One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted.
I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting for sleep-dep survival traits; only people who can work insane hours make it through hospital medical training, and only people who can take shift work in their stride make it as hospital nurses.
(Also, my observation of hospital doctors is that anyone you see on a ward outside core office hours is relatively junior, i.e. aged about 22-35. Senior consultants and professors work normal hours like everybody else. As for the nurses ... my understanding is that ICU nursing burns them up.)
(Source of observations: former hospital pharmacist here, who just got a refresher course c/o a relative who spent three months on an acute stroke ward this fall.)
I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.
* Through roughly 9 hours, the error rate was about the same. Say, x%
* In the 10th hour, the error rate increased. Say x + y%.
* In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%.
* In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%.
* In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16.
I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum.
Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things:
1. They had personally witnessed someone make an error they could attribute to tiredness.
2. They themselves had never made a mistake due to tiredness.
3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.
I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.
And the sleep deprivation and hazing "I did it so everbody else must too!" is definitely a cultic thing.
I use cult very deliberately to point at the reasoning being entirely irrational and social as opposed to underlying value. And also because actual cults use slerp deprivation.
Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..
So she's only "scheduled" for ~67 hours a week averaged throughout the month, but realistically it is in the 85-90 range.
It's easy to see how a more demanding or emergent field could seriously select for folks who are more able or willing to work on less sleep.
The original rationale was that the "on call" hours were not supposed to be busy and the duty doctors could spend most of them sleeping in a bunk or studying: but by the late 1980s (when I heard about things) they were working more or less constantly through their shifts.
The EU Working Hours Directive was supposed to fix this by banning workers from putting in more than about 50 hours a week without very specific protections being enforced, but one of the first things the UK's Conservative government did in 2010 was to stop enforcing this.
I know labor unions (sometimes rightfully) get a bad rap, but it seems this is exactly the type of abuse they were designed to stop. There are some  but the rate is low, less than 15%, and there's a sort of self-censorship style of pressure against pushing harder for them.
It controls a great deal about doctor's education and working conditions. It does not collectively bargain, so it's not strictly a union. But it's more powerful than most unions at this point. So a glib, "maybe doctors should get a union to represent them" answer to poor working conditions for residents doesn't really make sense. They already have a powerful organization that should represent them.
I think that there is at least some group of physicians who really think that poor working conditions for residents improves patient outcomes and doctor training.
As for patient outcomes, I'd love to see a study of them for the roughly 15% of residents that have a union and very modest work place improvements, compared to outcomes for the rest of residents. You're right, many doctors do seem to "feel" the traditional method is superior, but I'd like to see hard data.
I found this paper: http://www.acgme.org/Portals/0/PDFs/Position%20Papers/Commit...
It's citations have some hard data. Maybe the most interesting part for me was this:
"There exists instead a widespread belief that physicians can be trained to defy the biology of sleep and that safeguards are in place so that patients and residents are not harmed by work schedules that are unheard of in any other workplace, let alone a hospital. That belief is most evident today in the FIRST and iCOMPARE studies that set out to prove that there is no difference in patient outcomes from residents who work 16 or 30 hour shifts. The principal investigators were so convinced that no harm would come of these experiments that they determined it wasn’t necessary to obtain informed consent from either patients or residents in the hospitals where the studies were conducted. This determination has been widely disputed and is now under investigation by the Office of Human Research Protections."
I don't know at what point the errors from sleep deprivation exceed the errors from patient handoffs. People seem to take different views depending on what side of the work hours debate they fall on.
Not in the US. The doctor per pop count is very low.
Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.
I would challenge that assumption because I don't believe there's any consistent number of hours worked by residents in rotation, is there? I mean there are published schedules and then there are actually the number of hours worked which at least according to the other posters is even more than scheduled. So if there's already an element of randomness here and different doctors are getting different numbers of in-rotation hours then it's plausible hours could be made consistent and reduced, isn't it?
I'm sorry about your mother in law regardless.
In a plane in level controlled flight, there is very little to hand off between two type-rated pilots. Both folks understand the machine, and the machine is working the way it is supposed to. Humans work the same way! Parents "hand off" their healthy kids to schools or babysitters or relatives every day.
But imagine a plane that is in the process of crashing; it's in a dive, controls are not responding as expected, one of the engines keeps turning off. A pilot is fighting to regain control... how comfy are you with THAT pilot handing off the aircraft to another pilot in the middle of that situation?
