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The zombie doctor apocalypse?

Sleep-deprived physicians making medical decisions. What could go wrong?

The governing body that oversees medical residencies (doctors-in-training) has proposed radical rule changes that would allow first-year residents to work as much as 28 hours at a stretch and to work seven or more nights in a row. Young physicians with something to prove may sacrifice their own health - and patient safety - to gain a competitive edge.

First-year residents are already overworked. In addition to the high attrition rate, they are more prone to suicide and drug abuse. What is the point of pushing some of America's best and brightest to a military-style breaking point? More importantly, how is health care improved when patients are treated by sleep-deprived "zombie" doctors? Let's hope the deciders back down from this ill-advised plan.

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Long hours are linked to medication mistakes and diagnosis errors

The Accreditation Council for Graduate Medical Education sets the industry standards for training and preparing resident physicians. After medical school, young doctors typically serve 3 to 7 years in "residency" in medical specialties under the supervision of veteran physicians.

The ACGME leadership is considering new rules that would relax the current checks and balances, with potentially dangerous repercussions. Some of the proposed changes:

  • Allowing residents to work up to 28 hours in a row (the current limit is 16 hours)
  • No reporting requirement for those who "choose" to work past 28 hours
  • No guarantee of 8-hour rest between shifts
  • No guarantee of one day off per week
  • Deleting references to "strategic napping" on long shifts
  • 10 percent deviation from the 80-hours-per-week cap (i.e., 88 hours)

The ACGME gives lip service to patient safety, flexibility and work-life balance. The bottom line is medical residents forced by administrators or feeling compelled to work longer shifts. Sleep deprivation in the general population increases suicide attempts as much as threefold, and medical residents are already tired and stressed at the current 16-hour threshold.

Sleep deprivation is also linked to adverse patient outcomes. Similar to drowsy truck drivers, overworked doctors are more likely to make medication errors, misread test results, misdiagnose patients, commit surgical mistakes or otherwise cause serious and lasting harm. Longer shifts or less rest between shifts can only make matters worse. The inevitable injuries or death would certainly invite medical malpractice lawsuits if the resident had been on duty long past a sensible number of hours.

Source: You do not want your doctor working 28 hours straight (opinion article)

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