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Demystifying Medicine One Month at a Time

1st Gear Weekends

May is one of my hospital teaching months.

I have the privilege of taking care of patients sick and vulnerable enough to need hospital care. In addition, I have the opportunity to work with medical residents and students, who always teach me new things in exchange for the ‘wisdom and experience’ that I bring to the bargain in acting as their supervising physician.

This one's for the kids. D'oh!

One of the maddening things I’ve noticed about hospitals is that very little gets done on weekends. This is true from the smallest community hospitals to the major teaching meccas.

It doesn’t make any sense.

How can we work in overdrive for five days every week, madly admitting, diagnosing, and discharging patients amidst a flurry of medication, lab testing, radiology, and arranging of follow-up services, only to slow down to a crawl every Friday afternoon?

Let’s look at the airline industry for comparison. Medicine is often compared unfavorably to airlines. Airlines allow price comparisons. Airlines reward loyalty. Airlines have a blame-free culture of safety that says, “We’re all in this together. If one of us goes down, we all do. ” So anyone is empowered to call a safety check when something isn’t right.

Hospitals? Not so much.

Do airlines put their passengers on board planes every weekend only to hold them on the tarmac until Monday morning rolls around? Who would stand for that?

Americans decry how much is spent annually on health care, yet 29% of every week in a hospital runs so slowly that essentially nothing gets done. [With a long weekend, it’s 43%!]

What do I mean by ‘nothing?’

Certainly hospitalized patients get outstanding nursing care around the clock. They get good doctoring and respiratory care, too. They get excellent food service, environmental service (cleanup), and nursing aides who help with many tasks. I don’t mean to disparage any of these folks. They work hard. Medication is dispensed. Heck, some hospital patients even convalesce and start to feel better.

But hospitals aren’t in the convalescence business anymore, at least during the five days of the work week. Those days are a flurry of ultrasounds, radiology tests, physical/occupational therapy assessments, and interventional procedures–like having feeding tubes placed, biopsies done, and elective surgeries performed.

Other industries have figured out how to schedule their employees to optimally meet demand for services on weekends. Airlines. Restaurants. Factories. Retail establishments. Police and firefighters.

Why are hospitals so special?

I admit, I like to have my weekends off like most other people. It’s especially useful for those of us that are parents.

But who is the weekend slowdown really benefiting?

  • Not the patients. They have stay in the hospital longer.
  • Not the hospital. They have a bed that could be used for a newer, sicker patient.
  • Not the doctors or trainees. They are mostly in ‘babysitting’ mode waiting for specialized services that won’t fire up again until Monday.

I’m often told that there’s a shortage of ultrasound technologists in America. Are they to blame? Try getting an ultrasound on a weekend. Cue the tumbleweed.

Radiologists, especially the kind that are good at biospying body parts or putting in invasive catheters safely, are never available past Friday mid-afternoon. Tumbleweed drifts.

I just know if I were a patient (I am), I would be pretty peeved to spend a May weekend in the hospital when I could be home with my family. Oh, did I mention that my diagnosis and plan of care depends on the biopsy or the line getting placed? Crap.

Wait ’til Monday, I guess.

Bonus points and innovation awards to the smarties who can solve this one. Doesn’t seem like rocket science to me. Could be an easy marketing advantage:

Bedrock hospital. Where 24/7 is not just a figure of speech. We figure out what’s wrong and we get you home. Faster than they other guys.

3 Comments

  1. Hello Dr. John – brilliant analogy between the airlines and hospitals. Do you think the twain shall ever meet?

    Patients either have to “stay in hospital longer” – or they stay in hospital not quite long enough. Let’s also consider that if you happen to be a hospital patient during the week, you will if at all humanly possible be booted out the door by noon on Friday. Let’s empty out those beds since there’ll be fewer staff to provide care anyway over the weekend! A friend here was similarly booted out after her mastectomy, even as her family watched her oozing incision leave bloody puddles beneath her on the bedspread at home, a truly alarming sight that nobody in hospital had warned about.

    And the Archives of Internal Medicine has reported that, for heart attack survivors, the average length of stay has declined from approximately 12 days in the mid-80s to less than half that number over the next 15 years.

    Several of us survivors have openly wondered, in fact, if shorter hospital stays now may actually be contributing to the acknowledged link between MI survival and subsequent depression – although as the AIM reports, LOS appears not to be associated with poorer cardiac outcomes thanks to recent improvements in reperfusion therapies.

    But in the ‘good ol’ days’ of two-week hospital stays post-MI, both patients and family members had enhanced opportunities during that time to get their heads wrapped around what the heck had just happened, to meet with hospital social workers, therapists, nutritionists, rehab staff, chaplains, and many other patients to help them adjust to such an emotionally overwhelming crisis before they were sent home.

  2. Very weird, isn’t it? People are no less sick on weekends. Hotels, restaurants, taxis, and, as you say, airlines don’t take weekends off. People eat, sleep, go places on weekends, and get sick or stay sick. Would mean that more manpower is required, but these other industries cover weekends and so too should hospitals.

  3. Talk to your hospital administrators and get an accurate estimate of how much it would cost to have “specialized services that won’t fire up again until Monday” available seven days a week. After you figure out that it is not financially viable (Note: having someone work Saturday and Sunday but take Monday and Tuesday off does not count as seven days a week), then get an estimate of having these specialized services available not just during the day but all night too. Because isn’t that the logical extension of your argument? Then I think you should volunteer to do ward months at least six months a year, maybe nine months, or how about 12 months a year of ward months, including weekends. Everyone is going to have to do their part to get your 24/7 utopia going at Bedrock Hospital. The only way you are going to get it to work is by hiring a lot more doctors, nurses, and technicians of all types. And the only way you are going to pay for it is to churn the patients in and out 24/7. If someone is stable at midnight, discharge them and get a fresh body in that bed, a new DRG payment, baby, 24/7. Critically ill patients do get life saving emergency medical care 24/7 at every hospital I have ever worked at, but in the inane attempt to drive efficiency to some holy grail of maximum, I think we are ruining our profession, maybe even our way of life.

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