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Comment by ska | Hacker News Reader

Hence some of the dysfunction in medicine.

Medicine is an interesting case. The prioritization isn't so much on the health of medical practitioners and nurses, but on patient safety.

It is argued that patients have higher survivability rates when patient handoffs/shift changes are kept to a minimum. The focus has never been on the health of doctors, nurses, X-Ray technicians, etc. but from a public health perspective.

This has far-reaching consequences in itself.

Yes, I've heard that argument before. I've asked before if the research shows the problem is handoffs per se, or the protocol around them, but haven't had a good answer. There also doesn't seem to be good research into the longer term impact of these negative consequences on the practitioners.

I've worked around clinicians and clinical staff, and several times been surprised how much is left to personal memory and scheduling, including some inherently risky protocols/procedures that are at all functional only because the people doing them are careful ... some of these obviously easily improvable.

I have several friends who are doctors or nurses, and have talked with most of them about this. They all parrot the "doctor/nurse-patient continuity" line, but when pressed as to whether fewer handoffs actually outweigh the effects of exhaustion on outcomes, they all seem to take it as a given that it does, without being able to support it.

I suspect that, even if fewer handoffs does take an edge over exhaustion, the handoff process could be improved greatly; from what I'm told, handoff processes vary wildly, often aren't formalized, and even when they are, adherence to process is pretty lax, in part due to the effects of exhaustion.

It’s really interesting to do workflow analysis in clinical settings. It’s not uncommon to run into “we do it this way because that’s the way we’ve always done it” situations.

There is also a bit of machismo/pride for the shifts worked thing, which isn’t helpful.

The nurses may be working 12 hour shifts, but they’re unlikely to work more than 4 in a week. Overtime is expensive for employers, so they prefer to hire more or hire contract nurses where necessary.

Even the doctors usually cover 12 clinical 12hr shifts a month. They may do more work after another takes over, academic work, moonlight, or have admin work.

And having a good income allows you to buy your way out of most modern problems/work, like comparison shopping, cleaning, or even having and then raising their children for them.

A friend of mine who is a nurse tells me that she's at the hospital an hour before her shift starts (in order to prep) and is there a good hour after her shift ends (in order to help prep the next shift). So she's effectively working nearly 14 hours a day, even though she only works 3-4 consecutive days.

I stretches credibility to me that people can keep up a high quality of work for 14 hours straight, even with a 3 day break every 3-4 days.

> The nurses may be working 12 hour shifts, but they’re unlikely to work more than 4 in a week. Overtime is expensive for employers, so they prefer to hire more or hire contract nurses where necessary.

Or they're picking up more hours at a different hospital, so there's no overtime but they still make more.

I've just been reading Why we sleep by Matthew Walker. In it he mentions doctors will on average kill one patient during their residency due to sleep deprivation.

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