It's a little silly as an analogy, since plane crashes tend to be resolved pretty quickly one or the other. But conceptually, just imagine a plane that is in the process of maybe crashing for 12 hours. There's a good argument for a pilot to just see that through instead of "clocking out" at 8 hours.
Are you aware that on long haul international flights pilots do in fact rotate who is actively "flying" the plane? Flying is in quotes because most of the work is done by automation these days. I won't draw any analogies between the autopilot doing much of the work for pilots and nurses doing it for doctors because I can't actually support the statement with any data.
I should also point out that the vast majority of doctors don't work 120 hours a week continuously, rather, they experience higher-than-usual clusters of working time vs. not working time. That is, they might be on rotation for 36 hours straight but then off for 36 hours or more. And some of their shifts might only be 8 hours. Residents work longer hours, but are supervised by doctors.
I know several ER docs and they all cite the dangers of patient hand-off as the main reason they continue to support long shifts.
We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.
Patient hand-offs between shifts tends to introduce errors. Instead of finding ways to improve hand-offs, the ACGME is simply trying to have fewer of them.
These are supposed to be some of the "top minds" in medicine and that's the best they can come up with.
It's a bit like bringing someone from south Florida to northern Michigan this winter for some ice fishing. I understand that it's cold here, I intellectually know about, have observed the effects of, and can treat frostbite and other problems resulting from this cold - but all that would make it hard for me to intuit the problems of a visitor who was unable to control their fingers when they removed their gloves and dipped their hands into a minnow bucket to bait a hook. My fingers work fine in that bucket, everyone else on the lake is doing it, you're just going to dry them off in a few seconds and put them back in warm gloves...what's the issue?
I've just witnessed this with my partner's recent bout with cancer. While her oncological surgeon completely understands, her reconstructive surgeon had no conception of what she was going through.
That alone is 16 straight years of normalizing sleep deprivation. Time spent studying and working is regularly 80+ hours per week, certainly from med school onward and certainly the year spent studying for the MCAT.
If they start at 16 and finish their residency at 30 or 32, that's the only life they've ever known for all of their formative years. They cannot relate to people with a normal schedule because they have not experienced it.
Let's not even get started on how many nurses smoke.
Similarly, doctors and nurses do not have significant experience in being a patient, especially one who isn't around hospitals all day.
She eventually had to switch to another position, because it became too much. She said she lost a lot of her empathy for the people who had spent 60-70 years abusing their bodies, and now were just here to slowly die under her care (regardless of how good that care was). She also hated that so many people were kept alive on machines long past the point of having any life left, just to keep the families happy. She said after a while, she could tell the difference... that whatever made a person a person (the soul or whatever you believe in) was gone, and all that was left was a pile of meat being kept "alive" by the machines.
I think (without much data here) that medical training pushes insufficient sleep on doctors due to on-call schedules. While hospitals have doctors, many of their specialists come from private practice or multi-specialty clinics, which rotate being on-call between then (often in 12 hour shifts). The other cause of insufficient sleep is that if a patient under care of doctor has complications, they will often be called, even if just for a consult.
Economically, this is likely efficient compared to having hospital specialists (which may end up with nothing to do many nights), but causes docs to train for worst case scenarios sleep-wise.
I'd hope someone doing something as high risk and important as surgery would be getting as much as they need regardless of how much that is.
Exceptions are specializations that are essentially emergency/urgent but even most of them are on rotations like another poster mentioned where they've shifted their own sleep patterns to match their hours.
Since watching my friends become doctors (psychiatrists, uroligists, neurointerventional readiology) and my wife become a surgeon I have started telling friends and family "If your doctor looks under the age of 35 then you should ask them the last time they slept before they start treating you.
tl;dr : hospitals straight up own the futures of their med students/residents/fellows .. so they overwork them while paying them $40-55k year, and when they aren't working they have to study for their exams.
Can someone please tell me why they still put medical students through this institutional hazing?
The reason resident physicians work so much is because residents make $60k working 80+ hour weeks, and the PAs or NPs who would be willing to cover the floors at night would make $150k+ working 40hrs/wk. Residents also have no collective bargaining power because of the residency match system. You can't easily leave one program and go to another because you don't like the working conditions, for example. If you want to leave, you're more or less blackballed unless you're switching fields. And you don't want to speak up about the conditions because you've got $300k in debt and a degree that's useless until you finish residency.
