Thursday, August 30, 2007

On Sleep Deprivation and Medical Education

On the Over My Med Body Blog, see this eloquent rant about what it is like to begin a sub-internship. A sub-internship is an experience for (usually fourth year) medical students during which they function like interns, and hence functions as an introduction to the world of post-graduate medical training. Sub-interns, and later interns and residents are up at all hours of the night, taking care of often severly ill patients, with little experience and less sleep. Yes, they do have various forms of back-up, from sub-specialty fellows to seasoned faculty. But nothing can make up for the cloud of cotton wool that fills one's head after being up all night.

It's a sad testimony to our training system that the experience described is little different from the one I went through just about 30 years ago.

But now the intrepid blogger of Over My Med Body may be getting an inkling why doctors who have had years of training like this can get so upset when their dedication, knowledge, or work habits are questioned by some "suit" with a six-, seven-, or eight-figure income, a "suit" who is comfortably in bed every night of the week, and who never has to handle an emergency, much less a patient throwing up blood, hallucinating, and febrile at three in the morning.

But perhaps some of the money going to pay for those "suits'" fancy salaries could be used to pay for more hands on care givers in teaching hospitals, alleviating the need for those sub-interns, interns, and residents to work so many hours straight.

1 comment:

MedInformaticsMD said...

Sub-interns, and later interns and residents are up at all hours of the night, taking care of often severly ill patients, with little experience and less sleep.

Ten years ago I wrote:

"It should be remembered that a license to practice medicine is a privilege earned as a result of intensive study and abdication of the rights of leisure. Becoming a physician requires intelligence, high ability and extreme discipline. Basic training in the Marines is far easier than the year of medical internship, which is only a small part of the medical education process. Basic training in the Marines lasts only eight to sixteen weeks and has fairly regular hours reserved for sleep. The internship year alone is a physical and emotional marathon that runs 24 hours a day. Specialty training after internship, such as the residency (most U.S. physicians now take a residency) and fellowship, is often even more demanding."

I added that, regarding leadership of clinical IT initiatives:

" ... This medical background, or the training background of other clinical specialties, supplemented with healthcare IT expertise through medical informatics training, provides the ideal leadership qualities and abilities for meeting the challenges of clinical computing."