Why Should A Truck Driver Have To Get More Sleep Than Your Surgeon?: New Research Raises Questions About Physician Fatigue

sleepy doctor iii.jpgA couple of weeks ago, I blogged about the divergent approaches that we have taken to addressing the public health problems of medical malpractice and auto accidents. We seem to have taken a “hands off” approach to medical malpractice (even though it kills 100,000 people a year), going so far as to enact “tort reform” that insulates insurance companies from having to pay out in medical malpractice lawsuits. On the other hand, we seem to have taken a “get tough” approach to car accidents, cracking down on texting and driving while intoxicated and insisting that car manufacturers offer new safety devices such as airbags.
In reading through two new journal articles touching on physician fatigue, it dawned on me that we also take a tougher approach to operator fatigue on our roadways and in our airways than we do in the operating room. We subject truck drivers to stringent “Hours of Service” requirements to insure that their fatigue doesn’t harm innocent people who share the roadway with them, but, aside from some lax regulation of the number of hours that medical residents can be forced to work, doctors have a great deal of autonomy in deciding whether they should keep on truckin’ or take a snooze.
New research, however, is calling into question whether this is such a good idea. A recent journal article in the Journal of the American College of Radiology (hat tip Dr. Bob Wachter) shows that, over the course of an eight-hour work day (8 a.m.-4 p.m.), radiologists suffered a statistically significant decline in their ability to evaluate x-rays. As the (eight-hour) day wore on, radiologists were more likely to miss a fracture on an x-ray and to see a fracture where there was none. By the time 4 p.m. rolled around, nearly 1 in 20 more x-rays were read incorrectly. The article should be troubling because very often radiologists are working more than an eight-hour shift and very often they’re doing something more demanding than reading an x-ray – such as reading an MRI or CT scan with dozens of images.
This study follows on the heels of a 2009 article published in the Journal of the American Medical Association showing that daytime surgery patients suffer an eighty-three percent increase in complications when their surgeon is working on less than six hours sleep. Citing the JAMA study and other recent work, an essay in last week’s New England Journal of Medicine recommended the implementation of policies that would minimize the risk of a patient being treated by a sleep-deprived surgeon. The essay suggested that how much sleep a surgeon had the night before surgery might implicate issues of informed consent (!) and that patients should be informed of their surgeon’s sleep schedule the night before, with the option of postponing their surgeries if their doctor hadn’t gotten enough sleep.
Hopefully, these recent developments signal a sea change in how the medical profession addresses the issue of fatigue. In his “Wachter’s World” post on the radiology study, Dr. Wachter related a telling anecdote about the late, legendary heart surgeon Michael DeBakey. While visiting Baylor College of Medicine, someone reverentially told Dr. Wachter of Dr. DeBakey’s feat of performing sixteen open-heart surgeries in a single day. Instead of being impressed, all Dr. Wachter could think was, “Boy, I wouldn’t want to be patient #16.”
When you are possessed of Dr. DeBakey’s singular talents, you must feel an immense burden. There are more patients who need your life-saving abilities than you could possibly ever treat and have time for rest and family. But there is a tipping point where you’d be better off with the next-best doctor than you would be with Dr. DeBakey and medicine is finding out that that tipping point might be reached earlier in the day than anyone had ever imagined.

This blog is maintained by the Boston truck accident lawyers at The Law Office of Alan H. Crede, P.C. The blog neither offers nor contains legal advice.