My shift had finally ended. As a second- year resident, I was driving home after 30 hours awake straight. During this time, I delivered several babies, performed a cesarean section or two, a couple of circumcisions, rounded on many patients the following morning, triaged new patients, and taught medical students. Never during that 30 hours was a 5- minute nap possible; clinical load would not permit this.
I couldn’t wait to get home at the end of the shift as I was completely exhausted. So, I buckled up and prepared to drive the 20 minutes home on interstate 95 so that I could finally get some rest before my next shift started less than 24 hours later.
I could feel my eyes starting to droop as I was driving. I turned the radio up loud, drank a big gulp of my hot coffee, and rolled down the window. I had done this many times previously after these long shifts and had figured out all the tricks to make it home safely, or so I thought.
I must have not been able to fight off my increasingly heavy eyelids, because I woke up suddenly to the jarring bumps on the side of the road- intelligently placed to wake up drivers such as myself who may be drifting out of the lane. This startled me, and I turned the wheel hard to get back on the road. However, I overcompensated, confused, and dazed from no sleep, and spun around 180 degrees so that I was facing the opposite direction of traffic on the interstate. I slammed into the wall of an overpass and my car came to a sudden and jolting stand still.
My heart was racing, my hands were shaking, and I tried to get my bearings to understand if I hit someone, or if I was still in danger and needed to get out of my car. I quickly got out, unbelievably unharmed (and miraculously no one else either) and called my husband with trembling hands. I was only 5 minutes from home.
A man with his wife and children in the car quickly pulled over to see if I was ok. He could see how shaken I was an offered to sit with me until the police and my husband could make it.
My car was totaled. I walked away fine, without a scratch, but with a new understanding of the inhumane conditions expected of physicians.
Ultimately, I believe patients have the right to know if they are receiving care in optimal situations that promote safety and decrease preventable medical errors. Physicians have an incredibly strong, important and powerful ally in our quest for humane working conditions- our patients.
We’ll call it the wristband challenge. It works like this:
Physicians take call for any varying amounts of time. I propose physicians start wearing rubber wristbands (like those commonly seen promoting the “LIVE STRONG” campaign) signifying to their patients how many hours straight they have been responsible for patient care without a break
Green: 0-24 hours
Yellow: 24-30 hours
Red: 30+ hours
Think this could never work, or that nobody would do this? Guess what, its already been done. Please see how the South African Medical Association came to bring this project to fruition in their country. https://www.samedical.org/campaign “The SAMA campaign makes it easier to identify doctors who have worked longer hours. It is also a visible reminder that South Africa should employ more doctors to manage their workload”.
This is a way to promote transparency with patients. They should have a right to know if their obstetrician is on their 30th hour awake and about to deliver their first born child. Or if their physician is admitting their father with congestive heart failure and writing detailed medication orders without sleep for over 24 hours.
Physicians want to have humane working conditions that promote patient safety, but it is complicated for a profession such as ours. We have been told it is illegal to form a union. We are threatened that going on strike puts patients at risk. We can’t just all walk out of an ER at the same time, and therefore we don’t, out of respect for our patients and concern for their well-being. However, this puts us in a trap of beneficence where “do no harm” compels us to continue working in unsafe conditions not only for our patients but for ourselves.
A physician can wear their wristband and not have to fear speaking out or arguing with an employer or worry about being labeled a “trouble maker”. If the bands become standard, hospitals who are employing safe practices can use this as a bragging tool that their physicians are well rested and rightfully claim to be advocates for their patients. It is a silent tool of protest for physicians who will continue working without going on physical strike and allow our patients to do the fighting. In the end, it is the collective voices of our patients that matters most and will get the most promise for change to a dysfunctional system.
As a patient you may ask, “well, why don’t you just not schedule yourself for more than 24 hours on call”? If you are a physician in private practice you can. However, the trajectory of medicine now has more physicians employed through a hospital or HMO. The loss of autonomy in these positions does not allow a practicing physician to dictate the amount of time on call thought to be “reasonable” or “safe”. This is especially true for resident physicians and medical students who are bound by their teaching programs rules. Importantly, the number of residency spots has not sufficiently increased each year to allow for enough doctors to fill in the patient needs that continue to increase in number.
Up until now, no hospital or CEO of an organization wants their patients to know how long their doctors have been working straight. It isn’t posted on websites like C-section rates, repeat hospitalization rates, or complication rates. The government isn’t mandating reporting this statistic that directly impacts the safety of patients AND physicians. Perhaps if the public knew and could see first-hand, in real time, the types of hours the doctors caring for their family members were working, they would demand change.
It would no longer be an abstract concept. I don’t blame current residency programs- they are simply trying to meet patient needs with the limited number of physicians employed to fulfill this demand. This would mean increasing the number of residency positions so that we have enough doctors to provide required care. This in turns means there needs to be increased funding for residency positions from the government.
we can seek meaningful change in our profession without going on “strike”. Patients will see wristbands turn from green to orange, and ultimately red. Patients will begin to speak up. Not only out of concern for themselves, but out of care for their physicians.
We remain a team, with health and healing at the core of our mission. With enough help from our patients I do believe we can see a change in the culture of medicine. I believe this should start with our teaching institutions and residency programs that are treating our most vulnerable of patients.
