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Doctors Shouldn't Be Allowed To Work 28 Hour Shifts

2026-03-02 19:51:06

I once pre-booked an Uber ride, and when the driver arrived he explained that he'd had to log off for 30 mins in the middle of the day in order to be allowed to take this ride in the evening, because the app has a maximum daily shift length of 12 hours before it locks the drivers out. Hey, safety first right? Driving can be dangerous, and tired drivers make more mistakes.

Meanwhile, your literal doctors are allowed to work 28 hours straight.

Here are some rules (apparently) from different professions for maximum shift lengths:

Profession Max Continuous Shift
Airline Pilots 8–9 Hours (flying time)
Truck Drivers 11–14 Hours
Doctors (Residents) 28 Hours

Three things should stand out to you here:
1) Doctors are allowed to work 28 continuous hours
2) But only the Residents
3) This is bananas

I'm currently reading a book called Sleep Groove (v good, recommended). Among many interesting and unexpected points, it makes the entirely predictable point that people perform worse on all kinds of tasks when they haven't slept enough. The decline is really, really sharp and the trough is really, really low.

Why are doctors allowed these shift-lengths? I have heard two opposite explanations, both of them bad:

  • senior doctors treat junior doctors like fraternity pledges because they can. Medical residents technically count as students/apprentices rather than employees, and so are exempt from labor protection laws. At one point the residents tried to sue about this and then an unholy alliance of the medical establishment and Senator Ted Kennedy worked together to legally screw over medical residents for the rest of time so senior doctors could continue profiting.
  • junior doctors actually WANT to work 28 hour shifts, because working 28 hours straight and then getting a five day weekend (or whatever) is more fun than working three 10-hour shifts spread across multiple days.

I just want to be clear that, whyever the current situation persists, I don't think it should be allowed to. We have both internal and external evidence that people make bad decisions when tired, and (crucially) that they don't know in the moment that they're making bad decisions when tired. We don't trust drunk people when they say "I'm totally fine, I can drive!" because the same thing that impairs their judgment is also impairing their meta-judgment about the impairdness of their judgment. Similarly, we shouldn't trust doctors who say that they're fine to work on limited sleep, no matter how much we love and appreciate doctors more generally.

The main argument used in favour of long shifts is "continuity of care", i.e. that it's better for a patient to see the same doctor continuously and prevent "handover errors", where something in the treatment goes wrong because information got lost when going from one doctor to the next.

I'm sorry, but this is the kind of process problem that the modern world is actually good at solving. I haven't worked at a hospital and I'm not saying the solution here is easy, but the solution is some version of "develop a procedure which standardizes the way that information about patients is handed over from one doctor to the next, minimizing error."

Of course, hospitals already have such procedures because shifts still end and handovers are still done; the only question is where to make the tradeoffs between "more handovers" and "sleepier doctors."

I am extremely grateful that doctors exist, they do a very difficult job and I celebrate them for doing it. But I fear we've got in a situation where the difficulty and importance of the job itself creates a taboo against other people having an opinion about it, which feels wrong. As mentioned, I'm not actually clear that the doctors who work 28 hour shifts even want to be doing that, or if it's enforced on them by a cartel of their elders who entirely control their job prospects, in which case it's extra-good for outsiders to speak up and help shift the equilibrium. But even if it's the case that doctors (overall) prefer to work fewer, longer shifts, that doesn't mean it's a good outcome. Patients – which, of course, ultimately includes doctors and their families too – shouldn't tolerate it.

A Boring Archetype

2026-02-25 19:44:23

Over the last year I met a few incredibly boring people who all reminded me very strongly of each other. This got me thinking: taxonomically, what defines this particular boring archetype? In some sense the answer is just "not reading the room" – my definition of boring is "someone who talks at me, at length, without listening to me, and indifferent to my disinterest." But what are the more specific components?

Drone-y delivery. The delivery is important because it must never be clear to the listener when a story is going to end, and the listener must never really be situated in the story: they should be unsure moment-to-moment where in the arc of the story they are. This generates a kind of internal frustration beyond the pain of listening to someone monologue in general. The effect is achievable through a "classically boring" monotone, but it's also possible through a kind of Scandinavian-style lilt where you're just constantly uncertain where you are in a sentence or paragraph.

Quoted Speech. I'm not sure why this is such a commonality, but these people always insert extensive quoted speech into what they're saying, in a way that I rarely hear from anybody else. E.g. "So then Jo says, I think it's time to go to the bus, and I say, Yes you're probably right, and she says But we're not going to make it unless we run, and I said You are so right Jo, it's five minutes away and we're six minutes away from it."

