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Dr. Kirk and Bob answer patron emails. 


100 Percent Odd and Unethical


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The Psychology In Seattle Podcast ®


Trigger Warning: This episode may include topics such as assault, trauma, and discrimination. If necessary, listeners are encouraged to refrain from listening and care for their safety and well-being.


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SeattleTransAndNonbinary ChoralEnsemble

Like you, I was under the impression that doctors make more mistakes at the end of 14-18 hour shifts because the stupefying effects of sleep deprivation are well documented. However, I recently found out from Sawbones that the time the most iatrogenic harm occurs, by far, is during the change from one shift to another. The critical care period when a patient is at highest risk, the doctor and nurse who was there when they are admitted should take care of them as long as possible. Every shift change, an hour is wasted informing the incoming staff the unique circumstances of the patient’s case, finishing notes, changing clothes, washing and signing out, and another signing in, getting dressed, debriefing, getting used to and building rapport with the new patient. During these periods, one nurse may have to be monitoring every bed in the unit and miss alarms in the chaos of shift change. As counterintuitive as it may sound, the negative impact of sleep deprivation is much smaller than the negative impact of being unfamiliar with the patient or having your attention distracted by shift change. Thus, ER and ICU staff fight hard against bills that attempt to introduce limits on doctor and nurse shifts to 8-10 consecutive hours or less, because it would harm the patients and disrupt the flow of the work day. In specialties where the problems are slower to emerge and resolve, there may be less impact, but it gets very complicated to have staff all leaving and entering at different times and sometimes involves HR overhauling the entire scheduling system, in some cases only to find out that the hospital functions significantly worse and switching back to the old schedule after all that investment. Just like they get used to night shift, people can get accustomed to working 3 days of 15s or 4 of 11s in a row, getting a full work week plus 4-5 hours of overtime and then having 3-4 full days off to spend with family, travel and/or catch up on sleep in a way that works with their circadian rhythm.

Anonymous

I could listen to a full episode of Bob and Kirk saying Washington State town names like Wanachee, Chelan, Yakima, and Waputa.