I'm over 50, have been doing emergency medicine for more than 17 years and I
schedule the physicians in our group. There certainly are various types in
the circadian grouping. I prefer nights for work. Swing or middle shifts are
OK too. I really don't like day shifts. (Hate getting up in the mornings
even when I'm off.) I am occasionally referred to as the "vampire" in the
group. Another young physician in our group, 3 years out of training also
prefers nights. Between the two of us we often do more than 20 night shifts
a month. This leaves few night shifts for the others in our group. They are
quite happy about this. Week day shifts are all 8 hours. Weekend shifts are
12 hours. One of our group prefers to work a weekend day shift followed by a
weekend night shift. I've tried this and one is usually not as fatigued.
I'm an "old soldier" from Viet Nam and after severing in I Corps for a
year, I find that after more than 25 years, I can still fall asleep without
difficulty at almost any time. If I'm not tired, I don't go near the bed. I
have been know to drink a cup of coffee right before I go to sleep.
Ronnie, did any of your studies include combat military personnel in
them and whether there was a difference from the general population?
Bruce Hart, MD.
From: Ronnie Waldrop <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Date: Wednesday, February 11, 1998 12:19 PM
Subject: Re: Circadian Dis-stress
>I did circadian neuroendocrine research for many years prior to my
>emergency medicine career so I can comment with some expertise on this
>subject. Unfortunately, there are but a handful of useful articles on
>shift work. To summarize briefly, humans as all vertebrates are born with
>genetic tendencies toward various circadian neuroendocrine characteristics.
>In other words, while almost everyone has a roughly 24 hour rhythm of
>sleep-wake, activity, food ingestion, etc. based on neuroendocrine
>variations and synchronized by typical social cues (i.e. lights on, alarms,
>noise, social expectations), there appear to be categories of individuals
>with various degrees of "circadian flexibility". People in general fit
>into 3 categories - those who easily switch work cycles between night and
>day without much maladaptation in personality and basic function, those who
>are literally incapacitated by these switches, and those in between. It is
>important to decide your category and adapt your life since difficulty in
>adapting to these cycle changes is thought to be the core problem in many
>if not all psychiatric disturbances and social maladaptation (i.e. seasonal
>affective disorder). We have all seen EM physicians who suffer great
>psychiatric shifts with night work. It is my opinion that burnout in
>emergency medicine has as much to do with circadian disorganization as the
>work itself. In addition, it is clear now that circadian flexibility
>decreases with age leading to the old adage that EM physicians hit the wall
>between age 40-50 leading to career changes. As far as schedules, the
>healthiest is one which phase shifts forward - Day 1 AM, Day 2 Swing 1, Day
>3 Swing 2, Day 4 night, then 4 days off for example. Next would be blocks
>of time - 5 nights on 5 nights off. Finally, the worst is scatter
>scheduling - night, off, day, night, swing, etc. due to no consistent
>circadian shifts or recovery period. As for myself, I am fortunate at 40
>to be still flexible - all nights 7 PM - 5 AM, 5 on, 5 off, 2 on, 2 off.
>Exercise of my legs( bike)and weigh training, creatine tabs (1/day), and a
>megadose multivitamin keeps my fatigue to a minimum. The day after the
>last night I sleep little and do some physicial activity in order to phase
>shift the next night and wake up in the AM refreshed. I occasionally take
>1 tsp of phergan DM as a mild sleep aid. I must admit though there are few
>out there this flexible at age 40-50 but it is best for my family.
> Ron D. Waldrop MD, FAAP, FACEP
>------------------ Reply Separator --------------------
>Originally From: Dale Steele <[log in to unmask]>
>Subject: Circadian Dis-stress
>Date: 02/10/98 04:19pm
>What helpful strategies have list members found for working a mix of shifts
>which includes days, "evenings" and overnights while remaining sane,
>married with children who recognize you, and at least some productivity in
>academic, teaching and administrative realms?
>How is this influenced by number of clinical hours? age beyond 35? length
>of shifts? blocks of nights? Sleep strategies? Drugs?
>Dale Steele, MD
>PEM, Hasbro Children's Hospital
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