There's been a lot of talk about the work hours of resident physicians. Given that sleep deprivation has been shown to impair various aspects of human performance, it certainly seems reasonable to limit the level of "resident impairment". But we have surprisingly little data to work from. And, for better or worse, physicians post-residency don't have much of a choice when it comes to work hours.
My wife often remarks on how I'm able to answer a page out of a deep sleep, give orders, and go back to sleep. Upon morning review, these orders do, in fact, make sense. It was my training that allowed me to be able to function this way, and it's a damned good thing. I'm not arguing that residents should be worked into the ground like in the good old days. We must take into account the impairment that lack of sleep may cause, but we must also recognize that learning to think and act under a variety of conditions is important. Also, patient continuity of care is important, and the more that a patient is "handed off" from team to team, the less likely any one doctor is to take responsibility for that patient.
But that's not really what I meant to write about. Let me give you an a glimpse of doctoring in real life.
A couple of hours ago, at around 4 a.m., I awoke to the sleepy, unhappy call of, "Daddy!!!!" Since then my kiddo hasn't been able to sleep, so...
My wife and daughter have been nursing fevers for the last few days. My father-in-law has been in the hospital for the last couple of weeks, so I've been keeping an eye on him and on my mother-in-law, making sure they're doing OK and that he's getting good care. Since I'm in the hospital anyway, it's not hard to pop up to his room and say "hi". Yesterday, I started at the office at eight. I saw patients, answered pages, and spoke to my father-in-law's doctors. My wife stopped in for a peek at her throat, and then headed over to the hospital with me to visit her dad. I worked at the hospital until around 9:30, then came home for a bite and crawled in bed. It goes without saying that I must be able to care for the patient in front of me, answer a page from the hospital, take a phone call, and return to the patient without losing my way. Multi-tasking is an essential skill for a physician.
And today, I have to be able to do all of that again, but on four hours of sleep.
I. Friggin. Love it.
As much as I would rather have had a good night's sleep, I love being a doctor. I love managing multiple problems at once, and I'm happy my training prepared me well for it (thanks, Northwestern!).
We must protect our residents and patients from resident over-work, but we also have to realize that when they graduate, they will not be kept resting in a box with "Break glass in case of illness" written on it. They will not only be busy physicians, but they will most likely have families to fold into the mix. So, while I'm a little tired, I'm still happy to go to work today.
Besides, I had an extra two hours to cuddle with my daughter this morning, and that's not something I'd give up for anything.
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What does chronic sleep deprivation do to the lifetime odds of killing someone on the road?
Most people have to multitask at their jobs, and many use extensive training. Many also have great responsibilities. Sleep deprivation affects perception, memory, and sensory input -- which affects judgment. Yes, let's argue for a middle ground.
I thought this study in JAMA was an interesting way to look at it. They followed on-call workload, total sleep time, shift duration, and educational activities in medical interns. Unsurprisingly, the more work (measured by shift length and number of admitted patients) the interns had, the less they went to educational activities.
I'm a college student planning on heading off to medical school. Working in a neurology clinic this summer, I definitely noticed that the busier doctors (including my very pregnant boss) were less likely to make it to grand rounds. I had another job that often left me with 3 or 4 hours of sleep before those 8am meetings, but I always made it and enjoyed it. Then again, I'm a 20-year-old fascinated by everything medical, not a 35-year-old with a family, a medical degree, and hundreds of needy patients.
I just wonder when the novelty wears off, I guess, and if the excessively sleep-deprived end up missing those kinds of opportunities.
That said, I certainly foresee myself living a life not very different from yours and being pretty ecstatic about it.
Enjoy your twenties. The maintenance free days seem to end at 40 or so.
"They will not only be busy physicians, but they will most likely have families to fold into the mix. So, while I'm a little tired, I'm still happy to go to work today."
How many other doctors feel this way? 80%, 75%? Even if its 95%, that still leaves 5% of personnel that are having a problem and thus may increase the rate of medical errors. What about nurses and other medical staff who are often required to work the same horrendous hours; they have not had that extra special "dedication and trial by fire" process that you have gone through; what makes them any different? Should we ask them to work less hours because they weren't trained to live without sleep like you have been?
"We must protect our residents and patients from resident over-work, but we also have to realize that when they graduate, they will not be kept resting in a box with "Break glass in case of illness" written on it."
Maybe that is the problem. Medicine is not like other professions where there might be multiple backups for the failure of one individual. The burden is heavy, therefore the workload should be lightened, especially in the case of residents who are missing vital things like attendance at grand rounds where the training they get may make the difference in saving someone's life or not. Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths during 2004 through 2006, according to HealthGrades' fifth annual Patient Safety in American Hospitals Study. How much of this could be attributed to lack of sleep? If even a small portion of this could be attributed, then it is time that the medical profession "wakes up" (pun intended) and changes a tradition that continues to be a stranglehold on the delivery of quality care.