> “Sometimes I worked from 6 a.m. to 3 a.m.,” he recalled, adding that the pressures had cost him his first marriage.
I don't understand how a medical doctor can fail to consider sleep deprivation and overworking not to be a health threat. There is just so much evidence out there that sleep deprivation has similar health effects as alcohol consumption, both in terms of impaired cognitive abilities and long term health effects.
> Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine.
It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.
Personally, I don't think it's a doctor issue, I think it's a Medical Practice and Hospital Group issue. MD's don't really want to take call, but if they can take call for the entirety of one weekend and then have the next 3-5 off, they'd rather do that than take call for 12 hours 2 weekends in 4.
What lead to the systemic disaster that causes this situation to come up in the first place? The scenario is presumably a hospital in a major city in peacetime; doctors shouldn't be working those hours to begin with.
The real question is how to push back.
We have an oversupply of pilots, so we can afford to be harsh/abusive without fear of it boomeranging.
wow I never considered how much of modern work culture has suffered from the influence of a minority of cocaine addicts
For a part of the program that I'm familiar with, a rotating fellow will be expected to be the sole physician of that specialty on-call for the entire weekend for 3 hospitals in a large US city. Then, on Monday it's back to work again at 6 AM. If it's a busy weekend, good luck getting more than 1-3 hours of a sleep a night during that time.
I'm so sorry about your dad.
The comparison is a good one, because we have figured out how to minimize the risks for fighter pilots, but doctors rebel when asked to adopt the same style of work.
Before taking off, all pilots - from Cessna to A360 - go through a pre-flight checklist. No pilot is expected to remember all the things that need to be checked - we know that we can't rely on memory. We tried this before, and people died.
Yet doctors only now are starting to adopt checklists, which are known to drastically reduce simple, avoidable deaths. Things like rates of IV-induce infections go down to nearly zero when doctors stick to a checklist -- but many won't; the practice is met with skepticism even though it is known to work.
It took a long time for doctors to start washing their hands and stop killing people that way.
It's also pertinent to recall that surgeons evolved with and into the medical field from surgeon-barbers... yes, the people who give shaves and cut hair also used to cut into people.
If that ends up being case then 'choosing a human' may quickly become a Market for Lemons situation - you might have gotten better outcomes from human surgeons except the only ones still doing it by hand are full of themselves and too proud to admit they are human and make mistakes.
Those I know do understand the effects of their working conditions. The "appalling and tragic" aspect is that we accept them until they affect us.
My brother was on call this weekend and got called in Friday night at 10 P.M. and Saturday night at 2 A.M., then had to be back to work at 7 A.M. Sunday. Obviously sleep deprived, but there's nothing he specifically could do. This needs to change at an institutional level.
I've been to specialists offices who had a rotating practice where you saw whoever was in that day. You still usually had a primary person you saw for scheduled appointments. I still think patients prefer dealing with a single person and am sure things get lost in doctor's notes or even if you make a phone call to the original doctor.
Medical training seems to promote normalizing very long work ours and sleep deprivation. I know I've heard about law suits trying to point out the egregiousness of it. Long shifts and being on call 24/7 definitely simplifies staffing. I was in a tech support department that went from 40hr support to 24/7 and it was significantly more challenging to manage.
I hope we can improve things because it seems almost inhumane in how we treat medical professionals as well as patients.
NRC says that you can work up to 16 hours, then you MUST go home for 8. It takes some paperwork to get a one-time exception.
(ii) 26 work hours in any 48-hour period; and
(iii) 72 work hours in any 7-day period.
As a 20 year operations shift supervisor this is still way too many work hours. Mistakes happen at the end of long shifts.
I also remember hearing from a vet student that their mentor used older techniques, medications, and practices for certain things, but because he had used them for decades were way more comfortable using them than newer techniques (which can some times be more idiot proof, but less nuanced). That student was convinced it was better than if he had stayed up to date and used modern practices.
Similarly, I remember hearing about aviators relying on automated controls so much that they're less capable in emergency situations. I'm not sure what you can do about that. Ideally, in aggregate passengers are safer overall.
Knowledge of sleep may not have been as pervasive as it is today.
Not if doing so raises the risk to patients to an unacceptable level.
Nowhere in the article is there a link or an embed to an example of his legendary rap.
I believe this is the documentary the article refers to: http://www.leimertparkmovie.com
There's a preview clip on that website that I believe shows him rapping as Dr. Flow: http://www.leimertparkmovie.com/media/06RonCarringtononThurs...
This also all happened in 1999, right before the LA Times articles in 2000. This was a KRS-1 publicity project that didn't end up working.
BTW, it's a straw man to pretend that this story being a fabrication means that the man himself was fabricated. I'm sure some retired white guy after having a stroke went to a rap open mic battle, got noticed by KRS-1 who thought he might be able to use him, which gave him the social capital to attend events regularly and make friends. I also don't doubt that once or twice during the period of his "rap lessons," KRS-1 trained him like a parrot to have a good minute on stage. Especially with the novelty, I'm sure people gave him a break, and there's no indication he wasn't trying hard, and people like when you try hard.
Those lyrics are horrific, though. Also, shit features like this remind me that if the media wasn't 24-hour Trump, it still wouldn't be covering anything important, it would just have to find 10x more stories about waterskiing dogs and rapping grandpas.
Sorry, I'm not clear on something: On what basis are you suggesting the Atlantic article is a "fabrication?"
I suggested the more general idea that journalists make up stuff frequently (even in more important and more fact-checking outlets). So my comment was in the line of "don't rule out that possibility".
Also, don't you have it backwards? Isn't the burden of proof of those presenting a story?
It's reasonable and healthy to question the summation or the evidence, of course, but if you are going to suggest a fabrication -- which is quite a serious charge -- it seems to me you should have some specific facts of your own in support of that. Or at least some specific impressions (e.g. "this particular quote rings false because...").
(To reply to your first question, it seemed you were suggesting fabrication given the context in which you said that journalists frequently make things up, as a reply to a comment defending the newsworthiness of the story topic rather than commenting on its accuracy. Maybe you intended to reply to the parent comment?)
The story is fine and interesting, the headline just detracts from it. The headline from earlier articles (such as the 2000 LA Times article http://articles.latimes.com/2000/apr/03/local/me-15542 -- "The self-prescribed therapy of Dr. Rapp") is much better IMHO.
We all knew each other's skills, but we still respected each other. It was a pretty interesting dynamic. I love hip-hop culture, and, like the Dr., think violence has no place in it. Ahhh, the good ol' days.
Is probably the most useful definition here.
Pre internet we still had the AP (Associated Press), if this was real we would have heard about it and seen it (Which we didn't)
There's more to it than "it's not on Youtube because camcorder footage is pre-Youtube".
And the point is the "Rap Legend" bit.
Stokes will cause people to do strange things, maybe he might have chosen rap when he never would have before.
But the concept it gives you superpowers it wrong and dangerous, it does not ever happen. A 62 who suddenly raps will not be good.... but might be having fun.