Doctors found unsafe to drive home after work

Some employers are now providing cab rides for physicians because they’re too fatigued to drive safely after their hospital shifts.

Just got this email from a resident [physician-in-training]: “OMG. See below. The violations and consequences pretty much deter you from ever bothering to want to use this service.”

CabRidesHospitalPolicy

My response: “If doctors are so tired they can’t drive, why are they being allowed to care for hospitalized patients? If they can’t safely drive a car, why are they being allowed to run ventilators in the ICU?”

His response: “Exactly. And then let’s offer residents a ride in the most threatening way possible so that there is no chance they will take it. It’s all so stupid that it’s painful. I think you need to publish volume two of Physician Suicide Letters—Answered and just publish documents like this. They speak for themselves just like the letters.”

I reply: “Sleep deprivation is a torture technique and a form of hazing common in medical training. Did you see my TEDMED talk where I discussed this?”

He responds: “The funny part is, how often does a doctor ever not work 12 hours and not feel exhausted. I think any physician would have difficulty abusing this. However my bet is, if you were to use this too often—whatever that is—(even within their stated criteria of 12 hours and exhaustion) you would be called in for a chat to ask why it is that you are so tired so often, and more absurd, humiliating questions. Kind of like our work hours reporting now. [Residents are limited to an 80-hour work week]. We have learned not to report working beyond 80 hours/week. If you do you are called in to discuss the “hour violations” and a chat about how inefficient you are. So everyone lies, everyone works way over what they report, and yes everyone is still exhausted. Round and round we go . . .”

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Pamela Wible, M.D., is a physician who is outraged by the health care cycle of abuse that wounds physicians and patients alike. She helps physicians break free of the cycle of abuse at biannual retreats. Need help? Contact Dr. Wible.

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36 comments on “Doctors found unsafe to drive home after work
  1. Pamela,
    We need to get a legal foundation together to enable us to launch lawsuits
    against abusive administrations and individuals within those frameworks, whether they be hospitals or healthcare organisations, in cases where abuse against physicians, medical students, or residents has occurred. I think there would be a lot of physicians who would contribute to such a fund. It would give us some clout in this arena. A few large settlements and awards would make “the enemy” sit up and take notice. Perhaps, then they might consider listening to those on the receiving end of their mayhem. They are not only breaking the law, they are endangering patients with their abusive behavior toward physicians and physicians in training. We all remember the Libby Zion case. It sounds like there are some people who need to fear for their administrative jobs and teaching positions. Their names need to be made public. The corporate veil needs to be pierced and the criminals punished and exposed for all to see.

  2. Thomas Luck says:

    Too fatigued to be driving but not too fatigued to be working!!!!

  3. Tad Luck says:

    Too fatigued to drive but not too fatigued to have been working!

  4. Robert Haile says:

    During my training in Boston 80 hours would have been a relief. In the 70’s and 80’s 120 hours was common. Where one wished the ER admission did not survive to add more work during a 36 straight hour stint. Where the opportunity to sleep 1-2 hours was not taken as it made you feel even worse. They said I’d get faster, but I did not as I realized the speed came from dangerous shortcuts. Through my career, I chose to spend my time with patients, making less money. But the stress accumulated: two cancers, one pre-cancer, 4 brain surgeries a total of 25 major surgeries, stress related illness. I am now broke living on less than $13,000/year after medical bills are paid. I had to retire at 62 due to health issues. I moved to a poor country to survive. Not all doctors are greedy.

    • Pamela Wible MD says:

      Most doctors are not greedy. Most are humanitarians. Many are idealistic when they start. By the time they are in the middle of their careers they have PTSD and other mental and potentially physical health issues. These are all occupational hazards of our work. Thank you for adding your voice to the long overdue conversation. I am so sorry medicine has been so wounding for you (and many others). We must stand together ad stop perpetrating this abuse on the next generation. And we all need mental health services and legal protection and recourse for our unsafe working conditions.