The 3rd year of medical school is much tougher since we spend about 10 months of that year on rotations in the hospital. While some rotations are much lighter, others like surgery again get close to the hours limits. This is complicated by the shelf exams we take every 8–12 weeks. These require an additional ~2–3 hours/day of studying and most of a weekend day as well. Obviously, this study time is not counted towards the hours limits, but it definitely factors into fatigue and burn out.
Sounds like they should just legislate away the "Residency match system."
Pre-med = college, and aside from the highly scientific work load is no different than any other college experience.
Medical school (no longer called "pre-med" by anyone) is typically 2 years of classes and 2 years of clinical rotations. The rotations are not going to be 120 hours a week but may be 60-80. But unless you go to a teaching hospital and consent to student contact (which may or may not be a requirement of treatment) no med school student is touching you.
Residency is after med school (they're full doctors now) where you train your specialty, and at least in the 4 year program I'm familiar with, their title is intern, resident, resident, senior resident for each of the four years. They have increasingly high levels of responsibility as they progress and by the 4th year they are basically oversight/management of the other residents who assist on complex cases and bring in at attending physician(s) for big stuff. Hours are typically 80+ and I'm sure you could approach 100 for very demanding or emergent specialties but it's certainly not "pre-med training" and 120 is pushing it for sure.
After you graduate residency you move to an attending, fellowship, or research position and the hours drop back down to the 60-70 range and decrease as you gain seniority.
There are only two reasons for someone to be in an ICU: they require a therapy no other floor will administer, or their condition/therapy requires very frequent administration/titration/observation. These two reasons frequently overlap.
Sleep isn’t optional in general. It’s optional in the ICU, because the premise is “if you don’t need this level of attention to survive, you absolutely shouldn’t be on this unit.”
I also wonder if, like 'emergency room', 'ICU' has lost some of its meaning in some places.
For non-ICU stuff, yes there could be some better coordination around sleeping time, but again there's so much non-verbal stuff going on in just a physical assessment.
What would really be useful is having cleaning services and admin/billing services come at the same time (well, right after) a nurse comes, to take advantage of that interruption.
I don't want to make it sound like it's impossible. It's not. But it is incredibly inefficient - which is why it doesn't happen - and the answer to "How can we make it happen?" is "Pay for it."
That’s cost effective for the hospital but simply not viable longer term. To be clear waking someone up every 2.5 - 3 hours is very different from waking them up every 2.5 hours and another 2+ random times during the night.
As long as somone is only in the ICU for 72 hours it’s not a huge deal, but start talking a week and it’s a significant issue.
If the hospital staff had sent her home, she would not be woken every two hours. The medical staff were fine with that.
It would have been perfectly reasonable for them to let her sleep; it would have been no more risk than they were advocating for.
Clearly it was optional.
Unless there was some regulatory, legal, or hospital requirement that she receive a certain standard of care. They may have been fine with her sleeping through the night at home, but if she's in the hospital they need to take care of her.
It would not be an easy sell in a courtroom to explain that while you checked everyone except her every 3 hours, you let her sleep through the night and there was an issue that cost her life.
Not that the physicians and nurses should have been taking that into account but the folks crafting the regulations or hospital policy very well may have.
What you've just said supports the article's argument that hospitals are designed to prevent people from sleeping.
- Elementary school starting so early all the kids are half asleep in class.
- College + Sleep? Not gonna happen.
- 24 hour construction in certain part of NYC, check!
- Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, and all your neighbors do the same!
- Having attention deficit? Lets start with ADHD medecine, not with a sleep study, no sir.
- Bazillion jobs requiring on call, waking people up at all manner of time, as a standard thing.
- Neighbors woke you up? Toughen up bro!
- Myth around how so many people apparently can do just fine on 5 hours of sleep.
The hospital thing is just a symptom of a society built around lack of respect for sleep. No one seems to consider it an important thing. If you're drowsy because you couldn't sleep, it's considered a minor inconvenience and little more.
Keep in mind that in our school district, elementary school students need to be in by 8:40 while high school students need to be in by 7:50.
