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I think it's true that neurosurgeons have a higher rate of Alzheimer's than the population. This always bothered me.

Even when controlled for factors like being richer than the general population and therefore more likely to grow old?


I read the abstract (but not the whole article), but how does neurosurgery mortality compare with other employed rich people?

That is, I'd expect cases of Alzheimer deaths to be higher in the wealthy just because I'd expect they would live longer and not die of other ailments before Alzheimer's "got them".

Is it possible that neurosurgeons don't actually have a higher rate of Alzheimer's Disease, but just get correctly diagnosed more often than the general population? I suspect a lot of poor people with limited access to health care die of that disease but it never gets labeled or recorded. But neurosurgeons can recognize their own symptoms and generally have access to the best possible care.

The only way to be sure would be to perform detailed autopsies on a large random sample of the population.

The problem with that theory is that they get diagnosed at a higher rate than other types of surgeons. This would indicate that their direct exposure to something related to the neuro part of their job title is involved.

A possible explanation could be based on research suggesting that regular lack of deep sleep increases risk of Alzheimer’s. Given that Neurosurgeons have a grueling 7-8? year residency period after medical school, it would be possible that they undersleep far more than the control group.

I would like to see how the prevalence of Alzheimer's among Neurosurgeons compares against a population with similar work/sleep schedules (eg. finance)

Do they ever stop? What does a surgeon do in their free time?

From cursory googling it looks common for programs to expect you to work right up to the legal limit (80 hours/week based on 4-week averages) during residency. Having 16 hour days for ~7-8 years means that you probably have to get used to being a bit sleep deprived all the time.

What a great idea, to have sleep deprived surgeons. Really, the legal limit should be much less than that for safety reasons alone (patient safety, not surgeon safety).

Part of the problem apart from handover (which wouldn't typically affect surgeons), is the level of complexity. Much of the idea of the modern surgical training (and many other fields) is that the only way of learning well enough is to do, as much as possible. So we push surgeons to carry out as many surgeries as humanly possible.

Whether we have the balance right in terms of maximizing repetition vs. minimizing mistakes from tiredness is a good question, but it's not a given that reducing the number of hours worked for surgeons would improve patient survival without a great deal of care in how (e.g. ensuring you cut their number of hours without reducing their critical skillset).

The grueling schedule of medical students is the result of a coke fueled dean about a hundred years ago.

The airline industry was forced to stop pushing people so hard, the medical profession should do the same.

Somewhere I read tired health workers are better than fresh workers who need to take over patients (losing context and details in the hand offs). Not sure if that explains it though.

Yes, I've read this several times: it's the handover that is most problematic.

However, IMO you can do things to mitigate this but it involves paying workers who aren't working at full capacity; basically doubling staffing costs I think. If you have a large shift handover period, a staff member doesn't take on a new patient unless they can finish their active input within the shift, it goes to the people sitting idle waiting on the next shift - people are never under a single worker for less than a half-shift; so you can't start with one nurse for half-an-hour at handover and then get passed on, you'd start with that nurse and get half-shift + ½hour. At the back end of the shift the nurse -- and other personnel -- would not be taking on new patients who couldn't be signed-off within their shift, meaning they have fewer patients, meaning they can focus more on handover of the patients for whom it's necessary.

There's probably holes in that, it's like reverse pipelining.

You might get enough effect by having a smaller overlap and having workers shadow the worker who is going off-shift but that's not really reducing handovers so much.

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