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What Could Possibly Go Wrong When Doctors Are Forced to Work 28-Hour Shifts? Part 2

Yesterday I blogged about how medical residents are being forced to work 24-28 hour shifts.  Today, let’s look at how the National Resident Matching Program (the Match) devised a system to create residents programs that enables hospitals to pay low salaries while demanding double or triple the hours and not have to pay overtime. Wow. Resident work hours and conditions are considered worse than the horror stories you hear about Chinese factory workers. Really?
 
I vividly remember Match Day at Stanford Medical School in 2013. 80+ med students gathered with their parents in a large auditorium in March.  The med students had interviewed all over the country to rank their top~10 hospitals where they hoped to do their residencies. The president of SMS handed out white envelopes to each medical student and asked them to wait until all of the students had received theirs.  Then, all of the students opened their envelopes at the same time (across the nation) to see where they were going to spend the next 3-7 years of their lives (depending on specialty). What happened next surprised me. Some screamed with excitement, others burst into tears, while others stood in shock.  I was appalled by this seemingly inhumane and unprofessional way for a medical student to select the best residency program. These students had previously chosen their colleges and chosen their medical schools. Every other profession gives more fluidity in making these important decisions.  So why does the Match have this arbitrary protocol that gives residents no say in where they’ll be doing their residency?
 
It’s always about the money.
 
The Match is a computerized processing system that assigns each medical student graduate to the hospital where they will do their residency.  The system is supposed to allow med students to rank the hospitals and the hospitals to rank the students to create this fair match based on who wants whom the most.  Although it might sound fair on the surface, it really isn’t.  Here’s why:
 
First, this decision is non-negotiable.  The students sign the contract before the Match to accept all employment conditions such as position, schedule, pay, and benefits - whatever is inside that envelope. 
 
Second, the hospitals collude in salary-setting across the nation.  They make some exceptions only for cost-of-living increases in different cities.  
 
Third, residents can’t change hospitals. This gives hospitals no incentive to offer fair wages or humane work schedules.
 
Fourth, residents are required to work 80+ hours per week and 24+ hour shifts. Hospitals use residents to do non-patient care (clerical work or transporting equipment and patients) to save money on more expensive employee wages. 
 
The consequences are dangerous – for everyone.

What Could Possibly Go Wrong When Doctors Are Forced to Work 28-Hour Shifts?

When my daughter did her “time” – at Stanford Medical School – I was outraged.  Being her mom, it worried me to see her work 14-16 hour shifts, and then go home to study for 4-5 hours, and then get up a few hours later to start again.  This became her norm because she might not get a day off for 2 weeks. In hindsight, they were going easy on her because the American Medical Association (AMA) supposedly protects medical students from being abused.  Medical students get holidays off, but not medical residents.  
 
Nicole finished med school back in 2013 and started her 4-year emergency medicine residency at Harbor-UCLA that same year. She was thrilled to work with the best emergency docs in the country where she had the opportunity to work with diverse and high-risk patients.  A typical shift for residents is 10-30 hours and shifts rotated from day, swing, to night at random.  She often worked 6 days in a row without a break, and even when she had a day off, she often covered for other residents who had family emergencies. Today, first-year residents cannot work more than 16 hours per shift.  SIXTEEN hours!  That is outrageous! By law, other employees can’t work more than 8 hours without getting overtime.  The Federal Aviation Administration (FAA) requires airline pilots have to log in 8 hours of sleep before being allowed to fly commercial planes, and they’re allowed to fly a maximum of 8 hours per shift. So in what universe does anyone think that it’s a good idea to have doctors making life and death decisions during a 16-hour shift? 
 
But 16-hour shifts will soon be "the good old days", because now first-year residents will be allowed to work 24 hours (sometimes 28 for transitions between shifts) per shift without a break. Seriously? Second-, third-, and fourth-year residents already work 16-30 hour shifts.  The Accreditation Council for Graduate Medical Education (ACGME) made this executive decision that will take effect  on July 1st of this year.  They claim that residents need to see a patient through from the beginning to the end, and that patients want to know that their doctor is taking care of them.  Really? If I needed to be in the hospital for 24 – or let’s say 36 hours, I would want her to go home after 8 hours to get some down time and sleep so I could see her again during her next shift when she’s at the top of her game. I’d much rather have 3 or 4 alert and conscious doctors taking care of me than a doctor who is delirious with sleep deprivation. 
 
Dr. Michael Carome, director of Public Citizen’s Health Research Group, says “Study after study shows that sleep-deprived resident physicians are a danger to themselves, their patients, and the public.” This cruel and antiquated system is really hazing at its worst.  Many established doctors feel that because they went through it, all new doctors should go through it too. 
As an educator, I recommend that students get 8-9 hours of sleep per night in order to be able to learn and retain information.  Sleep deprivation alters everyone’s conscientiousness.  This is not a new revelation so why would an important institution demand such ridiculous hours?  
 