Our neighborhood is setup for walking. The elementary school is a six block walk, so most people walk their kids to school. My daughter didn't sleep past 7:00 for most of elementary school. Our experience was that elementary really could have started closer to 8:00.
I'm with you on all your other points. But, I think our experience was significantly different for elementary school.
Our corporation hired a firm to do a study, found that younger children performed much better during earlier hours, and flipped the schedules. The next year, the high school started at 8:50, and the elementary school at 7:45, and the schedules have been essential unchanged since. I can't describe how much of a difference that 1.5 hours made to a 16-year old.
As a father of 3 young children, they rarely sleep past when I have to wake them for school anyway. The same is definitely not true of teenagers.
Kids are different, and we really don't have very good ways of dealing with that in some ways...
What I would suggest is that there is not a Pareto-optimal solution here short of redesigning how schooling works entirely...
(Our no-longer-elementary-schooler, by the way, never really had this problem. He just seems to sleep a lot less in general.... kids are different.)
Some of the kids mindfulness podcasts (Peace Out as an example) are also good for this kind of thing
The one of reading age is already reading after he's in bed. The hard part is getting him to stop and actually go to sleep.
I will look into the podcasts; thank you for the suggestion!
However, she still seems wired to fall sleep at a certain time, and we finally decided that fighting biology is a losing battle. The strategy of moving bedtime a little bit earlier each day didn't work at all.
One can try but you will be limited by biology: The problem is that our internal clocks are reset by daylight. You can't just shift yourself to another timezone, since your circadian rhythm will always set itself back to the respective local time. So if your brain prefers you to go to sleep and to wake up at certain points it will always be relative to "local (sunlight) time", not relative to human clock time.
I work in the education industry, and the education experts in our company have been saying this for years.
All the sleep-cycle research is on his side. And he was friendly, focused and persistent. But his campaign failed.
A later school start would have cut into the available daylight for after-school sports practices and events. Perhaps 30% of students participated in these, and perhaps 10% in total (or their parents!) were adamant that anything that short-changed the football team was an evil that needed to be stopped.
Still, the don't-do-it crowd was vocal and implacable. Eventually everyone else gave up. So high school students continue to get out of bed, very groggy, at a time that's too early for them, and struggle to get a grip on their morning classes. We wouldn't have it any other way.
Its basically that society used to require daylight to get anything done two centuries ago, and most people worked the farm by daylight, so fast forward generations and centuries and we are still structuring our lives around that - such that we are actually outside in the dark and doing our main activities indoors during the day.
Humanity is nothing if not set in its ways.
Your last sentence could not be more true.
The other problem is do you have any idea of how much bureaucratic nonsense would have to be changed in order to make one simple change such as changing the schedule of a school start and stop time.
It makes you wonder how hard it is to change things that may be of higher importance than this.
I feel like a big part of it is that very young children are geared towards being early (at least from my perspective) risers. Parents end up shifting their day to account for that. And then as kids get older, their rhythms start moving to starting the day later, but by that time the parents' routine is molded around being up early.
Not sure where I'm going with this exactly, just an observation of mine.
Now that’s in essence the whole problem with tax cuts and privatizations: public service is cut to the bone, and privatized ones maximize their profits together with the citizenry’s inconvenience.
Do it like daylight savings time. Have everything start two hours later, all year. The issue for the kids is time related to sunrise, not time related to when the parents go to work.
Is that what it is? I thought it was total sleep duration. Do you have a link explaining more?
They're related. If you go to sleep at the same time (relative to actual-midnight) and get up an hour before school, you get more sleep when school starts later.
Or else what difference would any of it make? If all you did was start school at 9:30 instead of 7:30 and then kids used that to go to bed two hours later, nothing has changed. But when people go to sleep (and are inclined to wake up) has a lot to do with daylight.
That still doesn't seem all that helpful. If my high school had started at 10 instead of 8, I'd be out of class at 5:30 instead of 3:30, done with fencing practice at 8 instead of 6, etc. I'd finish the night's homework two hours later, and finishing that was already well past sundown even on the original schedule. A later start time wouldn't have been an opportunity to stay up later -- it would have been an obligation to stay up later.
The total lack of unscheduled time is an independent problem.
The obvious problem then being that the routes are too long.
