The Fruit of your Labors

[surgblumm]

The Fruit of Your Labors

Bob Blumm, MA, PA-C, DFAAPA

When the average individual hears the statement above there is a tendency to think of a nice house on the prairie, a Range Rover leaving the house for a summer vacation with Mom, Dad, the two kids and the dog. This is a hard earned vacation and is usually called “the fruit of our labors.” Perhaps it’s a Corvette or a Bentley, a Gulfstream 7 or a vacation to Florence, Venice and Rome. All of these things are nice and the type of dreams we would like to see fulfilled. Let me lay out another scenario:

Going to the job with a sense of indifference and a loss of empathy. Feeling like your T-test is about 150 and you are a young, grumpy old man. Being angry with your colleagues and patients as well as your supervising physician. Forgetting what day of the week it is and arriving at the wrong hospital or perhaps at the office instead of the hospital. You are observing shaky hands while tissue is being sutured and to your amazement, the hands belong to you. You are second assisting rather than first assisting and you are retracting the spleen. Suddenly you notice that your blinks are extending and then you have closed your eyes only to be awakened by your own snore and the roar of the surgeon as the spleen is pulled from its position by your large Richardson retractor. This too is the fruit of your labors and the labors I am considering relate to overtime and too many per Diem jobs so that you can afford that upcoming marriage or the college fees for the kids. We exist in a world that has many interpretations of our acts and some of these are pleasurable and others are disasters.

A newsletter called ED Leadership Monthly fell across my desk and I read with great interest that fatigue in the medical workplace was responsible for adverse events and that five times as many diagnostic errors are a result of fatigue. There are more medication errors, more needle sticks, more poor judgment decisions and 300 percent more fatigue-related errors that led to a patient’s death. This has caused untold grief and loss for the family of the patient and an increase of litigation for the clinicians who need to make just a little bit more income. What is the cost? Loss of life, loss of the provider’s reputation and sometimes their license, loss of pleasant future dreams and all for what? We then begin to ask ourselves if amassing “things” are as important as we think. What actions are being established or put in place to prevent this tragic loss?

The Joint commission has made suggestions such as careful procedural handoffs in the ER and after a shift on a unit, assessment of fatigue related risks and good management that insures fair and equitable scheduling of providers. Staff education about sleep hygiene and staff meetings with dialogue by all present to share their concerns and experiences. Perhaps among the more important actions is to encourage teamwork, to share patients, to pick up another person’s chart if they are overworked and to be vigilant about observing our colleagues and alerting them privately if they seem to have the symptoms. We can use this as an opportunity to help each other and to prevent errors and deaths.

Bob

[jsfelder0417]

A very real concern. I am definitely one of those that do not handle sleep deprivation well. The longest I went was two days without sleeping while in the Army, and I could not be trusted to do anything more involved than putting on a shirt. I felt horrible: unable to concentrate, slow to react, a headache, and my back and jaw hurt. The only thing I could do was focus on finishing my job so I could get in bed, and I could have fallen asleep anywhere with less than 5 minutes of inactivity. It was downright scary what sleep deprivation did to me. I can't imagine what it's like for residents (especially surgeons) that do things like this for years. Makes me shudder just thinking about it.