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Last Saturday in Sunlight

Start late or leave early?

Start late or leave early?  

21 members have voted

  1. 1. Which would you prefer? A day when work/school starts an hour later than usual, or a day when it ends an hour earlier than usual?

    • Starting late
      8
    • Ending early
      13


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What it says in the title. Let's suppose you get an unexpected change in schedule, and an hour is shaved off your regular work/school day. But which one would you rather not have, if you get the choice? The first hour of the morning or the last hour of the day?

 

—Alorael, who realizes this may be different if you find out a month in advance or just hours before. He didn't break up the questions. In fact, for himself he knows it depends on the exact day and schedule of the day. But it's still one question; answer as best you can.

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Zaego   

I definitely like it to be ending early. If I have a schedule, like work in the morning, I can't get anything done anyway because all I'm doing is just browsing YouTube and watching the clock fly. Ending early, I get home earlier and get all manner of stuff done.

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Edgwyn   

I would find it hard to sleep in for the extra hour and so would rather have the extra hour at the end of the day.  It would be a harder question for me if you made the choice between work starting an hour earlier and ending an hour earlier or work starting and hour later and ending an hour later.

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I sort of assumed this would be a landslide for "starting late."  Wow.

 

That said, I have a job that starts a little earlier than most; I might feel differently with a different typical schedule.

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Insufficient sample size!

 

I am not a morning person. I'm in the starting late camp, with one caveat. Sometimes I work overnight, and if that's the case I'd much rather get to go home an hour early in the morning than show up an hour late. (Actually, it used to be that work would start at 6:00 PM and end at roughly 9:00 AM. Now it's usually 8:00 AM to sometime between 9:00 AM and 12:00 PM the next day. And I'm not all that sure whether I'd rather start that long day at 9:00 or end it a little earlier.)

 

—Alorael, who brings this up after a discussion at work with passionate defenses on both sides. The one thing everyone could agree on is that work days starting at 1:00 AM were terrible. Fortunately they're a thing of the past.

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Zaego   

1:00 in the night? Oooh, that's just torture, that. Worst I've ever had to endure is to wake up at 3:00 in the morning to get myself to get to work at 5:00. Even that was pushing it, since I could never get myself to bed early enough. I'd have always decided to be in bed at 20:00 in the latest, and still find myself doing something utterly unimportant at 20:30. 

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Edgwyn   

I have only done 24 hour shifts a few times (and 36 hour shifts twice), and I have never understood why the medical profession thinks that they are a good idea.  With that said, any night shift schedule is unpleasant to me as I always found it hard to sleep during the day on my days off when my family is up and wanting to do things.

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The medical profession doesn't think they're a good idea. Well, some probably do; there's still a culture of character-building cum hazing. But someone has to be working overnight. Having done both a bunch of consecutive night shifts and isolate 24+ hour shifts, they're both terrible. But at least the latter is briefly terrible.

 

—Alorael, who says this knowing he's due for a 24+ hour workday tomorrow. Somewhat perversely, the busier the afternoon and evening, the later he has to stay in the morning. There's a strong incentive to be obtusely useless and dump all possible work on the day team.

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Zaego   

While it's true that someone has to work overnight, doesn't that cause a working hazard because the person pulling the 24+ hour shift probably can't focus correctly at the end of the shift (coincidentally in a profession that -- I would think -- requires more concentration than many other professions combined)? 

 

I raise my hat, by the way, to you two. Until this minute, I thought I've had it bad with (mere) 16 hour shifts... :p

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nikki.   

Starting later every time. I was recently forced to switch jobs, and my new job has a flexi-time system where I can do my hours between 8-6. I'm doing 10-6. 

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The 24 hour medical shift is a holdover because it's been used for decades and is getting phased out in some hospitals because it causes medical mistakes with exhausted doctors. It still exists because past doctors suffered through it so they assume new ones should.

 

I'd go with sleeping in late because I usually get to sleep late.

