On the Romance of a Doctor's Endless Hours

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Commentator Joe Wright is in his fourth year of medical school. Among many other things, he's learned why working long hours are part of the culture of doctoring.


Commentator Joe Wright is in his fourth year of medical school. Last year he spent much of his time in the hospital and in clinics. He often set his own hours. And he learned why doctors are famous for working long shifts.


All through my third year I visited patients in the hospital. Late at night patients would ask me, `You're still here?' Early in the morning they'd say, `Do you sleep at all?' I came to think of these questions as part of a kind of romance, the romance of the driven doctor and the appreciative patient. I never understood this romance before this year, and because I never understood the romance, I never understood the fuss about work-hour limits for doctors in training. The fuss about hours is worth reviewing.

Two years ago teaching hospitals faced litigation and the threat of legislation to regulate work hours. So the group that supervises the nation's doctor-training programs imposed an unprecedented limit on doctors in training, a radical policy shift. No longer could interns and residents work 120-hour weeks or 36-hour shifts. Now they can only work 80-hour weeks or 88 in a few circumstances. And a single shift can't last more than 24 hours or 30 hours in some circumstances.

Some recent research suggests that even these new limits still may represent safety hazards in the making. Even so, some people inside medicine still see the 80-hour limit as a disturbing sign of outright slackerism. From the point of view of policy, I find that reaction stupefying. Putting drastically sleep-deprived people in charge of other people's well-being is a transparently bad idea. One can make reasonable arguments about weighing the dangers of sleep deprivation vs. the dangers of more frequent hand-offs of patient care from doctor to doctor. But we can do something about the risks of hand-offs. The need for sleep is fundamental human biology.

But then there's the romance. In my third year, I usually determined my hospital hours myself. If I worked a 90- or a hundred-hour week, as I occasionally did, I had chosen to do so. And maybe I stayed because I wanted to keep a promise to a patient or look good to a teacher or see something amazing, like a middle-of-the-night emergency surgery. Whatever the reason, I stayed. And even as patients told me to go home, they would often grow more fond of me when they saw me at all hours. They would affectionately introduce me to their families, telling them that I was always there. I was their medical student, loyal to them, there for them.

During times when I felt like I had nothing to offer, my patients could make me feel wanted, important, almost like a real doctor. No one wants to watch a doctor punch a clock, even if research tells us it'll be safer for everyone. If we know a doctor is a worker, we want a doctor to be a hero. Even as my patients told me to go home, I think we secretly agreed it was much more romantic if I stayed.

SIEGEL: Joe Wright is a student at Harvard Medical School.

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