You have to wonder if there isn't some kind of carpool incentive the school could give to parents to get rid of 90-100% of buses. How many stay at home parents with 9-passenger vehicles would be willing to make $500/month by filling their minivan with other kids when they deliver their own kid as they were going to do regardless?
Cheaper than buses, kids spend less time sitting in vehicles because there are 8 kids instead of 30, fewer vehicles (and especially fewer huge diesel buses) on the road because those parents were driving their kids anyway.
RE carpooling, this probably cost competitive but their are other factors that make this harder than you think. Buses are allowed exemptions to booster seat rules, minivans aren't- do you leave the van full of car of booster seats all day? Do kids carry their own? My kindergartener still has issues buckling their self in in a crowded car, that really pushes up pickup/drop off time spent. How do you get kids to school if the primary driver is sick or has car trouble? Who is liable for accidents? Do you randomly drug/alcohol test your parents?
None of these are insolvable, but they also aren't easy.
School busing in the era of autonomous vehicles gets a lot more interesting- you could have much smaller and efficient pick up routes. However, I think it will take (US at least) society a while before they are willing to leave 4-8 children alone in a car for 30 minutes a day. It just takes a couple 5th graders fighting in a car before the district decides supervision is needed.
Buses are allowed exemptions for pragmatic reasons, not safety reasons. Whatever the rule is, it should be the same for both, in which case there is no relative advantage. If you're not willing to allow it for a minivan, why are you willing to allow it for a bus? (This also doesn't apply to high school students who don't need them anyway.)
> How do you get kids to school if the primary driver is sick or has car trouble?
How do you do it when the school bus driver is? You maintain some level of reserve and you send someone else.
> Who is liable for accidents?
The insurance company. The better question is who pays for the insurance, but considering that the school would already be paying for it for a school bus, it still doesn't appear to be any disadvantage for the school either way.
> Do you randomly drug/alcohol test your parents?
They're voluntarily choosing to drive someone else's kids for money. If you want to do that and they don't, they don't get put on the roster and don't get paid. It seems like the only real question is whether (or how often) it's worth the cost given the expected probability of drug abuse in your parent population.
Speed doesn’t kill, change in speed kills.
With significant mass at play, a bus in a collission doesn’t change speed as suddenly as a car, thus passengers experience less G force.
The rule does appear to relate to weight, and safety reasons:
> Federal agencies like the National Highway Highway Traffic Safety Administration (NHTSA) have long maintained that even without seat belts, school buses are the safest mode of transportation for children. Between 2005 and 2014, NHTSA reported 1,191 crashes involving school buses or other vehicles functioning as school buses. That makes up less than 1 percent of the 331,730 fatal collisions in those 10 years. Among the 133 people who die each year on average in related crashes, only 11 are bus passengers or drivers.
However, that doesn’t help when the bus collides with an immovable object, so the rules are being reconsidered.
No, buses are safer, period, even without seatbelts. Occupants of bigger vehicles have much better outcomes in auto collisions, and buses are some of the biggest vehicles on the road.
Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is lethal.
By causing much worse outcomes for occupants of the other vehicle or pedestrians in the same collision. Not really something you want to have around your schools and homes where your kids may be the pedestrians or occupants of the other vehicles.
It's also no help for single-vehicle collisions, which are nearly two thirds of auto collisions. 12 ton bus vs. 2000 ton overpass, overpass wins.
In addition to the unfortunate high center of gravity that increases the probability of rollovers (which are especially likely to cause injury without seatbelts).
> Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is lethal.
Which is a reason why statistics make school buses appear safer than they actually are -- a minivan picking up the same kids would be on the same roads with the same traffic speeds, even if the "average" minivan would be on different roads traveling at higher speeds.
That may even be a good basis for the rule -- car seat required if traveling more than 35MPH.
This has nothing to do with whether or not bus riders need to wear seat belts.
> It's also no help for single-vehicle collisions, which are nearly two thirds of auto collisions. 12 ton bus vs. 2000 ton overpass, overpass wins.
> In addition to the unfortunate high center of gravity that increases the probability of rollovers (which are especially likely to cause injury without seatbelts).
You're making buses sound like deathtraps. And yet, per passanger-mile traveled, they, despite lacking seatbelts, are two orders of magnitude safer then personal automobiles.  0.11 deaths/billion miles, versus 7.3 deaths.
Buses, the way we currently use them, are much safer then cars. This isn't even a point of debate.
