Recently at lunch I sat with a general surgeon who I have known for many years. Like many of our peers, he is hard working and puts in many more than 40 hours of work each week. Before I decided to “slow down” a few years ago, my typical workweek was 60-80 hours. Dr. N, the surgeon, was lamenting about how things had changed and how new physicians did not share our same work ethic. He should know––his son is in training now to become a surgeon too.
“They don’t want to work as hard as we did,” he said. They realize they will make less money, but they want more time off for themselves and their family.”
“How can they do that and still practice good medicine?” I asked.
His response was simple and obvious––“Shift work.”
In the years since the two of us completed our training, the medical establishment has finally realized that putting in such grueling and long hours is not good for either the patient or the doctor. As an intern in the emergency room, I recall doing a two-month rotation of “24 on/24 off, meaning working non-stop for 24 hours, and then off for 24 hours. This pace was purportedly to prepare us for the rigors of private practice. It also weeded out those docs who would later enter a specialty with more humane hours like dermatology or pathology.
What it also accomplished was to wreck havoc on our personal lives and our marriages. Graduate medical educators finally realized there must be a better way to train doctors, and mandated maximum hours per week for interns and residents.
One of my lay friends asked why we cardiologists for example had to work such long hours. Being my patient as well as my friend, I tried to explain by example.
“Let’s say,” I told him, “that some night––like 3 AM, you have severe chest pain and go the ER––maybe you’re even having a heart attack. Who would you want to come in and see you?”
Without hesitation he said, “You, of course.”
“Well there you go, “ I said. “How good a decision maker do you think I’d be if I had just worked a 12 or 14 hour day?”
He of course had no answer.
I do believe that tired physicians make more errors, and in the end, these changes are probably for the better. It will however take some re-educating of patients to no longer expect their doctor to be there for them 24 hours a day, seven days a week.
A personal touch may be lost, but in the final analysis, this re-humanization of medicine will benefit everyone.