Haven't we all struggled with this issue! Kemp Crockett told me that for a
period of time they went to a "no nights" schedule ie 3p-3a / 3a-3p shifts
...didn't last long. The group of 18 physicians I schedule do not like the
three to four nights per month grouped together. Our night shifts are 8 hour
shifts and most of us "anchor" our sleep to maintain a normal sleep-wake
pattern, in sync with our families ie. sleep from 6P-10P, wake up and eat
dinner/snack/breakfast (whatever you want to call it) and report for work at
11P. Upon returning home catch another 4 hours of sleep from 8A-12noon and
then go to sleep at night with your family. We are lucky to have a PEM who
works only weekend nights at one of our hospitals.
Longevity: Does anyone out there give concessions for the older and wiser in
the division. At what age, and what kind of concessions?
From: Dr. Steven Lelyveld <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Date: Tuesday, February 10, 1998 6:41 PM
Subject: Circadian Dis-stress
>The older you get, the harder it is ......
>The most important aspect of switching shifts is to always have them
>progress forward, i.e., days -> pm -> overnight -> days .....
>The longer you can stay on any single shift, even if it is nights, the
>better it is for your sleep pattern ... but that means you will go through
>protracted periods of not being available either to your family or to your
>non-clinical ED duties ... it therefore takes a very supportive work and
>home environment ... police and fire departments may have it right rotating
>to a single shift for a full month
>The alternative, if you can do it, is one shift of each, and then a bunch
>of time off (i.e., 1 day, 1 pm, 1 overnight, 3 days off, repeat) ... and
>try to keep your clock on a "normal" daytime rhythm.
>I have found I've done best with a bedroom without windows, away from the
>normal activity in my home, and with a "white noise" machine or small fan
>to cover all extraneous sounds ... In one home we painted the windows black
>and used curtains for the aesthetics ...
>Having done 24, 16, 12, 10 and 8 hour shift schedules over a 20 year
>career, it frankly is less stressful to your family to work shorter shifts
>more frequently. You can, at times, get non-clinical work done on the off
>hours ... and see them, too.
>Drugs for sleep only work for a limited time. I have seen too many people
>get into trouble with long term use ... Stay away! Even the much touted
>melatonin only seems to work to readjust your clock to a new, long term,
>time zone ... not for shift switching ... same thing for bright lights,
>although the data is more interesting ...
>The ideal set-up for academic advancement, however, is to have a large
>group of young non-academic types doing the nights ... this flies in the
>face of who we really want to see kids (moonlighters vs PEM docs) and why
>we went into the field ...
>The bottom line is there is no ideal schedule, only ones that are more
>livable ... we chose this career path because we love what we do and think
>we can have an impact ... other medical specialties have their own
>negatives, and I wouldn't want them.
>Let's see what others have to say ... / Kermit
> Steven Lelyveld, M.D.
> Associate Professor of Pediatrics and Medicine
> Director, Pediatric Emergency Medicine
> University of Chicago Children's Hospital
> 5841 South Maryland - m/c 0810
> Chicago, Illinois 60637
> (773)702-9087 or (773)753-1880 pager#9333
> Fax (773) 702-0414
> e-mail: [log in to unmask]
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
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