Popular Science USA September-October 2017

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down. Anyone who has stayed up late at night, working or studying, knows how it feels to try to push through this point instead of dozing: “It is like hitting a wall,” Herring says. “You become cold, you become exhausted, your thinking slows down, and you become gassy.” Herring recalls a spooky happening during this stretch, which is also when an ER is down to a minimal crew. A middleaged patient came in at 3 a.m. with chest pains that could have signaled either heartburn or a heart attack. The EKG was normal. Unsure, Herring faced the patient alone and decided how to proceed. Instinct told him to do a bedside echocardiogram, which showed that a massive heart attack was, in fact, in progress, requiring an emergency catheterization. Everything turned out fine for the patient. But in retrospect, Herring thinks it was a close call. In the daytime, he suspects, that kind of decision would have been much more clear-cut. Since Oakland is a public hospital with growing demands and limited resources, it might not have the ability to address Herring’s concerns about shift work. So he and fellow doctors have come up with a Band-Aid based on the best science they can find. They’re adopting a solution used by Canadian ER doc Pat Croskerry. A professor in emergency medicine at Dalhousie University in Halifax, Croskerry is an expert in cognition and diagnostic errors. He is also a trained experimental psychologist. He advocates using a so-called casino shift: Instead of having one doctor work through the entire night, you have two doctors split the evening, with each of them sleeping for a bit during the witching hour. Even a little shut-eye at this time seems to improve doctors’ focus and reduce potential errors. But better ways of doling out late-night work won’t make the underlying problem go away. Keeping such hours will still push doctors to their limits. “You need to bake in the cost of night work,” Herring says. “The physiological cost on your body. The psychological cost. We somehow have to get the greater society to understand the terrible toll this is taking.” Leslie Kaufman, founder of the political newsletter Red for the Blue, also writes frequently on science.

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