I guess the meta-reason this is boring is because they could easily have synthesized this information ("So then we ran for the bus"), and the exact words someone used are rarely interesting unless they're really excellent words, so using this much quoted speech is normally an embodiment of "enjoying the sound of one's own voice + not really caring about the listener's experience," hence boring. But it's still striking to me that extensive reported speech is so prevalent in the boring community and rare outside it (though it's possible that interesting people are doing it too, but I fail to notice that because it makes sense in context and is interesting).

Fractal stories. This one I will really struggle to render, but I think it might be key. Every one of these people has a super-human ability to nest stories inside other stories, "My cousin Larry used to live near Tucson – his daughter went to school with Amanda Grayson, who was really quite short, she could barely reach over the counter at the grocery store, she used to have to shout up from behind the counter it's me, Amanda, is anyone there?, and..."

As I said, it's incredibly hard to render this pattern accurately but I think it might be the most important part of this unique archetype. I have met other boring people who are boring in other ways, but to me this archetype is DEFINED by the incredible ability to contain infinite stories within each of their stories. None of the stories have satisfying or interesting conclusions, and as a listener you're constantly in a state of uncertainty and anxiety since you're constantly in the middle of a series of open loops (which of course is compounded by patented Drone-y Delivery). The speaker flows through an infinite list of opened parentheses, occasionally closing some of them but always leaving more still open, giving their speech a remarkable texture and (of course) making it entirely uncompilable for the listener.

I think the difficulty of rendering this speaking style shows what a talent this is: like being a talk radio host, people think "I could do that!" but you cannot, it takes a kind of genius/and or extensive practice.


NOTE WELL: I am extremely worried that publishing this might put the exact wrong idea in the exact wrong people's heads, i.e. I worry that some not-boring people will read this and think I'm talking about them because e.g. they occasionally tell nested stories, or occasionally quote someone else's speech.

The main things I want to say to this are 1) if you're worried it's probably not about you, because the people who do this don't seem to have any concern at all about whether other people are interested in what they're saying, and 2) it's impossible to be boring in this way if you take up 1/n of the conversational space in an n person conversation.

I had a dear friend once who thought of himself as boring, and I was like "...clearly you're not?" Basically, from the inside he felt like he rarely had anything interesting to say, but then if he didn't have interesting things to say he didn't say them, so from outside he seemed a bit quiet, but never boring.

Meanwhile the most boring people I know consistently take up a disproportionate share of talking-space, they do not stop talking when other people try to talk, and for reasons quite beyond me seem to think everyone wants to hear them talking all the time – I assume their conceptualization of this is somehow completely orthogonal, they think they're the life of the party or something, that if they didn't tell their marvelous stories then everyone else would get bored. Essentially, being boring is a power move and that is actually one of the reasons I hate it. Point being: if you listen to other people and let them talk a roughly equal amount as you do, this post is not about you.

Bargains For Me

2026-02-23 19:11:43

If you're hunting for a new apartment in a place like New York City, you quickly come to feel in your bones that the market is pretty efficient. You want a low price for a large space and to be right near the subway, and so does everybody else, so that kind of apartment is not available on the open market: if a place is large and cheap then it's far from transit, and if it's cheap and near transit then it's small, and if it's cheap and large and near transit then there is something horrifically wrong with it (like the building I looked at which had deafening all-day construction noise outside, and a strangely optimistic realtor who told me I could solve this by buying a white noise machine). As a dear friend of the blog likes to say, bargains are bargains for a reason.

As a result, at some point in the apartment-hunt, the smart thing to do is start asking not "what would I ideally like in an apartment?," but "what do I care about less than other people do."

If you realise that you're out at work all day and won't get to see the view anyway, you can get a place with a bad view that is therefore better on size/cost/location than it would be otherwise.

Or if you don't care about "luxury building" amenities, like having a doorman or an in-building gym, you can get a better price by looking at buildings without those things. (I actively prefer not-having a doorman, for inverse Confucian reasons).

Eventually, you'll visit an apartment and think: ok, I understand why this place is priced lower than the size and location imply, and the thing that makes it worth less on the market is not as big of an issue for me as for the average renter, so this place is a bargain for me.

(There is still a decent chance you're about to get a terrible deal for reasons you didn't understand, and then spend the next year of your life regretting it, but at least there's some chance you're getting a bargain on your own terms).

Here's the point where I say something that takes economic principles and applies them to social life, to which some % of people will say "oh yes of course that makes sense," and another % of people will say "this is monstrous and you should be banned from society."

Namely: the same applies to people.