And the liability issues all seem to go the other way, don't they? Buses are less safe (they don't even have seatbelts), problematic incidents involve a larger number of students, the buses are more officially associated with the schools, etc. And actual parents obviously have better incentives to make sure their kids are safe than someone who is only doing it for a paycheck.
Some kids threw peanuts out the window and into his car. He followed us to the next stop and pounded on the door. She courteously opened the door and in he came, shouting the whole way.
The awkwardness was compounded when I realized I had known this man for 10 years.
I don’t have a very high opinion of bus driver training.
So the problem starts multiplying.
1. Can't afford supplies, facilities, etc.
2. Can't afford to be properly staffed.
3. The school is invariably going to be under-performing and we've decided as a society that if your school isn't performing well we're going to penalize it by cutting funding, which exacerbates the funding problem.
4. You've got all sorts of people, fiscal hawks, tax payers, etc who don't really want to pay for education, let alone pay for half empty schools and all that overheard. No one really wants to subsidize a ghost town...
So the result is school districts that are too small to make sense being combined together to try and pool their resources and maintain quality and efficiency.
So if you live out in super rural or low population density areas, and families aren't churning out children like they're old school farmers or Catholics, then this is the sort of reality you'll have to deal with.
We are lucky that our school district provides before and after school programs since my daughter's elementary school doesn't start until after 9:00 AM.
The battle to get up early is about as old as time. We aren’t that far removed from an agrarian-based economy, and farm work has always required very early rising (my father grew up raising dairy cows: he was fond of reminding us as children that the cows don’t care how tired you are).
“Early to bed and early to rise” is not a modern day mantra, but I fear we’ve kept the wake up call constant while continuing to push how long we stay up. I don’t know how to fix it: if your kid is in an after-school program until 6, comes home to eat dinner, and then still has to do homework... I don’t see how an early bedtime is even possible.
Have you actually looked? Ask some parents and see what replies you get.
Continuing our story time, as a child a very small number of my classmates were part of after-school programs. Kids today are much more scheduled and for far later into the day. I grew up wandering the streets and maybe had baseball practice one day a week with a game on Saturday. I was home from school around 3:30, had homework done by 4:30-5:00, ate dinner around 5:30, and was put to bed (in elementary school) by 8.
I remember the thrill of having my bed time pushed to 9 around 8th grade. Bed time was 10 in high school except for weekends.
Very few people rode the bus to school: most had a parent drop them off.
This game changes significantly when both parents work. If both parents have to be in the office by 8, kids have to take the bus. Which means they have to get up very early. If both parents work until 5, then kids have to be in after-school programs. They’ll get home by 6-ish and have to fit in dinner, homework, and whatever activities they need to put on their resume to get into college.
If you wanted to sleep, you shouldn’t have chosen to rent. Your landlord couldn’t be expected to pay $1000’s  extra to build your apartment, after all.
Do you know where the differing laws are?
Pretty sure it's the only time in my life where I've literally slept as much as I wanted...and felt great.
And %3.3 people have DSPS, who are just simply labelled as sleazy.
The primary purpose of K-12 education these days is to keep kids locked up so their parents can go to work. If Mom and Dad have to be at work at 8, as is often the case, the kids have to be at school before 8. Teenagers, who naturally sleep in later than younger kids, would be better served starting school at 9, but because our society still infantilizes teenagers and young adults, we can't systemically trust them to fend for themselves in the mornings.
This isn't to say that K-12 schools are entirely unconcerned with actual education, but it has to accomplish this goal within the constraint of keeping children locked up.
Wait, what? I slept so much in college. Way more than at any other point in my life. You schedule your own classes and aren't actually in class that much, gives you plenty of time to sleep.
The statement, however, said college means no sleep. That is a bit disingenuous to say that was meant to imply the person was working full time.
That would be like saying "living in an apartment means no sleep!" because you lived in an apartment above a 24 hour bowing alley.
I didn't hate it. Sleeping during the day has taught me how to put a pillow over my head in order to block out all light, and now I can sleep in the brightest loudest room without trouble.
I haven't had lucid dreams since then, or if I have, they've been really really rare and extremely hard to remember. Now that I think about it... Could my lucid dreams and OOB have been triggered by smog from the traffic in that area??
