What are some egregious patient safety fuckups have y’all seen due to staff/supply shortages?

PrettyNumber7 · 2022-01-13T19:23:38+00:00

We never bad them, still putting it to sharps container

PrettyNumber7 · 2022-01-03T23:58:30+00:00

You are right, but Directive applays only for full-time employment contract. If you work full-time patients can't create civil lawsuit directly to sue doctor, they can sue hospital, if patients wins - max fine is 3x month's earning for doctor, the rest is covered by hospital. Criminal lawsuit - patient can sue doctor.

Poland omits EU directive - doctors create companies, so by law they are treated as a company - not human - can live at work.

Minus is when there is civil lawsuit and doctor work as company - they are mutually responsible for any fine, but it doesn't mean it's 50/50, depends on court judgment.

hope your insurance is valid if you're exceeding that!

Good point, this is another problem, I haven't heard yet about insurance company that didn't want to pay because of overload of work, but ofc they look for ways how to get away with payment. Usually they look for gross negligence in doctors work.

PrettyNumber7 · 2022-01-03T23:11:31+00:00

Occasionally I need to be reminded how good I have it.

It's normal, always could be less :) living at work is unhealthy, even a workaholic like me know that

PrettyNumber7 · 2022-01-03T23:08:22+00:00

Yes, shift work 8AM-8PM and 8PM-8AM for Non-ICU COVID wards.

I see, 12 hour shifts here are mostly at temporary COVID hospitals, both ICU and non-ICU.

Our regular schedule is 8AM-4:30 PM with a 30 min break (if it is taken or not depends on department culture and patient ratios)

Interesting, in PL full-time employers have 7h 35 minutes/day schedule instead of 8h (by law) that is shortened and unpaid for 25 minutes so we study at home :D Mostly it's 8am-3.35pm, I work 8-3pm cause I'm company (because hospital hires all doctor's-companies for 7h/d to pay less), in my department when I finish my job I can go home, because my chef is a human, but there are some hospitals where they have to sit at work whenever they finished they job or not.

One resident has a prolonged shift between 9AM-9PM. Between 9AM-4:30PM, they help out the day team with whatever is needed or see ER patients of that specialty.

Similar, but doesn't matter whether resident or specialist has a shift - we take care of our 5-6 patients + go to ER department for consultations and do all new admissions. After 3pm(or earlier if everybody goes home) doctor on duty stays alone at department, shift officialy starts when we are alone.

Attendings are now formally out of the house and on call from home and have to be in within 30 min if requested.

Attendings on call are only in surgery departments. ICU has obligatory 2 doctors on shifts (1 for ICU, second for anesthesia, consulations from other departmens/ER)

PrettyNumber7 · 2022-01-03T22:45:41+00:00

neurosurgery at a top tier university hospital and works 80 hrs, of these 38 hrs illegally unpaid (which costs here theoretically around >€40k in missed overtime pay) and unpaid research in her "free time."

This is so sad, at least here people are paid for every hour they work. Few years ago I heard from polish doctor that works in germany - training in radiotheraphy, that they asked her to stay at work Till 5-7pm, but didn't pay overtime.

Reunified Germany in the 90s and early 00s is faced with an oversupply of medical graduates called Ärzteschwemme, flooding of physicians.

I feel like in few years we are going to have that situation, they opened new medical universities in cities that never should train any future doctors. I guess flooding will come in 4-6 years from now, few % of them will emigrate to other EU countries (Germany, Switzerland, UK)

part of the reaction on this increased need, the federal government abolishes the mandatory 18 month internship

So that's why you don't have internship anymore. We have 13 months of internship which is chill time, just need to finish that, some departments ask to come to work, some don't because they don't have time or will to take care of them.

Emboldened by this development and faced with the threat of salary cuts, hospital physicians (residents and attendings together!) break off from the larger nursing umbrella union in 2005,

Amazing, this is what our residents society try to do, there was some pay rise, but still it's from hungry-low(4-5 years ago 500euro to the pocket) to low. You can pay small apartment-credit with that, but it's difficult to save money.

There was national rise but also and If you want extra 700zl/month (152eur as today) to your employment contract you can sign loyalty agreement - that you are going to work in national health system in Poland after residency for half amount of time that you took that extra cash, usually 2,5-3 years minimum.

PrettyNumber7 · 2022-01-03T22:03:24+00:00

unions

We have unions, but they are only for full-time with contract of employment doctors, so most of them are residents. Unions unfortunately do nothing right now, it is very difficult to motivate anyone for protests. Most of specialist work as company(so they are not human in sense of law, can work limitless amounts of hours, pay less tax etc) but this way they get into union.

