities now and in the future so that people dont spend days in hospital waiting for placements in LTC facilities.
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    What about minimizing the mistakes occurring at handover? Handover mistakes are also present in a 24h model of care, and simply refusing to add more transfers won't lessen this already existing risk to the security of care.

    By eliminating or at least substantially reducing mistakes at handover, we can easily justify shortening shifts.

    In our highly interconnected, digital society where all of the relevant patient data exists on a hardrive in the health care system, there is no excuse for missing or erroneous information being transferred at handover.
    Comment ()
    If there was better connectivity between the patient's records, and all the care workers involved, along with an improvement in what's being recorded about those patients. Utilizing technology so doctors can access, monitor and provide input about patient care from anywhere. Than the entire medical system has no excuse for anyone to have longer than 8hr shifts, with the exception of specific tasks that require more time like long surgeries. Three 8hour shifts per day allows everyone to better care for themselves and still have a bit of a life of their own. Healthier health professionals will result in better care in the system. No human can maintain 24 hour marathons with any regularity and not suffer serious consequences. Even 12 hour shifts regularly are damaging to one's health. The twelve hour shift model needs to go too, in my opinion.
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    I think the only answer is greater investment in health-care. I don't think there's anyway around that.
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    The biggest problem is the conventions about nurses communicating with the responsible physician on shift. After being told it would take "hours" for the nurse to contact a doctor about pain management for a family member, I yelled in the phone I could reach a doc in Burma in five minutes. Voila, ten minutes. Disgusting.
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    Doctors are fatigued? That means they are overworked, trying to do more than they can handle. In that case, the answer is clear even to a student taking Econ 101. Hire more doctors. There's simply no way around this. Extra hands are needed.
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    The problem of fatigue and long shifts is not isolated to residents. Most staff physicians do 24 hr call as well, especially in community hospitals. As an Anaesthesiologist, I work 24 shifts when on call and have been doing that for 18 years. We have 2 members of our group of 24 in our community hospital who are over 60 years of age and do 24 hrs of call. There are not enough physicians to limit work hrs to 12-16 hrs at most. The healthcare system would grind to a halt.
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    Canadian Govt along with doctors association should think about incresing medical students admission numbers in all Canadian universities every year, docotor's shift are kept that way to control the medical business and increase doctor's salary. 12 hours shift is enogh for a doctor. More doctors on the floor will make the issue under control or manageable.
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    Health care needs money. Chase back the billion plus dollars lost to eHealth and ORNGE corruptions. Those money were set aside for the health care of everybody. The money were not for corruptions.
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    I have thought about this issue for several years. I always wondered why airline pilots have to have enough rest whereas nobody gives two hoots about medical residents working 60hours non stop (I worked those kind of hours as a resident but not in Canada). Then it hit me. Leverage. If an airline pilot makes a mistake and crashes the plane. The airline loses a multi million dollar plane. Hundreds of people are killed. It's a heavy price for a pilot to make a mistake because of fatigue. Doctors on the other hand can hurt or kill ONE patient at a time. What are the chances that one mistake by one doctor will kill hundreds of people? Very rare. Plus the fact that usually that one mistake can be traced to that one doctor and that one doctor has to answer for his/her mistake and bears the costs of any legal suits pertaining from that mistake. It's not anyone else's problem. Just the patient who was injured/killed and the doctor who made the mistake. Two people. And therein lies the reason why this issue has not been given that much reform over the years. The fallout from any mistake only ever affects two people (aside from the families of those two people of course).
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    I am writing this from my hospital bed awaiting unplanned bowel surgery on Sunday. It has been fascinating to see how "the system" works and what challenges it has. All the medical staff on the surgical ward have been great, and residents here don't do marathon shifts; they work in teams. My one suggestion for improvement would be to improve / update record keeping technology. Each doctor/nurse/student has to read paper charts, make paper notes, and decipher the notes of others. There are betterways of maintaining patient continuity.
    Comment ()
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