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darint   

With no lead time, ending early, particularly if I find out after I am already awake that day. Once I get started in the morning I will never be able to fall asleep for another hour, so the hour will be wasted putzing around. I would much rather just start the day on schedule and end early. If I have a lot of lead time, then I suppose it doesn't matter.

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In the US there has been a move to limit resident (junior doctor) working hours in a variety of ways, and intern (first-year doctor) hours even more. There's been pushback. The restriction on interns working more than 16 hours has been repealed, and they're now allowed 24 hours, plus a few extra to hand off work, like other residents. The tradeoff is always that each time someone ends a shift patients have to be signed out or handed off to whoever is still in the hospital. Handoffs are a known risk. But as risky as being awake for days? There's research, it's fairly consistent, and it tends to be expressed one of two ways:

 

1. The outcomes of patients cared for by doctors with limited work hours are no better, and therefore hours should not be limited; this reduces the number of handoffs.

 

2. The outcomes of patients cared for by doctors with limited work hours are no worse, and therefore hours should be limited; this reduces errors due to exhaustion.

 

There is also work on making the handoff/signout process more efficient and effective, and there's evidence suggesting that doing it systematically really does improve patient outcomes. But notice also that lost in this is the idea of giving doctors' quality of life any priority. That's not under discussion.

 

—Alorael, who can still work at the end of a 24 hour shift even if he hasn't gotten to sleep much (or at all). He can't sustain concentration to, say, read complicated medical literature (without falling asleep). He also doesn't store new long-term memories very well, so it's a terrible time to meet a new patient he'll be continuing to care for. But he can do a decent job of a workup and coming up with a plan of treatment that he can hand off. Is it an ideal system? No. But it's demonstrably non-inferior to other systems, and there's no clearly good way to provide 24 hour coverage.

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8 hours ago, Trading secrets for trade secrets said:

In the US...

 

But notice also that lost in this is the idea of giving doctors' quality of life any priority. That's not under discussion.

It would be easier to make this part of the discussion if typical doctor salaries did not already afford them a quality of life far beyond the bulk of the country's population.  Yes, I know residents and interns and so on don't make so much, despite being the ones to do most of these awful shifts.  But they're on their way to a pretty dope lifestyle.

 

I'm not, btw, saying that doctors don't deserve it.  As a whole they clearly are a hard-working and important profession.  But there plenty of other well-deserving professions that come with a significantly worse quality of life.  This situation makes it difficult to complain about doctors' quality of life, because from the outside it looks pretty gauche.

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Salary and quality of life aren't quite the same.

 

On the economic side the money is fine, mostly. From a free market perspective, highly qualified applicants vastly outnumber spots in medical schools; clearly pay could be lower and there would still be doctors. There are distorted incentives on speciality, but on the whole the money's good and job security is nice.

 

But physician rates of burnout, depression, and suicide are much higher than the general population. Particularly with the much-touted doctor shortage, this seems like a problem to me. I'd certainly take a significant pay cut in exchange for getting out of nights and weekends! (Many of my colleagues in fact work additional nights and weekends. Partly for loans, and partly because of the somewhat perverse way moonlighting pays far, far better than our regular salary. It also feels very different when you opt in than when you are forced into it as a quasi-legal requirement.)

 

—Alorael, who has heard that the situation is even worse in the UK, in part because there aren't the levels of protection for trainees that the US has, and possibly also because the monolithic NHS has such overwhelming ability to simply dictate what doctors must do and how they must work. Being limited to 80 hours per week and 28 hours in a row is better than the horror stories of the past, but can still be crushing.

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No, but lack of salary limits quality of life.  Again, I'm not suggesting doctors are getting more than they should on either account -- just that they are getting a lot more, on both accounts, than most other people.

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Edgwyn   

I find it interesting that the research shows that medical outcomes do not change based on work schedule much.  Commercial Pilots and Truck drivers have limitations on their work rest cycle/crew duty day that were supposedly established as safety measurers based on research.

