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Comment by DontGiveTwoFlux | Hacker News Reader

Medicine as well. Medical residents can have shifts that are 24 hours long.

Recently enough a group of doctors went on strike with perhaps one of the most reasonable demands I have ever heard. They didn't want to continue to do shifts that were over 24 hours long!

Well, as long as they only let people with jobs that can kill people be sleep deprived, it'll be ok

I understand that medicine is tricky because the handoff from one doctor to the next can be dangerous for patients. You have to balance continuity with exhaustion. That's not to say that they necessarily have the right balance now, but it's a hard problem.

I've heard doctors say this, but they never cite evidence. But there is a wealth of evidence that says that doctor performance drops significantly with motor performance being harmed so much as to increase the number of errors and excess movements. I'll add the citation at the end, but it's not about the single study; it's about the fact that there is little evidence to the contrary and lots of evidence saying it's the case. If this were a drug, we'd be prescribing it every which way.

And most importantly, know that this is not necessary. American doctor supply is restricted by the AMA. America could suck the best doctors out of many other nations if it so desired and its healthcare practitioners would be better rested, more mentally well, and far less error prone.

http://www.bmj.com/content/323/7323/1222.1.short

> I've heard doctors say this, but they never cite evidence.

Seems pretty well researched by a quick google. Maybe they're eliding the support not because it's an assumption, but because it's so thoroughly established they take it for granted?

http://www.nejm.org/doi/full/10.1056/NEJMsa1405556#t=article...

https://psnet.ahrq.gov/primers/primer/9/handoffs-and-signout...

...

> But there is a wealth of evidence that says that doctor performance drops significantly with motor performance being harmed

That's true too, but I worry you're trying to rebut (X & Y) with evidence for Y.

If we find ourselves slipping into a battle of emphasis, maybe we face a problem of optimization?

From what I'm seeing, your hypothesis about this being a question of optimisation seems well supported. I worry that medical professionals resist changes here out of cultural belief or a resistance to process. That wouldn't be without precedent. Even something as well-established as washing hands between patients isn't done without explicit process (compliance is near 13% without explicit reinforcement for something that everyone learns the legend of Semmelweis for), and surgeons refuse even _private_ outcomes tracking.

Agreed, I can't know from first principles if the right shift length is 4 or 8 or 30. I'm sympathetic to your suggestion that it would be a surprising coincidence if doctors landed on the perfect number through historical accident. Maybe they have a feel for safety in shift length, but they don't in other areas like washing, so maybe not.

It probably varies by specialty and even individuals, probably a monster of a problem.

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