    • some thing says:

      Not to belittle anyone’s situation… but… for every action, there is a reaction. I live with “one of those doctors” that chooses efficiency to be good at what he does, and see as many rare cases as he can as we are in a community with a high need in his specialty and his training is top-notch – he has a wait list a mile long to see him. He is anything but a villain, more-so a product of ivy league training. He has a partner that wants to spend “lots of time” with her pts. Guess whom is burnt out at 55?; not the one taking “more time,” but the one working his rear off to pay for all the overhead of the office, while allowing someone else a quality semi-retirement – she is happy and healthy from what I see. Further, it goes without saying, “they aren’t all greedy.” Frankly, as a nurse I have yet to meet one greedy doctor, most are burnt out, stressed to the hilt, exhausted, pessimistic, depressed, introverted, giving to a fault, at least in the hospital. One talks to herself down the hallway (a lot!), and bangs her head on the counter top in frustration at times. 12 hours? As a nurse, I do 16 hour shifts regularly, and come back for more up to 13 days in a row (and I make a tiny fraction of what my better half does, granted my training is a fraction of what he has, so hardly a comparison). I know RNs that have worked up to 23 days in a row. They, (admin) do not care if you are tired. Further, a side effect of this job (often) is divorce, so being neutered of “greed” (if it exists) will most likely take place. Let’s just do the math, office overhead, an ex that won’t work and wants to live a Beverly Hills lifestyle on air for income (literally), several (or many) self-entitled kids that will need financial support til 30, half of your income to Uncle Sam, you make the “most” in your family/siblings so get the job of supporting parents for life, etc. What’s left?

      • Pamela Wible MD says:

        You think it’s safe to work a 168-hour shift? Would you like to be the recipient of care from a nurse who has been working 16 hour shifts 23 days in a row? Or on a plan with a pilot who has been on for 23 days 16 hour shifts? Or driving next to a truck driver who hasn’t slept in a few days?

  5. Ioana Pereni says:

    Thank you
    Inspiring articles- make me feel so much better about how I feel in the NHS- still abuse and forced labour ‘ we just overbooked 2 patients on the list’-but I haven’t slept for 24 hours, did two clinics yesterday, spent half of the night answering calls and the other dealing with trauma in casualty/ main ED !
    Reply – ‘we can’t cancel patients as hospital gets fined’
    Great, another 2 redbulls and forever grateful to the NHS
    Surprising to see US system is similar on treating doctors badly
    I learned the hard way to get myself out of ‘burnout’- fill my life with positive enjoyable experiences non- work related. Can’t change the system? Change your life, youred or working environment
    Ultimately I signed an employment contract, with exit clauses and I haven’t signed my life away.
    Hospital doesn’t pay for my mobile contract, hence I answer calls I consider important and leave others in voicemail for next day.
    Take control of your time and make time for yourself, not selfish, but self caring and loving.
    Aim to change what you can, or accept until ready to move on
    Ultimately a happy content doctor will care far better for his family and patients than a stressed, a used ‘burnt out one’- if not doing it for yourself, do it for your patients!

  6. Lisa says:

    Thank you for this. This resonated very strongly with me.
    I am an intern and felt a lot of this when I started. The pressure and the judgment and the fatigue and the unclear expectations and the high stakes and some of my own health problems was somewhat overwhelming and I started to feel like Atlas holding the weight of the world on my shoulders, just struggling to keep everything from crashing down. It took a lot of reflection and soul searching but I emerged from it all with a much stronger sense of self. As the expression goes, “If I am not for myself, who will be for me?” I still get in trouble from time to time from the old school attendings who want me to “know my place,” but I stand up for myself. I listen to what they say and integrate what means sense into how I behave. I spent a lot of time in my mentor’s office, listening to his stories, learning from him, gaining from his wisdom. I was so frustrated with the healthcare system and how I couldn’t change it. He told me if I want to make a difference and be a leader, I first need to do my time and serve. Now I go to work with the idea of service in my heart and the revolutionary idea of putting my patient first in everything I do and treating them with kindness, respect, compassion, dignity and genorosity. I still get overwhelmed and overworked from time to time, but when I come back to serving the patient, it becomes a joy to go to work

    • Pamela Wible MD says:

      Exactly. It’s the patients who bring us joy and purpose. Too often admin ad our peers tear us down. Look out for one another. Be a healer not just for your patients, but for your peers and your attendings. They are often suffering silently. Be the change you want to see in medicine.

  7. Marcee Kniery says:

    I was rear-ended by a doctor who had come off a double shift. This was around 5:30 PM. He felt so terrible!

