Drowsy Doctors

I get it. We’re all sleep deprived. Whether it is from binge-watching our favorite series or burning the midnight oil for work, we are all exhausted from time to time. However, the problem with drowsy doctors is a real patient safety issue.

The evidence isn’t new or surprising. Studies have shown that the average physician puts in between 60-90 hours per week, with some reporting as much as 120 hours per week. Of physicians surveyed, many acknowledged that their fatigue negatively impacted patient care and safety.

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A recent study analyzed the correlation between sleep-related impairment, burnout and what they referred to as “clinically significant medical errors.” Sleep impairment was associated with statistically significant increases in preventable medical errors. The conclusion by the physician authors was that “interventions to mitigate sleep-related impairment in physicians are warranted.”

The science is clear. Fatigue affects performance. To be fatigued is to be impaired. Sleep impairment affects cognitive and motor performance. It also reduces concentration, which is proportional to the amount of sleep lost. Decreases in concentration are associated with impairment in performing critical cognitive tasks in medicine such as diagnosis, medical decision making and treatment.

The impairment in decision making has been quantified. One study demonstrated that sleep deprived doctors were less able to perform a proper risk-benefit analysis and selected more risky treatment options.

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In addition to cognitive impairment, sleep impaired physicians have been observed to have decreased operative dexterity and decreased vigilance. One study of physicians in training observed that sleep deprived trainees had less ability to discern arrhythmias on an electrocardiogram.

It has also been discovered that emergency room physicians working night shifts take longer to intubate patients and were found to have an increased propensity for error as their shift progressed. The same study also found that emergency physicians working five consecutive night shifts exhibited a significant decline in cognitive performance.

This isn’t just a doctor problem. It pervades other professions as well, such as nurses, truck drivers, police officers, shift workers, nuclear power operators and others. In fact, the Space Shuttle Challenger, the nuclear meltdowns at Chernobyl and Three Mile Island and the grounding of the Exxon Valdez were all considered to have been partly due to fatigue.

You’ve likely heard this before, but as a reminder, going too long without sleep can be the same as being drunk. Studies have shown that being awake for at least 18 hours is the same as having a blood alcohol content of 0.05%.

However, unlike other occupations where drowsiness can kill people, the healthcare industry does little to regulate this problem. For all you truck litigation lawyers out there, this will ring true to you! The Federal Transportation Safety Commission (FTSC) recognized a long time ago that pushing truck drivers to their limit and not allowing them enough sleep can kill other motorists. Therefore, they enacted strict regulations and required documentation to prove that trucking companies weren’t skirting the safety rules.

However, there is no such equivalent in the health care industry. Residency programs intentionally push their residents to the absolute brink of exhaustion. Emergency room physicians can pull very long shifts. Obstetricians keep notoriously difficult schedules.

Other industries have tackled the problem. Other countries have limited the number of hours physicians can work, but I am unaware of any widespread, systemic regulation in the U.S. healthcare industry.

The question is this. A drowsy lawyer is not a good thing, but a drowsy truck driver is worse and so is a drowsy doctor. So, let’s get serious about regulating this. In my opinion, there should be federal regulation of the hours physicians work and documentation required to be kept to ensure the safety rules aren’t being violated. Hospitals could take the lead on this as well as residency programs and many others. Unfortunately, like so many other patient safety issues, there seems to be little appetite for tackling the things we know lead to preventable medical errors.

Whether you have been following my articles here or not, I encourage you to repeat the following statement aloud. “Why should I care? Because I am a patient and everyone I know and love is a patient.”

Get some rest folks. Your clients will thank you for it and in the meantime, my occasionally well-rested self will keep fighting to improve patient safety for all of us.

Be well my friends.

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