Though not during the day, I lived in a second floor apartment that overlooked a traffic circle that had an elevated subway stop, was a main route for ambulances going to the hospital a block away, and a crucial interchange for traffic entering/existing that part of the city. I barely slept for the first few days and then got the best sleep of my life. I rarely woke up for anything other than my nightly trip to the restroom.
Fast forward a few years and I now live in the suburbs. I've been woken up several times in the past month by the sounds of a mouse scurrying in the ceiling of an adjacent room.
When I've stayed over at friends house (who are parents) they have very strict go to bed times for their kids. THOSE darn crazy kids are up at 5 or 5:30 banging around the house full of energy.
I remember having to get up at 5:20 AM four days a week, to leave 20 minutes later to catch a bus at 5:58 AM to be get to high school in time for classes starting at 7:10 AM. And a teacher complaining to my parents that I often seem tired.
That's the only reason I don't put my daughter on the school bus. I can save her an extra 30 minutes of sleep by driving her to the school myself.
In all seriousness, I've seen mentions of studies that suggest going from 8 hours to 6 does _not_ correlate with a 25% decrease in productivity, because most people aren't consistently productive for all 8 hours of a day. I know in my case, there's an extremely strong inverse correlation with productivity and how bored I am with a particular task. I'm sure I'm not alone.
When I first started freelancing hourly, it was a sobering feeling to see how little of my time was actually billable for actual work. It takes random screen grabbing software to make you realize that most of the time you are not working. Of course those days have long passed for me but I’m always left to remember just how wasteful office workplaces are and how much time people waste away in their life. More than half of their working life is a total waste. Tell me, how does that make you feel? :)
Lack of sleep is very rarely an issue with your employer.
The hospital staff absolutely knows that sleep is important, but they have competing goals that are deemed important enough to interrupt sleep for. That seems very much different from societal-level / cultural priorities.
Isn't the amount of sleep you get determined by when you go to sleep? So if elementary school kids need more sleep just... put them to bed earlier?
"Imagine having to get home from your commute, feed your family, getting the older siblings to/from extracurriculars and then getting the elementary school ones to bed by 9:00/10:00pm. It's easier said than done! School needs to start at 11!"
I must be missing something. How is your family life going to be less hectic after work with school being 2 hours later?
(1) The school day is too long and the school year too short, anyway, so chopping two hours off the end of the day and making it up by extending the school year would be a win.
(2) Even if you don't do that, eliminating the end-of-school to end-of-typical-fulltime-work gap would be a different win.
Another trend that I know of in the Netherlands (where I'm from) is that newly built hospitals have private rooms for all patients. These hospitals no longer have shared rooms by design. They also try to minimize hospital stays as being in a hospital exposes you to hospital infections, is expensive, and to be avoided unless explicitly needed.
That's a big difference with Germany, which is old fashioned on this front. The default attitude in Germany seems to be to keep people in a hospital much longer. In Germany you only get a private room if you need it medically or if you take private insurance.
I suspect a lot of this stuff is part cultural and part wrongly aligned incentives because hospitals just bill whatever to insurers and couldn't care less about patient comfort because their paying customer is the insurer, not the patient. The insurer cares about cost, the hospital cares about milking the insurer to the maximum of their ability. Between those two, patient comfort is not much of a concern.
The reason things have improved in the Netherlands is that they spent the last decade realigning incentives to cut cost between insurers and hospitals. People pick their own insurer (they are all private). However, all insurers are required to offer the same base packages (with extras if you want). So, people can easily switch insurance provider if they want and they do. So, insurers now compete on quality of service and cost. Which is why a lot of hospitals are actively concerning them selves with upgrading their facilities to improve customer happiness (still the insurers). Insurers are happy when their customers don't switch to another insurer and when hospitals don't waste their money.
As a patient I don't think about my insurer when I'm at a hospital. I just want to be treated.
It's more likely to be the opposite, where the hospitals with the better healthcare and care of the patients have to spend more money and thus get less contracts with the insurers, who have an incentive to reduce cost as much as possible. Out of the 4 hospitals I've visited for healthcare in my area, only 1 will currently be covered by insurers in their most basic plan next year, and that one is the most remote.
Basically, next year I cannot visit my regular hospitals to continue my current treatment plan without getting a more expensive basic healthcare plan (+15%, or roughly 220euro).