  8. Agbai Dimgba says:

    It’s a capitalist world: keep on using me until you use me up! You have to be drained of every bit of strength in you if you want to live like a ‘doctor’. And you’d better be good at what your doing otherwise any slip and down comes the hydra-headed ax of the administrators, lawyers and insurance companies. For some doctors by the time they’re ready to enjoy the money health issues arise because of the beating the body has endured over the years.
    But which profession does not have its downsides? We just need to work smart to balance work, family, service to humanity, and to God for those who believe, and of course come together for better collective bargaining…and know when to say ‘enough is enough’.

    • Pamela Wible MD says:

      How do you work smart on a 168-hour shift with little to no sleep? It’s incredible to me how many doctors have Stockholm Syndrome and refuse to comprehend that they have been abused. http://www.idealmedicalcare.org/blog/youre-not-burned-out-youve-been-abused/

      • Agbai Dimgba says:

        Doctors either work smart or work mad. How many doctors have had their licenses suspended or compelled to undergo mental health assessments? The medical profession is one field where it is ‘to thy tents , Oh Israel’. Each person is at the mercy of health insurance providers, patients, administrators and licensing boards. No professional welfare bodies to stand up for them. So what do we expect? Policies are rolled out unchecked to the physical, mental and even spiritual detriment of those who are supposed to ensure that these elements of the human being are intact. So who doctors the doctors when their tripartite being is dismembered. Doctors need to rise up and protect their interests and stop complaining to unhearing audience.

  9. carole baraldi says:

    This post brings back painful memories. I lost a close friend from medical school. During her intern year she fell asleep driving post-call and died in an accident. She was on her way to the airport for her first vacation.
    She was one of the most beautiful spirits I had ever met. She grew up poor helping her father raise her younger sister after her mother died. She worked so hard to get to medical school and fulfill her dreams. I feel again acutely the heartache of losing a dear friend and thinking about her father and sister who adored her and suffered another great loss in their lives. As an intelligent and compassionate young physician she had a bright future and I know would have been a healer to so many. This death was preventable. I know working too much and fatigue is not a problem limited to doctors and nurses, but I think in our field it is rampant. As you have repeatedly pointed out, how can we take care of others if we cannot take care of ourselves??? And why do our leaders not make that a priority??? If one life can be saved, isn’t paying for cab rides without even blinking an eye worth it? How many cab rides is a life worth? This hospital must not think that many. Thank you Pamela for all the work you are doing to raise awareness of a very broken system.

  10. Shegufta says:

    My mom was in a car accident when driving home from a residency shift once and ended up in the hospital. She woke up and she had driven into the back of a parked truck (the front engine part of the car was pretty much under the truck).
    After physically recovering she had to take a month off of work and probably had minor driving related PTSD after (she was a lot more nervous/shakey when it came to driving ever since and it has affecting the quality of her driving greatly)

  11. Ron Sautter MD says:

    In an ideal world, the only real organization we have, the AMA, would be standing up to fight on behalf of practicing physicians and residents. As it is, there is a heavy contingent of medical school and residency directors involved in the AMA leadership, so obviously we don’t live in an ideal world.

  12. Pamela Wible MD says:

    “Hello Dr. Wible, You most recent email certainly struck a chord…several years ago we bid good night to one of our ER FNPs after a long ER swing shift. She lived at some distance from the hospital, about a 45 minute drive. The next morning I received a call from the manager of my department, informing me that our FNP had fallen asleep while driving home after her shift, had struck head on into a bridge abutment and had been DOA on scene. Our next good-bye to her was a tearful and permanent one. She was in her late 40’s/early 50’s. This occurred after recent discussions among clinicians in the department about long hours, extended hours to complete documentation, and resultant provider fatigue. Profoundly sad and tragic.” ~ Cheryl K.

  13. James Wilk, MD says:

    I have fallen asleep (thankfully for only a few seconds) on I-25 in Denver, almost hitting the concrete barrier between the northbound and southbound lanes, when post-call during my internal medicine residency. More than once.

  14. Julie Greene says:

    I am heartbroken because I see too much irony here. I agree no one should be bullied. But by far, patient abuse BY HEALTHCARE PROFESSIONALS and you bet this includes doctors out numbers abuse done to doctors. I am thrilled that the docs have Pamela Wible to give them the voice they deserve. Where are the patients? Dead. Silent. Certainly we can’t get attorneys and most journalists ignore our stories, calling us crazy or ddisgruntled.Only 11% even get an apology. I lost my family, my career, and my home. I never bother with doctors anymore since I value my health and want to stay alive.

