Posts Tagged ‘ CMAJ ’

Should Surgeons be Trusted after All-Nighters?

July 25th, 2011. By Hunter West

Say your doctor was on call all night the night before your scheduled 6 a.m. surgery. Would you still want to go under the knife?

It has long been debated that the effects of sleep deprivation can be just as harmful—and just as much an impairment—as that delivered from alcohol, or drugs. Bottom line: when we’re tired, we screw up.

You run off the road while driving, your reflexes are slower. Worse, when you try to counter the fog in your brain and the yawn on your face with copious amounts of caffeine or other stimulants, you have reflexes unsupported by studied thought—a pure reactive state, with little depth or substance from a sleep-deprived brain straining to carry on with the aid of chemicals in the place of rest.

So why is there not more dialog on this with regard to the medical profession and medical errors?

Recently, the Canadian Medical Association Journal (CMAJ) published an editorial on the sleepy doctor syndrome. Not only did the CMAJ target the problem at the doctor and hospital level, it also called upon legislators to develop national standards in the regulated health care industry to protect patients from sleepy docs.

There is valid reason for this concern.

Beyond the temptation for some doctors to wear sleep deprivation as a badge of honor—or hospitals having to make do with fewer staff amidst the realities of a health care system under siege and shrinking health care dollars—are studies that paint an alarming picture of both where we are, and where we’re headed.

According to a story in the Montreal Gazette (5/25/11), studies have shown a near doubling in the rate of complications when surgeons operate with fewer than six hours of sleep—usually following a night on call.

Those complications have been found to include injuries to organs (a slip of the scalpel), and massive hemorrhaging. Such events can put a patient’s life in immediate danger, or affect their health over the long term.

The doctor, in contrast, goes home to a pillow and beyond feeling regret for the error, is not required to live with the consequences of that error for a lifetime. Unless, of course, a medical malpractice lawsuit is filed.

Mistakes happen, and to err is human nature. But in publishing its editorial, the CMAJ suggested that an already serious problem is about to get worse given the increasing complexities of the health care field. “Unprecedented” demands are placed on a doctor’s physical and cognitive health, as a result.

“Those of us who remain overconfident that we can continue to perform our duties properly with inadequate sleep should imagine the reaction if we were made to seek informed consent from each of our patients to accept treatment under these conditions,” state the authors, adding that working while sleep deprived is neither “normal nor acceptable.”

The authors also point out that—in Canada at least—limits on how long a resident, intern or medical student can go without sleep are not extended to practicing doctors, who often work without supervision and are often older and thus even more susceptible to the effects of lack of sleep.

Such situations are ripe for malpractice lawsuits—and doctors, together with the hospitals that employ them, need to be cognizant of that fact. Errors are unavoidable—but they can me managed and mitigated.

There are already efforts underway in other areas of the health care system. Increasing the use of checks and balances—akin to the checklist in the airline cockpit—helps ensure that the surgeon is operating on the correct patient and is performing the correct procedure in, or on the requisite are of the patient’s body.

Similar-looking labels on drug containers are being changed to avoid confusion in the pharmacy. Lawsuits, together with media scrutiny and public outrage, have helped to motivate the powers that be into action.

What of sleepy docs? Will a spate of lawsuits prompt the health care industry to action beyond mere debate? Lawsuits might be business for the lawyers, and monetary settlements necessary for the affected plaintiffs. But most would prefer to have been spared amputation of the wrong leg, or a scalpel nick that brought on a lifetime of pain or complication, all because the doctor yawned at the wrong time, or wasn’t in total control of his movements just because he was so bloody tired.

Maybe you can collect garbage on a few hours sleep. But I, for one, don’t want anyone going near me with a knife if they might be tired and sleep deprived.

Don’t be a hero. Sign out, go to bed, and let someone else do it. And somebody, somewhere needs to come up with a system that guarantees that.

Tags: Canadian Medical Association Journal, CMAJ, doctor error, Hospital Error, medical malpractice, tired doctors
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