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Comment by GavinMcG | Hacker News Reader

Have you looked at the research regarding which of those two options leads to better patient outcomes?

Just from looking at the massive amount research on the effects of sleep deprivation and burnout on humans, and assuming that medical professionals are humans, we can infer that performance would decline. But ok, I’ll play along.

https://bmjopen.bmj.com/content/9/1/e024778

https://www.healthecareers.com/nurse-resources/nursing-patie...

https://journals.plos.org/plosone/article/comments?id=10.137...

It’s a mixed bag, but strongly leaning against longer shifts, in my opinion.

Have you? I’d love to hear that answer.

I have. Longer shifts with fewer turn-overs results in better patient outcomes.

And that makes sense, but only if there are enough breaks and downtime in between, and probably not if the doctors hasten from one patient to the other.

Could you link the studies?

I would agree, assuming the patient workload is appropriate, I think it all depends on how busy the place is. I've chosen to do 24 hour ER shifts instead of 2 12-hour shifts in a place that would see about 1-1.25 patients per hour, mostly during the day so I would usually get 2-6 hours sleep overnight. But in a busier place, I would much rather work a 12, 10 or 8 hour shift as the intensity increases, say to 2-3 patients per hour. And the case mix also matters a lot, if you have a bunch of patients with coughs and colds, or minor injuries, you can see 4 an hour easily, if everyone is a demented nursing home patient or requires a translator, seeing 2 / hour might be crazy hard.

That's strange as you would expect quality to suffer in every single respect when forced to work inhumane conditions. I would find a different mechanic if I thought the one I was considering was miserable from being overworked. Was there an explanation for why outcomes improved? Perhaps it is necessary to look into who conducts these studies as I imagine someone up the ladder profits greatly from having 1 doctor do the job of 2.

One simple reason might be this over: people make errors over time, but they become familiar with the case. That familiarity is lost whenever they hand over a patient. And you can't solve that with documentation since people would be busy all day doing paperwork instead of caring for patients.

This problem exist in every domain, and in medicine it can have deadly consequences. People sign up to become doctors knowing that they will have to work crazy shifts. But I guess they underestimate how the system hobbles them since it is focused on being efficient, not on achieving the best outcome for the patients.

Quality does suffer as the hours drag on, but quality suffers more when you hand off a case (which can be quite complex) to someone else. The tired but experienced-with-this-case doctor still does a better job than the rested doctor who is brand new to the patient's case.

Source?

That answers the wrong question.

Source?

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