One time my family was charged $1000 for an ibuprofen for a perforated eardrum at an emergency room. We never even saw a doctor because we waited 7 hours and left. It was faster to get an appointment at our personal doctor the next morning. I can't imagine what it would have cost for a severe problem like a car accident...
This kind of maddening injustice is why I left the USA after living there for 3 years, and will likely never return even to visit.
If you fix that by giving them the possibility to take their money elsewhere, insurers are incentivized to behave a bit better. Likewise, hospitals will want to make sure they attract patients from good insurers so they keep their revenue coming in.
Of course if you are in the US you cannot shop for insurance, the law ensures that you take whatever your employer offers.
There are separate private insurers that are cheaper when you're younger and more expensive as you age, but that's a parallel system and you must earn over 40k Euro/yr. to purchase that (or be a state employee for some weird reason).
Single time when I was in hospital, but private assured, they did everything to keep me as little as possible, even skipping an OP for a non invasive procedure, because the recovery time was inexistent.
1. My surgery affected my nervous system and thyroid; maintaining blood flow (especially in my legs) was important.
2. Knowing how I felt at the time kept the nurses informed about the dosage of medicine they should administer. Hormones and their effects can change rapidly.
3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.
I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn’t always intuitive, especially if you’re not yourself yet.
> I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Well, yes, it would be enormously practical in a large number of situations if we wouldn't sleep. It would also solve a lot of problems if we didn't need to eat. Problem is, those things are biological necessaries with immediate adverse effects if we neglect them. I also believe there is a solid body of research showing the importance of sleep for recovery.
I'm not a doctor or nurse and the blood flow argument does sound reasonable - however, the other two arguments sound a lot like "it's more practical and less risky for us if you're awake", which I don't see is a valid reason. Also, by what medical school is >45 minutes of uninterrupted sleep "too much"?
"If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours."
"..I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am."
This mentality is fundamentally flawed. We don't allow truck drivers to drive for more than 11 hours a day because lack of sleep impairs your cognitive ability. But we're expecting patients recovering with potentially days without rest to make informed decisions?
A counter to your example...
When my youngest was born, my wife had complications with delivery due to high blood pressure. They refused to release her or the baby until two conditions were met. One was that her blood pressure was lowered and the other was that the baby put on a % of weight. Without intervention neither would have been released. I had to pull the care team aside during a group visit to ask them:
"Is high blood pressure a symptom of insomnia?" Yes
"Is a REM cycle 90 minutes?" Yes
"Have we had more than 45 minutes in recovery without your staff waking my wife?" No
They left us alone for 3 hours straight and magically her blood pressure returned to normal.
We then had to have the attending pediatrician point out to them that the medications given during labor caused water retention and that apart from the lack of weight gain, the child was 100% on track and doing extremely well.
The hospital we were at, Emory, is highly regarded but their whole system seemed to be fundamentally flawed because it didn't take into account the continuous interrupts. Or rather there was no distinction between 3 uninterrupted hours of rest and four 45 minute periods of rest.
I had a very severe head impact couple of years back, and while I was fuzzy at the time of impact, few hours before I go to bed, it was not until the day after when, my internal functions went half way south. I am not certain if the weakening of some of my external senses immediately happened or not.
This was dead, but it seems like a sensible question so I vouched for the comment to resurrect it.
My understanding is that with any head trauma doctors are concerned about the possibility of bleeding into the brain, and it's much easier to detect the neurological symptoms of this in a patient who is awake. But I'm not a medical doctor; someone else here may be able to provide a more in depth answer.
You're correct; as far as the patient is concerned, it's better for them if you let them sleep. But it's easier for everyone else if the patient isn't allowed to sleep, as sleeping and dying look exactly the same.
I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order.
Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.
Choking? Pulse goes up and breathing becomes shallow.
Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.
"and it's much easier to detect the neurological symptoms of this in a patient who is awake"
In this context, I imagine neurological symptoms would be things like cognitive function, spatial coordination, memory functions, and linguistic functions.
All of those are things that are not really possible to assess while sleeping, but would be possible to assess in a patient who is awake.
If the patient is sleeping, you can't use a) or b). Now, there might be an argument that everyone should get c) and lots of sleep, but drilling into a person's head is not risk-free either.
Maybe there needs to be some investment in better analysis equipment for routine draws.