Comment by pmoriarty | Hacker News Reader

Comment by pmoriarty | Hacker News Reader

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"The stereotypical banker who is coked up and accidentally destroys the economy isn't really as cool anymore as he was in the 80s"

Even in finance, the phenomenon of working crazy hours didn't end with the 80s. I'd be shocked if it wasn't still the norm there.

In the medical field, it's quite typical for doctors and nurses to work insanely long shifts and get by on very little sleep... this was the case even before the pandemic hit, but as everyone knows it's gotten even worse since as doctors and nurses started getting sick, dying, and quitting, leaving more work for the rest.

It's long been common in the tech field.. especially in startups, but even among established firms working long hours is quite common.

All sorts of people living paycheck to paycheck and undocumented workers are routinely exploited, and working long hours is common there too.

In many parts of the world it is the fortunate minority who can afford to have a healthy work-life balance and get enough sleep.

The way the medical profession treats sleep, in a field where mistakes cost lives, has always seemed absolutely batshit crazy.

There's, I suppose, a weird societal level "getting your money's worth" from their compensation - since their actual hourly rate would plummet on the basis of working 30 hour shifts non-stop and the like.

Not to mention that the institution as a whole has enormous difficulty actually properly handing off care between different providers, yet we would only see benefits from being effective at doing so - not to mention minimizing the impact of bad doctors.

The medical field could really use an overall authority that can force them to adopt safe practices. We treat truckers getting enough sleep as a higher priority, as a society, than surgeons.

Another thing is hospitals adopting air industry style checklists, which doctors fought tooth and nail as 'insulting'. Despite every ounce of evidence massively pointing toward this saving lives.

The US medical residency was mostly created by William Halsted, a very influential surgeon. He was partly responsible for this culture of sleep deprivation, insisting that residents be on-call 24/7.

He also was a serious cocaine addict who injected it every day. It's of course an oversimplified historical narrative, but at least part of the reason medicine does things this way is the traditions were set up by someone out of his mind on coke.

The studies that justify it are absolutely bonkers too.

One study compares the ACGME limits (max 24 hour shifts) against a "flexible" system with 28 hour ones. Unsurprisingly, there's no effect--since both groups are totally zonked at the end. Meanwhile, data from lab experiments and virtually every other field (trucking, aviation, etc) shows that performance craters well before that.

The rationale for long shifts (other than money) is "handoff": when a new doctor takes over, details about the patient's condition and treatment plan get lost in the shuffle. In some cases, they might not ever have been recorded (e.g., a subliminal impression of a patient's color or breathing). Many people are weirdly nihilistic about improving this, but it seems like it almost has to be the lower-hanging fruit since solving it doesn't require butting up against fundamental limits of human physiology.

I remember reading that the reason for long shifts at hospitals, for doctors or nurses, is that most mistakes are made during hand-over. The thing had a study cited, I'm sorry I cannot find the source, so the hospitals optimize for minimal hand-over. I would think they also did a control study on mistakes made during the last few hours of shifts when care providers feel the strongest effect of sleep deprivation, but I don't remember that being compared.

Doctors and Nurses actually have somewhat of a good reason, though I do think they are pushed too far (especially of late). Handoffs during shift changes mean opportunities for information to be miscommunicated or lost, which negatively affect patient outcomes.

In principle though, handoff errors can be reduced with better procedures, training, and technology.

Making tired people less stupid would require a fundamental breakthrough in neuroscience---and it's not for want of trying that no one has found a way to do so yet.

It's unfortunate though that medical professionals have a deep misstrust/hatred for new technology due to bad experiences from poorly run it contracting.

My mum worked for the NHS and I'd regularly hear her complaining for weeks/months on end about new IT systems that either didn't work, were hard to use or were months or even years behind schedule. All while knowing how much these projects cost (it's all public info here) and that the people working on it where getting paid in a day what she would be lucky to make in a week.

From (UK/NHS) experience handoffs are done I have certainly seen it when I have ben in hospital.

They could just focus on the patients they are monitoring and stop taking new ones after their turn is over.

Speaking of finance, a recent headline read "Young Goldman Sachs bankers ask for 80-hour week cap".

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