Timing Your Trip to the Hospital

Today I operated on my friend Terry. I called this evening at 9:00 to see how he was. It isn’t that I didn’t see him on rounds. It’s that he’s Terry, my friend, so I called.

I don’t often call my patients at night. There really is no good reason. This may not be the case in all situations.

What happens at night? Are they still patients when I am asleep? Of course they are. Day patients are night patients, even though the surgeons are sleeping. It’s the hospital that changes.

According to a personal account of a hospital by David Shulkin, MD, president and chief executive officer of Beth Israel Medical Center in New York, daytime is staffed and organized. Not so at night, a time that often brings some of the sickest and most needy patients to hospitals. After all, who elects to have a breast implant at 2 in the morning? The people who show up then often have chest pain, broken bones, or foreign bodies sticking into them — they tend to very acutely ill.

All of which brings me to Terry: he had surgery early. We cut skin by 7:15 a.m., though if I really, really wanted to make everybody crazy I’d insist on cutting at 6:00 a.m. Why? Partly because I am a morning person. But partly because I want my patients waking up by the time breakfast is ending. Why? Because I want them recovering during the day, a time in which I know the nurses and the nurses know the routines.

Night-time is perfectly safe where I work, at least for my patients, who tend to be relatively healthy to start with and very stable post-op. But many years of night medicine have taught me to do things by day. If you need surgery, try to have it in the morning.

You can click here to read Like Night and Day — Shedding Light on Off-Hours Care.

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