July First in Medicine, and Work Fatigue

   It is now Friday, and the holiday has passed. The new academic year has started as of July First. July First is a crazy workweek in medicine in General. First of all, the Senior Physicians are mostly off duty for the holiday. Then, in the teaching hospitals, the new med students come into clinical rotations. They are brand new, and slow on the uptake of the fast pace of clinical work. At the same time, the new interns come. This is their first day on the job. Moreover, many of the chief residents supervising them are also supervising for the first time. There may be a newly graduated "attending" physician, again, first day on the job as a supervising attending. So, we have a situation where there are many people in their new role on the first day. And remember, the senior physicians are away for the holidays. What this means is that there is going to be stress as everyone gets used to their new roles. While all this is happening in the teaching hospitals, community hospitals are not immune to the stress. Everybody is connected one way or another, in a multitude of ways.
   In community hospitals, the Senior Physicians are still going to take a holiday, leaving the more junior members working. And many physicians are on staff at multiple places. My hospital, The Valley Hospital in Ridgewood New Jersey, has many staff members on staff at teaching hospitals. We are an affiliate of Columbia University hospital just over the George Washington Bridge about 20 minutes away. That is one of the best teaching hospitals in the world. Many of our physicians go to Columbia. Columbia is not immune to July First issues. Nowhere is. We are also about 20 minutes away from Hackensack University Medical Center, and that is a teaching hospital. Many of our staff go there as well. And my hospital still has to take on the newly minted physicians graduating from residency and fellowship programs. They will be new on the job at The Valley Hospital.
   So, altogether, July First is a stressful time in the field of medicine. I worked through this holiday on call myself. And I did it last year as well. We can't all go away on holiday. Someone has to stay and do the work. 


   Here is a link describing this problem in the AARP: 
http://www.aarp.org/health/doctors-hospitals/info-06-2010/why_you_should_avoid_the_hospital_in_july.html

   Here is a link to another blog about it:
   http://neilbaum.wordpress.com/2011/07/23/dont-want-to-die-avoid-july/
 
   I don't think you need to avoid hospitals in July and August. That is a bit extreme. But, personally, if I was admitted, I would check out my medical team. If everyone was new on the job, from the students to the interns to the chief to the attending, I would leave that hospital and go to a community hospital. And I would make sure that my attending at that hospital had more than a few years under their belt. If, on the other had, everyone was new except for the attending, and the attending made a commitment to stay on the unit, then I wouldn't worry. If the attending was supervising from the mall or the golf course, then I would leave. If the chief was in their second year, then I wouldn't worry. Don't forget the night shift. That may be staffed by beginners, especially in the era of reduced work hours for residents. There are few places left where residents can stay for 36 hours to make sure their patients are safe. Most training programs have reduced work hours to make residents leave either at 12 or at 24 hours. This is so they can get some sleep and rest.
   Many neurocognitive studies show that being on the job after 24 hours is as disabling as being under the influence of alcoholic drinks. And many people without stamina are dizzy with fatigue sooner than that.
   My residency program had me working 36 hours on and 12 hours off for four years, not counting vacations.
   I think that some residents in training did very well under those conditions, and some did not. We knew the ones who did not, and they either washed out or we supported them through the tough days.
 
   Generally, to be a busy Ob/Gyn in the real world, a person needs to have the stamina to work days and nights. There may come a time when there will not be an excuse that "I'm sorry, I am too tired to take care of you." On the other hand, when a doctor reaches their fatigue limit, then the physician needs to take advantage of backup, cancel hours, and try to get some sleep. I have done this myself. Patients understand this need very well indeed.

   Thanks for reading my blog.

John W Marcus MD
Obstetrics and Gynecology
Ridgewood, NJ
Phone 201-447-0077
blog is at doctorjohnmarcus.blogspot.com