    • Pamela Wible MD says:

      You’re right! So many casualties long the way. My focus is to get to the ROOT of the cycle of abuse. Our medical education and practice models abuse these humanitarians who just want to help you, the patients. If we only dealt with the abused patents without stopping the perpetrators then we would be stuck in the cycle. Kind of like finding a safe haven for a domestic abuse victim without addressing the abuser (who will continue to abuse others) and the culture that breeds abuse. The cycle must be stopped.

  15. Cheryl says:

    Burned out family doctor at 42. 🙁
    never thought I’d be done mid-career. I wanted to be a doctor since I was little.

  16. Samantha Dutton says:

    After working as a behaviorist in a family medicine residency, your talk resonated with me. Although there were no suicides during my time, the stress level was unbelievable. I spent most of my time, not educating the residents in behavioral medicine but in “off the record” counseling. I am in agreement with changing the culture where it is learned…medical school. I would also advocate having a behaviorist (social worker, psychologist) in ALL residencies. I loved my residents, they were and are still very special to me…even if my office was the “cry room”.

  17. George says:

    During residency, I had to crank up the AC (even in the winter) and blast the radio to try to stay awake on my 30-minute drive home after shifts. Fortunately, I never fell asleep while driving. But I did fall asleep a couple times waiting at lights. When I mentioned this (and similar issues) to my attendings at the time, I was essentially told to toughen up. Scary situation!

  18. Luz Rodriguez says:

    That is totally insane, doctors are human beings not ROBOTS, I,remember working with residents that,were so exhausted they could not even walk on straight line but needed to be in surgery all night. The INSANITY need to STOP before we loose more doctor.

  19. Dr Moo says:

    I am a family physician, can fall asleep anywhere, anytime, day or night.If I have to sleep I pull over to a side street and sleep. This is not possible in some rough neighbourhoods and when on country roads. I live 50km from home,travelling to work on dangerous main roads with a high accident rate, high mortality rate.About once a week I have a near miss when other drivers tailgate or the unexpected happens. Once a small kitten dropped down from the back of a truck in front when it stopped momentarily in heavy traffic. He must have been sleeping in the undercarriage of the truck, then woke up and jumped down from the truck onto the tar road – straight into 6 lanes of heavy peak hour traffic. He tried to jump to the side, but he had nowhere to go except under the wheels of the cars. I cried all the rest of the way to work.
    Brake drums fallen off trucks, people running out in front of cars, small whirlwinds blowing cars out of their traffic lanes, loose cattle and wild animals on the road,heavy rain,hail, thunderstorms, it all goes on out here. Then I get to work and have to readjust from the survival rat run to be the dependable family Dr.
    Well, after my friend was run down by a garbage truck recently, I have taken stock and am moving to a job closer to home.Will also save on fuel costs.

  20. 1. What are the data regarding safety and accuracy for patients and for doctors in the USA?
    2. In other countries?
    3. In other lines of work?

  21. It was 1977 and 36 hour shifts where you didn’t even SEE your bed were the norm. I was on a Pediatrics rotation. It was near morning. I was sleepless and had a 12 hour shift ahead of me. The nurses called me to sit in the nursing break room, behind the nursing station, while they administered the first part of a “Methotrexate Rescue”. They gave the child a fatal dose of Methotrexate, and a certain number of minutes later, I was to give the Folate Rescue, to reverse the action of the Methotrexate. As I sat there alone, I noticed a Time magazine on the coffee table. It had a banner across the cover that said “Seizing Hostages”. My tired mind, the one that was about to rescue a child from sure death, could only think of hostages having seizures….Thankfully, the child’s doctor had ordered the correct amount of Folate and the nurses had it drawn up before they called me and seated me in the nursling lounge….

  22. Bill Mitchell says:

    It was common on surgery rotations for me to witness upper-levels commanding their lowers to send them a text when they got home so that they would know that they got home safely. As a med student I was protected from that much sleeplessness, thank goodness. I do look forward to the first time I receive such an instruction as an intern so that I can reply that I don’t send texts while I’m asleep and that if they can’t live with the uncertainty of my ability to stay alive on the roads they should consider trying to fix it instead of adding one more pointless bit of bureaucracy to my life. I’m anticipating being quite sleep-deprived at this point.

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