The Real Problem With Medical Internships

By SANDEEP JAUHAR JULY 1, 2015

New York Times

APROXIMATELY 26,000 newly minted doctors across the United States will begin their internships today. For many, this legendarily grueling year will be the most trying time of their professional lives. Most will spend it in a state of perpetual exhaustion, as near ascetics with regard to family, friends and other pleasures. I was an intern nearly 20 years ago, but I still remember it the way soldiers remember war.

Fortunately for today’s interns, regulations have since reduced some of the misery. Most interns now are not permitted to work shifts longer than 16 hours. They are also encouraged to nap while on overnight duty.

At first glance, such reforms make sense. Studies have found that doctors who got no sleep during a night on call scored lower on tests of simple reasoning, response time, concentration and recall. Indeed, a single night of continuous sleep deprivation has been shown to be roughly equivalent to having a blood alcohol level of 0.10 percent — that is, being drunk.

But there is a downside to these regulations. Limits on work hours lead to frequent patient handoffs, which are susceptible to breakdowns in communication between doctors, thus potentially creating errors. In aviation, most crashes occur on takeoff and landing, and in medicine, too, most mistakes happen during transitions.