Mirroring behavior — Botero Museum, Bogota, Colombia

A post in Slate caught my eye today, about the care delivered by residents and interns in hospitals.  Basically, the piece was documenting reforms made on medical intern work hours, which had been diminished from single shifts running 36 hours, to 24 hours with some mandated breaks.  From the article, “The Accreditation Council for Graduate Medical Education, the nonprofit that oversees residency programs, followed New York’s lead and barred residents from working more than 80 hours a week or spending more than 24 straight hours on duty caring for patients.”

When the results of this action were studied, though, the effect on patient morbidity was unchanged.  In fact, the situation may have gotten worse.  Why?  The obvious reason is that individual interns that stay constantly by the patient’s side are more likely to have up-to-date and continual information on the patient they’re monitoring, and as such, symptoms that may have large consequences don’t fall through the cracks.  When interns are forced to transfer information as part of continual patient care, the system breaks down.  By the time anyone has been up for 36 hours, their cognitive impairment is such that they’re equivalent to being drunk.  So what this is saying is that you’re better being looked after by a chronic alcoholic than two tired people forced to bridge a shift in patient care.

What it really exposes, however, is the deeply authoritarian and hierarchical nature of Western medicine, and the non-empathetic social structures that govern its delivery.  Everyone, in modern medicine, is viewed as a fragmented piece of the puzzle.  There’s some nod to the fact that interns may be connected to their patients (hence the benefits of constant monitoring) — but there’s little concern about the actual cognitive processing (or well-being) of the individual interns.  Add to that the fact that the non-empathetic social structure applies to what would be considered abuse in other professions (and is grossly illegal in many — such as airline pilots, etc.) because doctors are high-status in our society.  They OUGHT to know better.  But of course, we can only know, especially experientially, what our empathetic development allows us to know.  My dad was a doctor, and there’s a ton of mythical reasoning in the profession (this is the way we’ve always done it!)

What needs to happen is that interns need to be considered people — and have a regimen that boots them out of the Survival v-Meme, so they can focus on others.  Add to that a serious inventory of how information is actually transferred in hospitals, and we’re on to something.  Focus on information coherence and patient representation, as well as consider transients in care — as when supervising doctors come on to a shift, and when they leave.  Ideas wouldn’t be that hard to generate (what about shift overlap, for example?)  Then we would see care improve.

Takeaway:  Information transfer between people is critical for success for continuous running operations.  Lots of solutions appear when we realize that what we have to do is manage for information flow continuity, as opposed to ‘one person, one shift.’  The medical community has one thing right — nothing can replace experience.  But without considering a broadened systemic perspective, we can’t create the integrative environment that patient care actually needs.