Asleep at the Scalpel
If you blow a .10 on a breathalyzer, the law says you are too impaired to drive a car.
But apparently, our country's medical establishment thinks it's still okay for you to perform surgery.
I don't mean that literally - any doctor who tried to treat a patient while drunk would quickly lose his license. But consider this: Research has repeatedly shown that a brain that hasn't had sleep for 24 hours or more is just as scrambled as a brain with a .10 blood alcohol level. And all over America, medical interns are routinely treating patients while on a sleep-deprivation bender.
The latest research confirms what many of us have long known: exhausted interns make more mistakes - and some of those mistakes are fatal. In fact, the data show that in when interns work five or more marathon shifts in a month, fatalities increase by about 300 percent.
Technically, those marathon shifts are called "extended-duration work shifts" and they're defined as shifts that require at least 24 consecutive hours of work on a hospital floor. They've been around as long as there have been hospitals; in fact, many doctors see them as a vaulted rite of passage.
Increasing concern about patients safety has led authorities to rein things in a bit in recent years; the Accreditation Council for Graduate Medical Education (ACGME), the body that oversees all medical residents in the country, recently stipulated that residents could only be asked to pull a marathon every other shift, and couldn't work more than 80 hours in one week.
But even under those new rules, interns can still be asked to work shifts as long as 30 consecutive hours, as many as nine times a month. And as the data from the new study shows, when interns work those kinds of hours, things can go horribly wrong.
The study was conducted by sleep medicine specialists at some of the leading hospitals and medical schools in North America. They surveyed thousands of interns for 10 months on their sleep and work habits, and errors that occurred during their work.
The data they collected paint a chilling picture: when interns work five or more extended duration shifts a month, they are seven times more likely to have at least one "significant medical error;" eight times more likely to be involved in an "preventable adverse event;" and nearly twice as likely to fall asleep during surgery or when talking to or examining a patient. And as I've already stated, when interns worked five or more marathons shifts a month, fatalities climbed 300 percent.
Overall, the rates of errors, adverse events and fatalities climbed steadily as frequency of extended duration shifts climbed. That shouldn't surprise anyone - especially doctors. Who better to understand how fatigue affects memory, concentration, and motor and language skills?
In Europe, health authorities have eliminated all extended duration shifts, and limited all physicians to no more than 13 consecutive hours of work. I think the ACGME should consider following suit. But it won't happen quickly - the masochistic fixation on sleep deprivation is too deeply ingrained in the medical education system.
In the meantime, patients need to be aware and vigilant. Medical errors happen even with freshly rested doctors, so it's always wise to pay attention and ask questions (or have someone do it for you, if you can't). And don't avoid teaching hospitals altogether - research shows that they actually have lower rates of negligence than non-teaching hospitals, and they're often knowledge centers for specialized treatment and surgeries. But if you happen to go to a teaching hospital, and you have the luxury of time, don't be afraid to ask about the facilities' resident work policies. And don't hesitate to speak up if a resident providing care seems incapacitated - you'll be doing yourself - and the resident - a favor.