A few years ago, I called the California Labor Commission to inquire about the 16-hour shifts, lack of breaks, no overtime pay, and maximum number of consecutive work days. I fully expected to expose the labor abuse in medical residency programs and was happy to be the whistle blower.  But, I was appalled to find that the ACGME found loopholes making it legal for hospitals to demand 16-hour shifts without paying overtime, to not give breaks, to not give regular “weekends” or days off. 
 
Here is a link to a review of the studies reflecting the impact of duty hours on just resident driving safety (not including burn-out, quality of life, or patient safety).  It includes reaction times, falling asleep at the wheel, and motor vehicle accidents. With scientific research proving that there are more accidents, mistakes, and deaths caused by residents who work more than 12 hours per shift, I would like to see the ACGME set resident work schedules to protect the patients and residents, just like the FAA regulates pilots’ flight schedules to protect their passengers.
 

Every Kid Should Learn How to Build

My friend called me in a panic because her husband, a surgeon, had just attempted to “fix” their toilet and water was going everywhere.  She told me that while he was a brilliant surgeon, that’s where the brilliance ended because he knew nothing about common sense things.  Wow!  Today it seems that we are labeled and categorized to fit into specific places. We are neither expected nor taught to expand our understanding of basic survival skills.

Since the Industrial Revolution, we’ve become a society of assembly lines. We specialize in one skill, and then that’s all we do.  If we were robots, that would be the logical and practical way to utilize our time.  But we live in homes that have electrical and plumbing hidden behind sheetrock, and walls built with 2” by 4” on 16” centers.  We’re never officially taught how houses are built so when there is a plumbing problem, we call the plumber.  Electrical problem, an electrician.

Not knowing how things work around your house can make you feel incompetent.  Having to call in a contractor every time you need some minor work done is time consuming and costly. I think all students should spend a summer working with a building contractor to learn the inner workings of a house or building.  It would help students build a sense of independence and confidence.

For Christmas one year, I gave my girls tool kits complete with electric drills, Dremel tools, hammers, screwdrivers, measuring tapes, and anything I could fit in the tool box. While they weren’t thrilled with these gifts back then, I’ve noticed that they keep it handy in their homes today, and I’m glad to see that they know how to use their tools.

When they were in high school, they built their own vanities for their bedrooms one summer.  They learned how to use a saber saw to cut the shape, a router to round the corners, and a belt sander to smooth the surface.  Rob showed them how to wire 7 light bulbs around the mirror. 

I learned how to build furniture by getting tips from the guys at San Lorenzo Lumber.  I buy all of my materials from them because their staff (Mario and Craig are my favorites) are incredibly knowledgeable and helpful.  I’ve built 90% of my home and office furniture since 1976.  I love to design furniture because I get exactly what I want with the safe materials I prefer (no particle board or Masonite!).

Wouldn’t it be ideal for students to learn how to build a house and how to use power and hand tools before they move out to live on their own? Most students barely know how to handle a hammer and certainly don’t understand how to build furniture or any phases of building construction. We certainly want our kids to be able to troubleshoot problems in their future homes, right?

What Kids Should Know Before Getting Behind The Wheel

I remember when I got my first car.  I learned how to tune it up, change the fan belt, and change the oil and filters. I even rebuilt my 4-cylinder engine just to make sure I understood how the internal combustion engine worked – my father had one of his mechanics guide me through the process. It gave me great satisfaction to know when the carburetor needed adjusting and that I could maintain my car by myself.  Of course that was back in 1973 when cars were much simpler than they are today.

Remember when schools had auto shops? Schools have stopped offering these courses for several reasons: (1) to save money on building shops and outfitting them with the equipment and materials needed for these specialty classes; and (2) students (or their parents) are more interested in taking rigorous academic classes to stack their transcripts with AP courses to impress college admissions officers.

When my girls got their first cars, I created an auto shop class for them at Merit Academy where they learned everything they needed to know before they got behind the wheel.  They learned how to change the oil and filter, rotate tires, and check fluids and lubrication.  They also spent the day with an automatic transmission specialist to see the inner workings of a transmission. Other field trips included watching a car get smog tested, talking to a woman from Mother’s Against Drunk Driving (MADD), and visiting a rehab center where they met with paraplegic and quadriplegic teen survivors. 

At the end of the class, they met with a CHP officer to see what happens if they are pulled over for being under the influence of alcohol or drugs.  The officer actually handcuffed them after making them walk a straight line wearing vision-altering glasses.  Each student took CPR and First Aid at the American Red Cross as the final requirement for the course.