There is not an efficient market in friends or lovers, but there is some kind of market and some amount of efficiency. "Everyone" wants a tall and rich and handsome husband, so mostly it's the same deal as the apartments: if you meet a man who's tall and rich he won't be handsome, if he's rich and handsome he won't be tall, and if he's all three then there's something else horrifically wrong with him (e.g. he's a blogger).

The same goes with friendships. There are some traits that rub a lot of people up the wrong way, but are not (I'd argue) necessary friendship deal-breakers – for example, arrogance. Some arrogant people are still smart and interesting, they're just annoying and pompous about it. If you're unusually unbothered by arrogance, you can get a great friend "at a discount" – they have more time for you because other people don't want to hang out with them, so you get a great and interesting friend at a bargain for you.

How Many Friends Should You Break Up With?

2026-02-18 19:54:20

Occasionally I ask people how many friends they've "broken up with" in their lives – as in, how many people have they explicitly ended a friendship with?

(I think we've all had friends who we were close with & gradually lost touch with, but if you still consider them friends-in-absentia then I'm not counting those).

Obviously if I met someone and they said "yeah I've alienated every friend I ever had in my life", I would be pretty concerned about them.

But equally if I met someone who said they'd never ended a single friendship, I'm not sure (in most cases) I'd believe that's a good thing?

Over the year's I've had a few (former) friends who behaved really badly towards either myself or other people. And I could have stayed friends with those people by tolerating their behaviours, and in most cases it would have been easier to. But I think it would also be worse.

Like many such questions, there's no ideal answer in the abstract – it partly depends on luck, and partly on how many friends you have in general, and partly on how early in life you developed good judgment about other people. Still, the question interests me because I rarely know what answer to expect, or what exactly that answer means.

Why Are We Like This?

2026-02-16 19:11:25

Often I'll meet someone who (for example) is footloose and fancy-free, and when asked to reflect on that will attribute it (say) to having parents who moved countries a lot as a kid, and therefore never really settling down, and therefore now (as an adult) being very unattached to things.

And this makes sense as a story, but it also strikes me that the opposite story would equally make sense: your parents moved around a lot, and therefore as an adult you got married and bought a house and stayed in the same place for the rest of your life.

And therefore to me it seems like the "real" cause for this person's personality is actually something else: something about this person made them react to the childhood-moving by becoming footloose, instead of by becoming stationary, and really that's the interesting part of the story.

Many (most?) of the stories people tell about themselves have this format to me:

Why are you so rule-bound and studious? "Because my parents were very strict." Ok, but surely other people have reacted to the same kinds of rule-boundness by becoming wild and rebellious?

Why do you think you care so much about fairness? "Because I experienced great unfairness in life." Ok, but some people experience unfairness and respond by thinking "screw it, I guess it's a dog-eat-dog world so I'm gonna go eat the other dogs".

I've never been much of a life story guy – I am illegible to my own eyes, I cannot explain Why I Am Like This even to myself, and this causality-attribution issue is one of my core complaints: I don't think we know why we are how we are, and the stories people tell about it are largely unconvincing to me.

Sometimes I think it's Bad to be so non-narrative, that people are happier when they have a coherent life story whether or not it's true, and would be better off ignoring the question I ask here. If so: sorry!

Blame The System

2026-02-13 19:46:10

First, a caveat: if you think you've spotted a noble lie that seems to work for people, such that possibly if everyone knew the truth we'd all be worse off, should you write a blogpost about it?

I don't fully know if you should, but I am fundamentally a thought-gossip and if I think of an idea I just want to tell everyone, ruat cælum. So here you go.

I think a lot of typologies and systems (such as attachment theory, enneagram, astrology and so on) basically function to allow people whose relationship has soured to attempt a "reset" while blaming neither party.

If Alice and Bob have been fighting, and they've both dug their heels in, and they want to un-dig themselves, but that would mean admitting one (or more) of them is wrong.... it's so much easier to not to.

But then suppose Alice reads a book about how everyone (conversationally) is either a tardigrade or a barnacle, and tardigrades and barnacles often misunderstand each other because of their different world-models, but neither is fundamentally wrong, and Alice is a tardigrade and Bob is a barnacle.... well, suddenly we have a way to reset the conflict without either party admitting error.

This doesn't even mean that the system or typology is entirely pointless or arbitrary: in theory, it could also be pointing at a real difference in people's models of the world, of which there are many. But that isn't strictly necessary, the typology can be trivial or even false, so long as it gives everyone an excuse to forgive and forget, and try once more to make the perilous journey across the seas to another soul.

(Happy Valentines day everyone!)