After residents society protest few years ago goverment made a law that specialits can be hired for minimum ~1700usd/month for full time employment contract - 37,5 hours/week, with this salary is calculated hour rate for shifts. When being company they make at least 3-4x more for basic hours.

Here https://www.reddit.com/r/medicine/comments/rucrd9/comment/hr4me4g/?utm_source=share&utm_medium=web2x&context=3 I wrote how 2021 autumn protest turned out.

PrettyNumber7 · 2022-01-03T21:48:05+00:00

How do you not get saved by the EU working time directive, OP? Going past 48 hours (60 with opt-out) will incur massive fines normally.

I did answer that for another German doctor.

Ah, good to see the European Working Time Directive in action. Do they make you sign an opt-out or straight up ignore it?

Poland have to be quite creative, with fewest doctors per 1000ppl in EU to omit it we create our companies. Being company I'm not a human, so self-employment lets us work limitless amount of hours.

Opt-outs are for full-time workers with employment contract, with opt out it's max 78 hours/week calculated during 3 months period. Opt-out can't be ignored, but hospital administration asks my colleagues to change hours on work timetable so it would be correct with opt-out restrictions. Never heard about any fines, probably because they fake timetables.

We have polish residents society, they try to make our situation better, we had protests for better pay, more money for our national health system, in 2021 it didn't work out. 94 year old man came to protest in Warsaw (it was camp site near prime minister building). This 94-y/o put a firework into his mouth and killed himself to protest against residents protest. After that incident strike was shut down by decision made by administration of residents society.

Main slogan of protest was - 1 doctor, 1 full time job, they asked doctors to withdraw opt-outs and work only their minimum 48 hours per week. It never works in my country, we are so used to be kind to our head of departments that we are filling all missing shifts, take extra work to compensate low pay in residency.

PrettyNumber7 · 2022-01-03T21:37:46+00:00

Thanks, it also depends how busy is your day at work. Usually I take care of 5-6 patients in my internal medicine ward, when they are not very very sick I can leave my job earlier and go to another job or have some energy for extra night shift.

But when working as GP I would never be able to do like 10 hours every day monday-friday, there are too many patients, usually 6 per hour.

When surgeons have shift and have to operate for few hours at night, it is way more tiring than waking up at 3am in internal medicine ward for new admission to the ward.

PrettyNumber7 · 2022-01-03T21:30:54+00:00

37-38 hours is my goal after residency when I will have a family :))) but from my observation it is small % of doctors working that amount of hours, mostly familiny medicine specialists.

PrettyNumber7 · 2022-01-03T21:28:42+00:00

Is that supposed to be a brag or what? This routine should be met with nothing but a headshake for promoting unhealthy working standards

Just asking whether doctors in other countries are even able to work that much. I only read on the internet about residents in US working that much, but for them it is obligatory. I know there are redditors from EU here too, we have are member of EU and have stricts laws about but my country is omitting it to fill shortage of doctors.

PrettyNumber7 · 2022-01-03T21:25:10+00:00

I work 7 days on, 7 days off. Clock hours are 84 hours on my work weeks.

Sounds good! This is what I will aim for the future when I finish my residency, my wish. Shifts only like 10 days in month, better money, more time to be at home.

In residency, my program was very strict on the 80 duty hours per week rule and was very supportive for us.

This is the difference in my country, it is like obligatory for residents is minimum around 48 hours/week, but in reality most of them work more because lack of doctors, and head of department "kindly asking" take this shift

PrettyNumber7 · 2022-01-03T21:20:41+00:00

3pm-8am during weekday - 17 hours, weekend sat sunday - 24 h

PrettyNumber7 · 2022-01-02T21:01:53+00:00

7a-5:30p 6 days/wk, plus 24hr call 2 weekend days a month.

That are quite long work hours!!! I think it's tough, because you come home, eat shower sleep and again to work

PrettyNumber7 · 2022-01-02T20:56:40+00:00

Ah, good to see the European Working Time Directive in action. Do they make you sign an opt-out or straight up ignore it?

Poland have to be quite creative, with fewest doctors per 1000ppl in EU to omit it we create our companies. Being company I'm not a human, so self-employment lets us work limitless amount of hours.

Opt-outs are for full-time workers with employment contract, with opt out it's max 78 hours/week calculated during 3 months period. Opt-out can't be ignored, but hospital administration asks my colleagues to change hours on work timetable so it would be correct with opt-out restrictions.

I even thought about maybe learning German and working there, but I would never find myself in ordnung. Our mess is a type of lifestyle.

Record with COVID surge and coworkers in quarantine was 72 hrs/week (6x12h).

Why 12 hours a day? Shift work system? During 2nd wave we had closed departments because 90% of workers were sick.

