No more 24-hour shifts for Quebec residents - Macleans.ca
 

No more 24-hour shifts for Quebec residents

Could the ruling have implications across the country?


 

Quebec hospitals will have six months to reduce 24-hour medical resident shifts to a maximum of 16 hours, ruled an arbitrator in a grievance case led by the Fédération médecins résidents du Québec against the McGill University Health Centre yesterday. Arbitrator Jean-Pierre Lussier agreed with the argument put forward by former McGill employee Dr. Alain Bestawros that hospitals are violating the Canadian Charter of Rights and Freedoms by failing to protect their employees’ health. Their evidence was that medical residents are 2.3 times more likely to crash their vehicles after working 24-hour shifts. In addition, they argued that patients’ rights are violated by the fact that doctors make more more errors when they’re tired from day-long shifts. “We know it is dangerous for patients and residents,” Dr. Charles Dussault, president of the Fédération médecins résidents du Québec told the Montreal Gazette, who also said he is pleased by the ruling. Because the decision was based a Charter principle, Dr. Bestawros hopes it sets a precedent for other provinces.


 
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No more 24-hour shifts for Quebec residents

  1. The ruling applies to medical residents, not medical students. Medical residents have graduated from medical school (hence Dr. Dussault’s title of ‘Dr.’). This is not to say that the rule will not be applied to students as well but, in the meantime, perhaps a change in the title of the article would be a good idea?

    • It would be nice if they would expands this to clerks as well (medical students in 3rd and 4th year). I have several friends who have mentioned that they almost got into accidents driving home after 24h+ shifts during clerkship.

      • Most Medical Schools have already implemented changes in clerkship.

  2. This is going to be very difficult to implement in practice – and I’d be interested to see the evidence that residents are significantly “more likely” to crash their vehicles post-call. I have only ever once driven home post-call, and if I’d felt I was too tired to drive I would have, ya know, taken a taxi or walked. Why should residents in Quebec be exempt from exercising basic responsible behaviour and refraining from driving when overtired?

    And it’s not as if one never sleeps while on overnight call. In any case, rules for clerks tend to follow whatever the policy for residents is, so the change will affect all housestaff.

    • Josh, my friends who are clerks say that the issue is the fact that when they get in their cars to drive home, they don’t realize how tired they actually are until they are partway home. I’m not a clerk, so I have no idea what it’s like, but they tell me that they are running on adrenaline and that, when they leave, they honestly feel awake enough to drive. It’s only when they are partway home that they realize they really shouldn’t be driving.

      As a patient, I have to say I would rather have a well-rested clerk or resident looking after my care than an exhausted individual who has been up for far too many hours. Listening to my friends in medical school, I think the whole system needs to be fixed. Having exhausted doctors, residents and clerks just leads to mistakes, which can have fatal results, since they have people’s lives in their hands!

      So I applaud this move by Quebec and I hope to see it expand to all the provinces.

    • Josh,a few comments:

      First, the evidence is easily available…just Google it. Here is a PubMed reference for a recent review.
      The 10-Year Risk of Verified Motor Vehicle Crashes in Relation to Physiologic Sleepiness. Sleep. 2010 33(6): 745–752.

      Second, residents (and the population in general) tend to underestimate their sleepiness and overestimate their abilities (again read the literature).

      Third, obviously you haven’t been on any heavy-duty rotations in medical school or residency. Try trauma call in a Level 1 Trauma center…there were many nights I didn’t catch a wink of sleep as a student or as a junior resident. Most of those days I drove home just to get out of the hospital asap.

      And finally, no, the change will likely not affect all housestaff. Attending call won’t change and neither will nursing shifts.

  3. There really is not much evidence that such exhaustion is associated with increased mistakes, much less fatal ones, and these sorts of night float arrangements carry their own problems. Simply put, the most errors occur around shift changes and handover – and the more times the staff change, the greater the risk that something will get missed.

    From a patient safety perspective, it is definitely not clear that eliminating 24-hour call will improve matters and there is evidence that it may be detrimental.

  4. If residents are prohibited from being on call overnight, they will be much less experienced, less confident and less competent, unless the period of training is extended, thereby cutting back on the number of doctors able to enter the system.