Doctors-in-Training: Desperately Seeking Snoozin'

There’s an old saying that says, “If you get sick, don’t go to the doctor. And if you end up going to a doctor, don’t let him (or her) put you in the hospital!”

Even though that can be construed as amusing or simplistic, there’s an element of truth in this adage. Physicians, and particularly, physicians in training are some of the most sleep-deprived shiftworkers you will ever find.

According to a recent article from the Journal of the American Medical Association, most physicians-in-training in US hospitals are required to work 80 hours or more per week and often pull shifts of 30 consecutive hours or more. Some also work more than 130 hours per week and are on call every other night.

From what we already know about shiftwork and sleep deprivation, this is definitely not a good thing for us. According to David Dinges, PhD, fatigue prompts a wide-ranging series of unacceptable deficits. He explains that as lapses of attention increase, alertness and vigilance becomes unpredictable. Cognitive slowing occurs and time pressures increase errors. A physician may respond to a medical emergency, yet fail to recall critical information relevant to patient care, or record it properly into the records or charts.

The Institute of Medicine estimates that medical errors cause more than one million injuries to patients in US hospitals each year, and may trigger as many as 98,000 deaths annually.

These sleep-deprived individuals are also at greater risk of motor vehicle crashes, near misses, and traffic violations. As we have discussed in a previous article, drowsiness impairs drivers’ abilities to make sound, split-second, and often, life-saving decisions. According to the U.S. National Traffic Safety Administration (NHTSA) driver fatigue ranks higher than driver misbehavior, inattention, or poor judgment as the most common cause of human error behind the wheel.

They also report that approximately 100,000 police-reported crashes each year involve drowsiness or fatigue as the main cause of these accidents. specific risk factors for drowsy-driving crashes are sleeping less than 5 hours per night, feeling sleepy, and having been awake for more than 20 hours immediately prior to the crash. These accidents frequently occur between 4:00 am and 8:00 am, when human performance is at its lowest.

A major study is scheduled that will examine the impact of a schedule which will be designed to minimize sleep deprivation of interns in a 3 week rotation. The researchers will compare the performance and health of these interns against a control group of those working the current national standard ICU resident work schedule. Charles Czeisler, PhD, MD, who directs Brigham and Women’s Hospital in Boston division of sleep medicine will conduct the study along with colleagues at the Harvard Medical School.

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