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Zaego   
18 hours ago, Edgwyn said:

(...) Commercial Pilots and Truck drivers have limitations on their work rest cycle/crew duty day that were supposedly established as safety measures based on research.

 

I'd wager that it's the sitting position and monotonic never-ending road that dulls the brain faster than situations where you'd have to constantly interact with other people, which would logically stimulate the brain more effectively.

 

I'm not saying that it's right to keep people awake for 24-28 hours in a medical profession, but it's more likely to get into an accident if you're sitting and "doing nothing" behind a wheel.

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On 11/16/2017 at 6:22 PM, Edgwyn said:

I find it interesting that the research shows that medical outcomes do not change based on work schedule much.  Commercial Pilots and Truck drivers have limitations on their work rest cycle/crew duty day that were supposedly established as safety measurers based on research.

 

The research is actually a pretty mixed bag. Being awake for too long increases medical errors, but so does handing off patients to someone else. Work hour restrictions haven't clearly led to better results. To be fair, they also haven't reliably led to residents actually working fewer hours, and have created the idea of "night float" which research does consistently show is even worse.

 

—Alorael, who thinks there is immediate and catastrophic consequences to sleep deprivation in pilots and drivers that doctors don't quite have. But another big difference is that if you don't let pilots fly or truckers drive, then the planes and trucks just don't go. Less work is done. That doesn't work for doctors; you can't have a doctor be off duty without another doctor going on duty, because there's no way to put people being sick on hold for a mandatory rest. Crises can't be predicted or delayed the way a transit route can.

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Kelandon   

Clearly, the solution is self-driving doctors!

 

I would think, as a matter of policy design, it's probably easier to design better handoff systems than to design more sleep-deprivation–resistant humans. So if we're looking to reduce medical errors (and improve working conditions as an ancillary benefit), we'd probably want to reduce hours and improve communication. You mentioned that there's some work being done in that direction, which I'd expect to be a good thing.

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Edgwyn   
20 hours ago, It's been 0 seconds since this sign was last read. said:

That doesn't work for doctors; you can't have a doctor be off duty without another doctor going on duty, because there's no way to put people being sick on hold for a mandatory rest. Crises can't be predicted or delayed the way a transit route can.

But you can work on better handoff procedures and develop shift procedures.  Commercial planes on domestic routes often have more than one crew operating them in a single day because of duty day limitations.  Longer international routes travel with a larger crew so that adequate rest can be maintained.  Air Traffic Control has a very strict duty day limitation as well and has a much harder handoff problem than piloting or driving do.  

 

I wonder how accurate the patient outcomes statistics really are.  Our knowledge of how an airplane is put together is really how as the most complicated airplane is something that we have engineered and built and is far simpler than a human.  The default finding in an accident investigation in aviation tends to be pilot error unless some other cause can be clearly identified.  Even then, pilot error is often listed as a factor.  That has created a major incentive to reduce the amount of human error possible (and will lead fairly soon to self-flying planes and self-driving vehicles).  I wonder what portion of medical errors are obscured by the greater complexity and greater difficulty getting data on a human being.  Aviation accidents tend to be fairly noticeable, medical errors can be far more subtle and I would think that they would be more likely to be under reported (they are harder to determine).

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I've been hearing about medical malpractice in some detail recently from a friend who is an attorney.  Apparently a decent chunk of malpractice cases involve a course of diagnosis and treatment with enough different components -- and often a large number of doctors and other staff involved at different points -- that it can be difficult to assess which component (or which professional) is most likely to have erred, even when dealing with conditions and procedures which are well understood.

 

Of course, malpractice cases are clearly not representative (at all) of all cases of medical error.  But this definitely made me think about similar difficulties surrounding those statistics.

