Anesthesia residents offer eye-opening insights on drowsy MD perils

anesthesia-300x153Some of the very medical specialists who are supposed to put patients to sleep experience big problems themselves staying awake, with more than half of anesthetic trainees reporting in a new national survey in Britain that they had crashed their cars or nearly done so while headed home after long night shifts.

American doctors’ social media responses to this new research indicate that work weariness and drowsy driving are perils for practitioners on this side of the Atlantic, too.

The doctors’ complaints also underscores the irrationality of recent decisions by American medical educators to reinstate long shifts for interns and residents, trainees who play important—and sleep-deprived— front-line roles in providing medical services to too many patients in academic medical centers and hospitals nationwide.

In Britain, more than 2,000 anesthesia trainees responded to a survey in which 84 percent of them said they were too exhausted to drive home after late night shifts, and 57 percent self-reported accidents when they did. Many said they were saved from more serious car wrecks only by road bumps that jarred them awake. Some said they struggled to stay awake sufficiently so they could walk or bike home.

Just a third of these aspiring specialists—Britain’s equivalents of American medical residents—said their hospitals or medical centers offered them room where they might get a few hours of sleep in dire circumstance. Just 17 percent of them used such facilities when available, and many complained they were charged to do so.

Michael Gibson, an interventional cardiologist, cardiovascular researcher, Harvard medical school professor and social media maven on medical matters with more than 300,000 followers on Twitter, posted about the sleepy doctors’ study, and got more than 3,500 responses to his queries.

Many doctors said they had similar bad experiences, with 61 percent of more than 2,000 respondents saying they, too, had driven drowsy, had car wrecks, and knew of medical colleagues killed in vehicles after falling asleep at the wheel.

Gibson, who quoted traffic experts who estimate that drowsy driving causes 1,550 deaths, 71,000 injuries, and $12.5 billion in losses annually in the United States, reported that many doctors want hospitals and academic medical centers to pay to transport them home if they feel too sleep-impaired to drive safely. Few institutions will do so.

Instead, the U.S. Accreditation Council for Graduate Medical Education recently issued a memo telling hospitals and academic medical centers that it, again, is professionally accepted and recommended that residents be allowed to work 24 hour shifts. The standards-setting body said it had looked at evidence about residents’ health and wellbeing, as well as considering patients’ treatment, and found that for educational and “continuity of care,” medical trainees sometimes must undergo long shifts.

That decision flew in the face of some tragic, well-documented cases in which exhausted interns and residents have made major errors. It also contradicted rising practitioners own angry and public comments that crushing, excessive duty hours aren’t the exception but rather the rule for them—to the detriment of young doctors, their patients, and families.

In my practice, I see the major harms that patients suffer while seeking medical services, even under favorable circumstance. Why would professional preparatory programs and hospitals want exhausted interns and residents anywhere near patients, other than for cruelty or “just because it’s the way it’s always been done?” I also don’t grasp why, as British trainees reported, nurses and other doctors all too often were the zealots in insisting that young doctors go without sleep. It is true that anesthesiology, as a specialty, can require practitioners to devote long spans to patients, not only putting them under but also staying with them to ensure their safe, appropriate recovery of consciousness. But with the money most hospitals and academic medical centers rake in for surgeries, they surely can afford to hire the right number of medical staff and not exploit and wear out their doctors of tomorrow.

Of course, as much as we can empathize with bone-tired MDs, the bottom line stays the same: Do you want doctors who can barely stay awake taking your life in their hands?

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