Driving a car requires maturity that most 16 year olds don’t have, but giving them an education and hands-on learning experiences so they know how to handle their cars gives them the foundation to make smart decisions. Since everyone drives a vehicle, shouldn’t schools offer classes to teach the students more than traffic rules?

Why Kids Don't Cook or Sew - And Why This Has to Change

 

Remember when students used to be able to take classes that they enjoyed, instead of taking classes because they “look good” to college admissions officers?  Remember when schools offered home econ classes where you learned how to cook and sew?  Somewhere over the past 50 years, schools have stopped offering courses that all students need to lead healthy, productive lives today

I learned how to make Potato Boats in 7th grade Home Ec.  It was simple: It’s just a baked potato that is gutted and mixed with butter, chives and chunks of cheese, and then baked again.  Today it’s always a hit at dinner parties. A real foodie, I love to whip up dishes using Indian spices and create healthy, yet delicious meals.

Maybe because it’s so easy to grab a burger or take-out food, that we don’t cook at home anymore.  Or, is it because we’re so busy that we can’t justify the time it takes to shop, cook and clean. But then, we put our nutrition in the hands of corporations who are more interested in bigger profits than our good health.  So we’re eating foods that aren’t even real foods.  When fast food chains claim that their burgers are “All Beef,” they actually can have meat from hundreds of animals including horse meat and chemical fillers.  So let’s get back to feeding our children good home cooked meals and get them in the kitchen to help!

I also learned how to sew in a sewing class in 8th grade.  My teacher showed me how to make my own patterns, sew zippers, and create just about anything with a sewing machine and a good pair of scissors. While my girls were into dance and theater, I made 6 tuxedos, 8 lederhosen, and 100s of costumes.  I even won a costume award for one of Jaclyn’s dance competition costumes.  But more importantly, it was fun as I designed and showed my girls how to create something out of a bolt of fabric.  They both took sewing classes at Merit Academy during the summer and made dresses.  Just yesterday, I sewed cushions and a custom cover for my dogs’ crates. Both cooking and sewing are skills that I am so grateful to have.

It used to be that sewing clothes was less expensive than buying them, but when you can buy clothes made in 3rd-world factories by slave labor, it’s cheaper and easier to just shop at Target or Ross. Do a little research about where your clothing is produced and who is doing the sewing, and I’ll bet you’ll reconsider where you buy your clothes. You might even start sewing simple outfits like skirts, shirts, and dresses.

Instead of indulging our children’s every wish for new electronic devices every time something new hits the market, buy them a sewing machine. It’ll probably last them their whole lives and it’ll give them the ability to hem pants, bring clothes in or let them out, and make fun things like pillows.  With just one sewing class, you can open the door to more independence and creativity.  And, they’ll have a skill that their peers don’t have. I’m surprised that so many people don’t know how to sew today. It’s really a lost art.

Rather than force students to study US History for years or to take biology, chemistry, and physics when they might not be interested in STEM, let’s give students the opportunity to learn skills that they’ll need when they grow up.  EVERYONE NEEDS TO KNOW HOW TO COOK AND SEW. 

What We're Remembered For - It's Not What You Think!

Everyone strives to be successful – whether it’s to be a doctor or engineer, the first to do something exciting, or to be mega-rich – it’s engrained in us from the moment we start school in kindergarten and throughout our lives. So wouldn’t true success culminate in an obituary listing your successful career?  Actually, no; and here’s why.

I just watched an interesting TED talk about Lux Narayan, owner of a company that focuses on future insights that marketers can derive from past data, who analyzed over 2,000 obituaries in the New York Times to see how both famous and ordinary people were remembered at the end of their lives by loved ones.  He stripped out their names and filler words to compile what was “real achievement” for these people.  Over 40% considered contributions in the arts (theater, music, film, and dance) to be indicators about their success.  Wow.  So why do people think they have to be doctors, engineers, lawyers, or businesspeople to be successful? 

Narayan’s research showed that people valued the extraordinary things that their loved ones did that made a positive dent in others’ lives. The take-away message here: If more people lived their lives trying to be famous in death, the world would be a much better place.

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If Delhi Can Ban All Disposable Plastics, Why Can't Everyone?

When almost 9 million tons of plastic ends up in our oceans every year, recycling is NOT the solution. I’ve been trying to get that concept across to students, teachers, friends and family for years but most people think I’m eccentric. We need to stop buying and using plastics PERIOD. Instead, use glass or metal!

When I heard Delhi banned plastic bags, cups and cutlery, I was thrilled because 60% of plastic waste found in our oceans comes from India. France was actually the first country to ban plastic cups, plates and cutlery. Yes, France!