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Bender89   

Interesting Question, I would opt for late start but all depends on the job. I've noticed that the medical profession has a whole big issue with malpractice and am a strong advocate of lowering shift hr's and weekly hour caps. But I tend to want to hasten the coming techno/scientific paradise world ran on reason and logic without undo stress and violence or undo awfulness,  instead of our greed impulse, controlled near mob rule(nice as it may be). 

 

I can only imagine the complexity of the human body, and have enormous respect for all involved in the medical profession, Living so close to Johns Hopkins even I forget how quick emergency rooms get flooded. I used to want to be a doctor as a child (and be an astronaut heh) but you know how those teenage year's can screw up your plan's. 

 

Anyway I hate seeing people abuse the hospital's and vice versa.

 

Any of your thought's on single payer or socialized healthcare? It make's me happy that professional's such as yourselves play these games! I guess it's good practice for quick math.

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Zaego   

Well, I know that if it wasn't for my country's socialized style of handling the healthcare via the government funding the healthcare across the country (paid for by moderately high tax rate), I wouldn't be alive. Well, if I was alive, I'd be in a wheelchair since my family has never been blessed with high income. Consequently we couldn't have paid the numerous operations it took to operate my spine which was deteriorating fast back when I was 11 years old. Same goes for my brother. Of his 40 years of life, he's been on disability pension for nigh 15 years.

 

So, yep. Socialized healthcare all the way.

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Bender89   

Without Obama care i'd be in the poor house too. Not that there is any poor house's left, was that a real thing anyway?

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Zaego   

In historical times? Yeah, they had those. You can find an article on Wikipedia about it. It wasn't a glorious existence, but better than dying on the streets. The origins of the poorhouses or workhouses went pretty far back into the medieval period. The poorhouse would always produce something that they could both consume themselves and also trade onward. The tenants would have to work for their share of the production, the amount of work for each one evenly confined by their health and age.

 

If I remember correctly, monks in some monasteries would hold and upkeep poorhouses for people without money. They'd receive some kind of funding from the crown or the church, or just as donations. Or, as mentioned above, in the form of sales from the raw production of the poorhouse. 

 

It's 3 o'clock in the morning, though, so I might not remember all the details correctly. 

Edited by Zaego
Details. Not the devil. Just details.

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I'm not really an expert in either work-hour rules or the research about the subject, so take what I say with a little bit of skepticism.

 

Better hand-off systems can be and have been designed. Getting hospitals to implement them is an uphill battle (medicine is a conservative institution generally, with some good reason, but making positive changes can be slow going), but it's happening. Still, it's pretty clear that hand-offs come at a cost. Even with the clearest summaries and instructions, overnight coverage doesn't know patients as well as the primary team unless it happens to be the primary doctor. But having the same doctor on-duty and knowing the patient well 24-7 doesn't work. It's all finding the optimal balance, and it's not obvious.

 

Planes and flights are more interchangeable than medical care. You can have one pilot go off duty, another come on, and it goes smoothly. The same could be true for a patient, probably; it's less true for dozens or hundreds of patients at a time.

 

Medical errors for these studies are often things caught before there is any potential harm. Things like ordering the wrong medication and nurses or pharmacists catching and correcting the problem, or something important being left undone and only caught with later review. Malpractice requires both actual harm and some kind of deviation from standard of care; not doing the right thing, or doing the wrong thing, can be noticed later and counted as medical error even if nothing bad actually came of it. You can also have bad outcomes with no error. Some of that comes with the job of taking care of sick people, some of whom will have bad outcomes because of the nature of illness. Some is because of mistakes; figuring out where things when wrong, like when the wrong thing was done or a critical sign or symptom was missed, is a big part of medicine (legally, with assigning culpability in malpractice, but also for root cause analysis to try to avoid having the same bad things happen again if it's avoidable).

 

—Alorael, who is in favor of everyone having access to healthcare. There are a number of ways to accomplish that; single-payer is one, but not the only one. There are reasons to pick among the options, and he's not expert enough to have a professional opinion. Simply not providing coverage for people is a reasonable free-market choice, but he views it as morally untenable; the current system also doesn't let doctors or hospitals leave people to die even if they want to, so it's not even like there's a true free market now. It's just a really expensive system that will provide care without repayment only in extremis, which is the most miserable and expensive way to go about it.

