June, 8th 2016
Sleep deprived health care workers have been the focus of the media for 30 years. Starting with the case of Libby Zion whose tragic death at the age of 18, brought to light the care she received from exhausted residents working over 100 hours per week. Her death led to the Bell Commission report which recommended reducing work to 80 hours per week. Subsequent reductions in work hours have ensued through the ACGME in 2003.
Unfortunately the argument to allow extended work hours has resurfaced in a surgeon sponsored research study published in the NEJM, http://goo.gl/pMbzwg . The study erroneously concluded that because there is no increase in deaths or serious post surgical complications, that residents should be allowed to work more.
The research on human performance when sleep deprived is extensive and clearly shows that being awake for 17 to 19 hours is the equivalent of being legally intoxicated. 24 hours of being awake leads to performance equivalent to twice the legal intoxication limit. The dramatic increase in car crash injuries and deaths by exhausted residents has also been extensively reported. The sleep deprived doctors have been described as unguided missiles. Both motor and cognitive abilities are severely impaired. Would anyone get into a plane with a pilot whose performance based on sleep deprivation was the same as that of someone arrested for DUI. Should we allow doctors to take care of us or our families in this state?
The NEJM published research is inherently flawed. If you ask the wrong question, you always get the wrong answer. The study only measured death and serious post operative complications. What about the myriad errors that are made by exhausted physicians but that by serendipity do not cause direct harm or are corrected before harm results. I personally have fallen asleep at the wheel during my internship dozens of times but fortunately never had a serious accident nor caused an injury. Should we then conclude I was able to care for patients in a reasonable, safe fashion? Front page newspaper articles describing surgical trainees falling asleep in the operating room have been reported for decades.
The specious arguments about the value of long training hours and benefit of continuous care should be ignored. Doctors impaired by exhaustion must be prevented from caring for patients. Public health is at risk and these inhuman work hours must end.
Please see followup post,
Nicolas Argy, MD, JD