Don't Get Sick in July

Because a dear friend of mine became a night manager at a convenience store this year, and I've observed the effects on her working the graveyard shift, I've been looking at the effects of sleep deprivation. I also have heard her stories about the "night people," the people that frequent the store between midnight and 4:00 a.m. Many of them shift workers, and many of them working more than one job. Some have done so for years, and say, "You never get used to it."

What does it do to you to be up all night when you're supposed to -- biologically -- be sleeping? We'll be taking a look at this from different angles and here's one.

Maybe you haven't heard of this if you aren't in the medical community -- DON'T GET SICK IN JULY.

Why?

July 1 is when brand new baby physicians begin their internship, residency and clinical duties at teaching hospitals.

Common sense (emotional intelligence) would tell you you want an experienced professional if hospitalized, not to mention a rested and alert one, but I can tell you, having been married to a physician, that those schedules are grinding - almost a test of how well you can function without sleep.

There is some data to back this up.

According to "Near-miss errors in laboratory blood test requests by interns," there is an increased risk of error.

From the article:

The overall incidence of near-miss events when interns practiced during the first month of training vs. subsequent months was 1.6 vs. 0.6 cases per 100 intern-days at risk. The odds ratio for a near-miss event during the first month of intern training vs. subsequent months was 2.64.

That isn't exactly "alert the press information" -- that's why interns and residents are supervised. How well, is a function of hospital rigor and chance.

But take a look also at the effects of interns' on-call shift schedule as well:

One half of the near-miss episodes occurred during an intern's on-call days and another half of them during an extended on-call shift; none of the events occurred during a standard working shift. These events peaked in frequency when on-call interns had worked for 12–20 h.

So here's a matter of EQ -- if you, or someone you love, is hopitalized ever, but particularly in July at a teaching hospital, check out the 'state' of the doctor. You don't want an intern during his first month of clinical work who's on his 19th hour of duty on an on-call night ... do you?

When a Physician Makes an Error

Emotional intelligence makes you better able to handle stress and more resilient. IF there's anything a physician needs, it's that.

Doctors makes mistakes. They react emotionally when they do.

In what purports to be the first study on this, the Joint Commission Journal on Quality and Patient Safety reported "The Emotional Impact of Medical Errors on Practicing Physicians in the United States and Canada" this month. (See article here: Study Indicates Physicians Experience Stress Following Medical Errors on Yahoo! News )

Of course the pressure in this life-and-death field is tremendous to NEVER make an error. It draws perfectionists and highly competent individuals, and if you are being cared for by a physician you would say -- I should hope so. I was married to a doctor and I know what they go through.

I can miss an appointment with a client. You can make a mistake and send the check to the wrong person. Nancy over there can cut some one's hair too short. Tom can mess up someone's bill. A cop can cuff the wrong person and a college professor can cite the wrong date or theory. All these mistakes can be corrected. But for a doctor -- procedures, diagnostics, treatment -- make a mistake and someone dies. Actually it's usually called "an error."

The errors of omission are just as potentially fatal as the errors of commission. When I worked with a group concerned with medical ethics, there was a case where a patient had been "left in the basement of the hospital" on the way for some test, and expired there.

That sort of responsiblity is understood in the field, but that doesn't make it any easier.

According to the study, 80% of physicians expressed a desire for help after such an incident, but found there were many barriers.

"Counseling needs to be made available to patients and health care professionals so that everyone involved with errors receives the support they need," said Waterman, who led the study.

Notable findings. After a mistake, physicians reported:

• increased anxiety about future errors (61 percent),
  
• loss of confidence (44 percent),


• sleeping difficulties (42 percent),


• reduced job satisfaction (42 percent),


• harm to their reputation (13 percent) following errors

Only 18 percent of physicians surveyed had received education or training in disclosure of errors, and 86 percent expressed interest in such education or training.

While some physicians thought counseling after-the-fact would help, 35% did not think so. 25% were concerned about their malpractice insurance costs going up if they sought counseling, negative peer reactions, lack of time to seek services.

RESILIENCE

Making mistakes and recovering from them is about resilience, an emotional intelligence competency. It means being able to bounce back from adverse events, to recover and continue to move forward. As I say in my EQ and Resilience courses, the good news is you will get lots of practice. That is also the bad news.

Why not emotional intelligence training? I have coached physicians who were also burnt out from listening to other people's problems all day, trying to sort through the approximate language and high-level emotions, having to deny drugs, and having to tell someone a bad diagnosis.

Part of medicine is factual and a science. Part of medicine is emotional and an art and this has largely been ignored in medical training.

Emotional intelligence is a pro-active way of dealing with stress. You know that stress is going to happen, and if you study resilience and emotional intelligence, you can prepare yourself. It's the emotionally intelligent thing to do, because bad things happen to good people, and good people also make mistakes.