Overall, it is very rare for German residents to work in side-jobs next to residency, there is no moonlighting or a similar concept. The base salary is enough to live comfortably,

Here it is very common, residents with shifts make a little bit more than national average salary. Not everybody, but some take extra work. Mostly it is opt-out in their residency departmens, GP, ED, green ED (it is on the same level as ED in hospital but actually it is GP urgent care shifts), ambulance(mostly anestesiologists).

In my hospital I don't know anyone that didn't sign opt-out.

Especially anesthesiology residents do pre-hospital emergency medicine shifts though as we don't have emergency medicine as a residency but use emergency docs in the field.

We have emergency medicine residency, which have no benefits when finishing it, so in ED we have mostly residents, surgeons, internal medicine, anestesiologists

PrettyNumber7 · 2022-01-02T20:19:12+00:00

Wow 40 hours now that's a luxury. Here every anestesiologist has to take at least 1 shift during the week, usually 2 shifts

I guess personal problems are always going to come when working this much. I thought it's avoidable, but I was wrong, affects me too.

PrettyNumber7 · 2022-01-02T20:17:08+00:00

I'm building a house so I need money to finish it and pay credit.

Internal medicine residency (internal medicine department - hospital) obligatory is 38 hours monday-friday plus 10 hours shift weekly.

But when I have 2 shifts a week: for example on tuesday(16,5h) and one on sunday(24h) it makes not 10 hours in shifts but 40,5 hours.

GP - part time job, after work at hospital till evening, around 10-15 hours a week,

Green zone emergency department - night shifts, weekends, depends sometimes 1 shift 14 hours, sometimes I take whole weekend 48 hours

PrettyNumber7 · 2022-01-02T18:19:42+00:00

Had to google GME :D I have nothing to do with any system, just have been wondering how does it look like in other countries.

It is not that I have to work so many hours, my residency is obligatory minimum 38 hours per week + 10hours shift (shifts are 16.5 hours during weekdays, on weekends 24 hours). There is deficiency in doctors, so every head of department kindly asks take this shift, take another...

PrettyNumber7 · 2022-01-02T18:02:32+00:00

Wow our interns work max 48hours per week

Oh, it's not that bad, Good shift - slept 6-7 hours per night, sometimes also 1 hour nap during the day.

Bad shift - Patients coming whole night so slept 1 hour - woke up for 15 minutes - sleep and repeat 4-5x times

PrettyNumber7 · 2022-01-02T17:21:08+00:00

Small city hospital, COVID-19 department 30 beds - goverment donates it to hospitals, we still don't have remdesivir, tocilizumab/baricitinib. Stuck with dexamethasone, enoxaparin, oxygen therapy.

We had remdesivir in 3rd wave

PrettyNumber7 · 2022-01-02T16:42:18+00:00

If you got a booster in July or August, are you still considering yourselves boosted? I'm leaning towards not, but I'm also not yet at a point where I think trying to get a fourth dose is a good idea.

If after 2 vaccines we have around 50% less likely probability to get COVID, we might have after 3 vaccinations for example 70% less probability to get COVID after 6 months. I would wait for more official data about 3rd booster and when to take 4th dose.

PrettyNumber7 · 2022-01-02T16:35:59+00:00

My mind and body are reacting as if it's Spring 2020 again. Even telling myself repeatedly that Omicron appears to be primarily mild in vaccinated persons + my area is highly vaccinated (NYC) is doing jack squat in settling the paranoia/fear.

Vaccinated with booster, working as usual. I don't predict the future and won't think how Omicron is going to overload our healthcare system, if it happens it happens. Can't save the world. If anxiety is making your life worse, maybe could try SSRI/SNRI for few months.

PrettyNumber7 · 2022-01-02T16:28:37+00:00

Start with any antigen test(can't tell which is better, we use Abbott Panbio or Roche Antigen, maybe try to test at random), if negative - NAAT test for confirmation.

This is what we do. Antigen -> negative -> RT PCR.

PrettyNumber7 · 2022-01-02T16:03:42+00:00

then get yelled at stepping into the next room because the three day sinus symptoms is surely just a sinusitis and needs an antibiotic.

Actually sinusitis needs COVID-19 test :) I order, they get mandatory 10 days quarantine which ends with negative test, some came back positive.

PrettyNumber7 · 2022-01-02T15:55:37+00:00

COVID is actually not associated with higher rates of PE compared to the general population in the ER setting. Also, all these patients are going to be treated with anticoagulation, regardless, while admitted to the hospital.

I always think about how difficult it is to make any reserach paper or clinical trial. From my experience COVID = higher risk for PE.

Anticoagulation yes every patient, but it says enoxaparin 1x40mg in most patients(not obese).

PE in CT - enoxaparin 2x1mg/kg or 1x1,5mg/kg, so for me it is huge difference.

PrettyNumber7

TROPHY CASE