This isn't an argument that longer shifts result in better outcomes, this is an argument that the hospital's current handoff processes are insufficient, and that better handoff process would improve outcomes.

Humans have 24h circadian rhythms that likely affect patient care due to timing of cortisol release and other cyclical bodily events... It makes sense for an attending nurse/physician to be present for that full 24h cycle to gain a holistic understanding of patient recovery during various phases of the day.

If you're handing off a patient every 12 hrs, you're going to have fewer experiential data-points to judge if their condition is improving or worsening, no matter how detailed a hand-off can be. It'd be even worse with 8h shifts. Further, if a Dr has a patient come in with a unique condition, they're not going to leave just because their 12-hr timer dings.

Define "holistic understanding."

Is the doctor actually sitting bedside with the patient for the entire shift? Of course not. More realistically, the doctor is coming in, making some observations, and then moves on to the next patient.

So here's an idea - couldn't you shoot video of the observation, and shoot a time-lapse video of the otherwise-lacking-direct-observation periods, and show those to the physician in the next shift? All that the attending physician has to do is vocalize his observations (of course a camera by itself can't sufficiently observe), and the hand-off physician can watch the clips just like he could read the chart. Such clips may also be accompanied by speech-to-text to produce quick summaries.

There's simply no doctor in the world who isn't privately treating a single patient who can compete with the number of experiential data-points which a computer can provide.

I mean... this is a thing:

https://en.wikipedia.org/wiki/Robot-assisted_surgery

It's not like the presence of cameras automatically makes medical care low-quality.

Is based on the premiss of a smaller incision and more precise tissue manipulations leading to better outcomes. Nothing to do with a camera ;)

> presence of cameras automatically makes medical care low-quality.

Of course not. My point is that it does adds ~ nothing to the quality of care, just like cooking thru a webcam should not be expected to result in tastier meals.

Doctor’s observations are a complex synthesis of information obtained through the five senses (and not only by seeing) and “gut feeling”. They can help narrow down the diagnosis, and predict forthcoming complications. This cannot be captured by a camera.

I’ll give you an example of the “holistic understating” kirse was probably alluding to.

A 80-yo guy is admitted at 9pm for COPD exacerbation, is treated with the usual drugs, gets better. Was very anxious and well awake on arrival. You come to check back on him at 2h AM, and he seems a bit slower, and uncharacteristically relaxed. You suspect he’s getting hypercapnic, order a blood gas, and discover that he is indeed. You proceed to treat him with a BiPAP, and save the day.

If you did not see the patient before, it is very easy to interpret his sleepiness and relaxed breathing as a totally normal state for a 80-yo guy. It is indeed very easy to think he’s got better. See, he’s finally sleeping, breathing calmly, everything’s fine.

Even a family member sitting by the guy side since his admission is likely to miss the subtle signs, precisely because his observation is continuous, and the change is slight and slow. Discrete episodes of reassessment by the same qualified person is key !

I think it's possible that both things are true. The problem comes when traditionalism is in charge (as it usually is, being senior). "I had to work 48h shifts and I never killed anyone who didn't have it coming, why shouldn't they?!"

It also ignores —in the way only a doctor can— that being away from your family has both a cost on them and you. This isn't something you can just throw money at. You need numbers.

But yes, good handover procedure is essential to. However long the shift.

An awareness that we need to study these decisions before making them has finally taken hold. To that end, trials are now ongoing that have randomized residency programs to the (shorter+more handoffs) vs (longer) shifts.

Patient outcomes are obviously the most important, but measures of physician wellness would be a valuable secondary outcome.

As an engineer, I used to think I didn't have what it takes to work long hours. After about 5-6pm, I'd start making mistakes, and my productivity would be roughly halved. I'd occasionally come in the next day and realize I had screwed up and would spend the morning redoing the work I did after 5pm the previous day.

Then I once stayed at work late not for my project, but to help other coworkers who I thought "had what it takes". It was insightful to see they made the same number of errors that I did, and had I not been there, they would have had to redo the work the following morning as well.

This is especially true for simple, tedious work, which a lot of medicine is about (at least at the nursing level). Things like administering medications.

I'd like to know what magic they use when training doctors in their residency to avoid such errors that other industries have not been able to master.

Yes, handoffs are risky for patients. As is being tired.

This totally makes sense.

Do you have a citation for that?