So why is plastic so bad?  It’s a petroleum product (HINT: need to use fossil fuels to produce it) and it never breaks down. Fish and birds mistaken it for food, and die.  Over 100,000 marine creatures die each year from ingesting or getting tangled in plastic.

I personally refuse to buy drinks sold in plastic bottles – instead, I drink water with lemon juice out of glass bottles. It’s clean and can be reused and recycled.  Bacteria can be washed away in glass unlike its plastic counterparts where the bacteria remains in the plastic even after washing. India is setting a great example in banning all disposable plastics.  I hope the world follows suit and bans disposable plastics. 

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In An Age of Robots, Are We Preparing Our Students For Future Jobs?

With artificial intelligence and robotics capable of calculating and producing products and doing what people have done for centuries, the future of jobs for human beings will be creative, critical and social. So why are classes designed to teach students to act like machines? Regurgitating facts and sitting quietly in rows doesn’t stimulate innovation. As the director at Merit Academy, I have been approached by several Chinese schools (public and private) to help them improve their rote curriculum.  Their students are bright, eager to please, and hardworking but they can’t compete in our entrepreneurial and technological world because they aren’t taught to analyze and think critically. 

The average Chinese class size is 50, but many classes have as many as 80 students. In order to manage a class size that large, teaching has to be a one-way lecture and learning has to be done with worksheets and multiple choice answers. Students don’t learn how to write research papers or literary analyses.  Imagine editing 80 essays for one class? It’s simply impossible for a teacher to manage.

I take pride in watching Merit students thrive.  With one-on-one classes where teachers engage in conversations with students, and students are encouraged to think outside the box and explore concepts and ideas in depth, it is really the ideal environment for developing our future leaders.  I’ve met with the teachers and love to hear their plans for each student they teach. The students ranked their teachers with the highest ratings possible. My favorite role is as their college advisor who guides the students as they launch their projects. Each student finds their passion and sets out to change the world.  Imagine if all schools – Chinese included -- encouraged this type of leadership? We could solve many of the problems we face today. I feel like I’m the luckiest person in the world to have this opportunity. 

Biohackers Want to Make Gene Editing a Human Right

Remember Dolly – the first cloned mammal that was created in Scotland in 1996? That created an uproar worldwide about cloning any living thing.  Today, expert panels have been trying to set guidelines to ensure that scientists don’t start creating superhumans using Crispr, a gene-editing device.  I wrote about Crispr and how difficult it will be to keep unethical people from misusing this genome-editing technique that is available in university and science labs around the globe.

Biohackers claim that people should have access to technology that can cure diseases, which most people probably agree with.  But, how do we stop this same technology from increasing people’s IQs or changing their physical attributes? Gene-editing technology is available online and many entrepreneurs are claiming that it is a human right.  Their argument: genetic choice is a human right.

There is no simple solution to this ethics debate but there is a need for universal policies to be set to prevent misuse of this technology, and it needs to be done now.  Chinese scientists now lead the way with gene-editing technology and claim that they have already modified human genes in their labs. It’s time to settle this debate and set some guidelines to protect mankind.

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Sleep Cure: More Important Than Diet and Exercise

Did you know that 70-85% of teens DON’T GET the recommended 8 ½ hours sleep per night? And 30% of adults don’t get their 7 hours of sleep per night. According to Dr. Matthew Walker, professor of Neuroscience and Psychology at UC Berkeley, he used to suggest that sleep was the 3rd pillar of good health, along with diet and exercise, but now he says that SLEEP IS THE SINGLE MOST EFFECTIVE THING YOU CAN DO TO RESET YOUR BRAIN AND BODY FOR HEALTH.”

Poor sleep is now linked to a higher risk of heart disease, diabetes, high blood pressure and obesity. It can also increase the risk of dementia and depression or posttraumatic stress disorder (PTSD) and anxiety. Poor sleep is linked to overall risk of premature death, just as smoking, bad nutrition, and lethargy. In a recent study on mice, sleep deprivation caused death faster than starvation can. Yikes!

Sleep's primary evolutionary function is to clean out the brain, quite literally, of accumulating debris, according to Dr. Maiken Nedergaard. “It's like a dishwasher that keeps flushing through to wash the dirt away." Our bodies need to get rid of these toxins that can damage healthy cells.

We all know that chronic inflammation is a leading driver in some cancers, mental decline, heart disease, Type 2 diabetes, and pain.  But did you know that one of the causes of inflammation is sleep deprivation?

So the take-away message here is GET YOUR SLEEP EVERY NIGHT!  That means that kids need 8.5 hours and adults need 7. Left to their devices, kids will stay up til midnight and get just 5-6 hours of sleep a night. Do the math and set your bedtime.  Be the adult in your family and force your teens and children to get enough sleep every night.  They’ll be healthier and happier for it!

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