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Bender89   
17 hours ago, Zaego said:

In historical times? Yeah, they had those. You can find an article on Wikipedia about it. It wasn't a glorious existence, but better than dying on the streets. The origins of the poorhouses or workhouses went pretty far back into the medieval period. The poorhouse would always produce something that they could both consume themselves and also trade onward. The tenants would have to work for their share of the production, the amount of work for each one evenly confined by their health and age.

 

If I remember correctly, monks in some monasteries would hold and upkeep poorhouses for people without money. They'd receive some kind of funding from the crown or the church, or just as donations. Or, as mentioned above, in the form of sales from the raw production of the poorhouse. 

 

It's 3 o'clock in the morning, though, so I might not remember all the details correctly. 

Interesting, Being poor is treated like a disease these day's. Mean spirit's abound, and coldness everywhere including in myself. But somehow I think this trend of: big screen to little screen to work and to a photo op's is going to subside. But My personal boycott has left history with my own words on my life. And no proof of my most daring deeds. 

 

And I've taken a look at your artwork, very good stuff. My drawing of faces is never going to be that great. My drawing's tend to be cartoon like and kind of dark. Once again I have few that were never just given away or lost to time. And I've lost much of my technical skill's.

 

(Just keep waxing poetic bender's ghost...)

 

And Alorael I appreciate the insight into this issue. I think most don't realize even when you go to the hospital that the hour's of work per shift is that unreal. I'm hoping that Computer's and communication and procedures will change and or be implemented. As well as this fanatical attachment to tradition's no one really values or like's, get swept away in a neo-futurism that has the means and staying power to create that near utopia we HAVE the necessary component's of already. I'm tired of corporate feudalism and I'm typing from the safety of my mother's couch.

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Zaego   

Yep, it's sad to see that callousness has taken root in our world in such a strength. Well, still, methinks we can fight back, by upholding bastions such as these Spiderweb's forums where friendly atmosphere flourishes and we can strengthen and encourage each other to remain rational, sensible and helpful to one another in these distressful times. 

 

Also, thanks for the kind words. I haven't drawn anything in a long time since I've been focusing solely on writing the Downfall, but that might soon change. Time spent creating art is never a wasteful prospect. 

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Getting away from the whole medical thing (mainly because I just saw the topic...).  My favorite schedule in my working years was a 4/10 week that started at 5:30am & got out at 3:30 (paid lunch).  Having that extra couple of hours in the afternoon when most people were working was wonderful as assorted chores were easily done (without the 'afterwork' crowds).  So put me down for the 'go to work early' column.  It also kind of depends on the time of year.  I'd rather have daylight in the afternoon/evening when I'm off so again, go to work early.

 

/that job also had me working the 4/10s on a rotating schedule - M-Th one week & Tu-F the next, a four day weekend every other week.... man I miss that one

//HR was always complaining that I never took my vacation... with a 4 day weekend every other week I never needed one...

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Lilith   

i have a job where i can set my own hours, but i generally end up doing most of my work in the evening, so i guess i've answered the question for myself already

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These should clearly be checkboxes and not radio buttons. :p

 

(But personally, whenever I get to set my own schedule, I end up working from "made it to the meeting just in time" to "the stores are about to close and I need milk". So I gravitate to the former, but I'm not sure if that's actually optimal for me or just indicates depression.)

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Edgwyn   

I have the opportunity at work to shift to a 5/4-9 schedule (five nine-hour days one week, three nine-hour and one eight-hour days the second week) with a three day weekend every other week.  I have not done so yet because of reasons, but next Fall I will relook at it.  I will enjoy the three day weekend every other week, but to shift to the nine-hour work day, I will leave my start time where it is and make my end time an hour later.

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