Creative Doctoring

Listening to my former students who ended up with MD degrees, there are negotiations in the medical profession, especially in large settings, which sound remarkably the same as any blue-collar labor negotiations. How many days off? Which hours for work? And so on. These are even issues that are negotiated up front during the hiring process.

Not too surprisingly, this situation means that (on average) the attending physicians who work in the evenings do not necessarily have the same profile as those who work during the day.

The demands from the greater fraction of sleeping people, in the evenings, are also less (just board a long-haul transoceanic flight that leaves in the afternoon or early evening – the cabin turns into a flying dormitory within moments after the refuse from that first, quickly-served meal is collected).

There are places in a hospital where circadian rhythm rest cycles do not matter: the Emergency Room, for one, and the Intensive Care Unit, for another.

Improving care in the ICU by coaxing senior physicians to take the evening shift is a challenge in doctoring.

The ICU is an interesting place, in addition, because the bulk of the information comes from electronic monitors, and these data are used to make strategic choices for treatment, often with an overriding sense of urgency.

I recently learned of an interesting solution to this situation (and the fact that this solution exists tells you that it is, in fact, considered a problem).

That solution? Find a comparable hospital in a time zone that is 12 hours away, in a reasonably interesting and attractive part of the world, and let the attending physician serve 8-12 months at this location, where the day shift locally equals the night shift back home.

Does being on-call and hooked up by distance, for a more experienced and senior physician, compensate for the day/night difference when that same person will never be serving the night shift back home?

Currently, data are being collected about this, but there is at least one large academic hospital that I just learned about (no, not the one where I am) that has been trying this out for a while. The other location is in a large city along the coast of Western Australia.

At first the idea struck me as just weird, but changed my mind within a few hours.


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