Slashdot Mirror
Do Sleepy Surgeons Have a Right To Operate?
Hugh Pickens writes "BusinessWeek reports that a commentary from the New England Journal of Medicine calls on doctors to disclose when they're deprived of sleep and not perform surgery unless a patient gives written consent after being informed of their surgeon's status. 'We think that institutions have a responsibility to minimize the chances that patients are going to be cared for by sleep-deprived clinicians,' writes Dr. Michael Nurok, an anesthesiologist and intensive care physician. Research suggests that sleep deprivation impairs a person's psychomotor skills — those that require coordination and precision — as much as alcohol consumption and increases the risk of complications in patients whose surgeons failed to get much shuteye."
Why not develop a test (perhaps a video game) which a surgeon should pass before entering the surgery room?
If Pandora's box is destined to be opened, *I* want to be the one to open it.
Come on, so you get into the ER, need treatment right away, you're gonna tell the only doc available to first get some sleep? Don't think so. The hospital/doc should have made sure that the staff is fit enough to even be on watch. This will just mean: yes sir we are very sorry you lost your kid due to bad handling from are doctor, but look here: that is your signature. So you can kiss that lawsuit goodbye. Hospitals shouldn't have people who are sleepdrunk on the watch. Simple as that.
Silly question. Surgeons never have a right to operate on people, any more than anyone else has a right to cut people open and poke around inside. Surgery must always be based on consent, now that can be complicated by circumstancses - an unconscious patient can't say yes or no and depending on the circumstances in which they were found and the consequences of waiting then reasonable assumption may have to be made as to what they would want. However, ensuring as far as possibel that they are able to give informed consent is the right thing to do, and that does mean providing information like "the surgeon's drunk" or "the surgeon is sleep deprived". Putting it in terms of a "right" to perform surgery is absurd.
Doctors should get a good night of sleep before a surgery, and it should be their responsibility.
Of course, the hospital should take care of not overworking him.
how long until
Any other question ?
I like the idea of patient consent, but it wouldn't always be possible. I just got into a motorcycle a few months ago and had surgeries, chest tubes, intubations, and couldn't even breathe on my own for a bit. I wouldn't have been able to consent to any of this, but it was necessary to keep me alive.
I work a night shift in a hospital. If you've never worked one before, know that some nights you will be absolutely exhausted. I'm sure most night-shifters have fallen asleep at work before, if not on a regular basis. Doctors are not above this. Our hospitalists have on-call rooms to sleep in every night. If you code in a hospital overnight, chances aren't bad that one of the doctors that shows up was woken up by your code seconds before he showed up in your room.
My point is, hospitals are open 24/7. There is a night shift. Those people are usually tired. Also, emergencies happen 24/7. Sometimes patients can't consent to anything.
Imagine this: A patient shows up at 2am with an injury that would kill the patient before the morning shift came in. All the surgeons are asleep. You'd have to wake up an entire surgical team. All of them will be tired when they come in. The patient, however is unconscious. Bringing this patient back to alertness would risk their life and put them in so much pain they wouldn't be able to sign or agree to anything. What now? (
I think attention should be paid to organizations overworking clinical professionals, but it should be kept in mind that sometimes work that a patient may not even want to save their life has to be performed by people who are incredibly tired and just woke up just to keep the person alive. That's just how it is.
Doctors should get a good night of sleep before a surgery, and it should be their responsibility.
Of course, the hospital should take care of not overworking him.
It's not just the hospitals. I know a surgeon that not only works her job, but also moonlights at other hospitals.
Her first year after passing her boards, she wrote a 6 figure check and paid off her student loans - then bought a high end BMW.
Asking me to sign a waiver should a surgeon about to cut me open be tired seems only like a CYA policy. I can't make an informed decision, and I am most likely in distress and need of the surgery and saying no would delay it.
I am already putting a huge amount of trust in his abilities, and that includes him being able to decide if he skilled and in shape to do the operation or not. If I can't trust my doctor to make that decision I can't trust him to operate at me anyway. Therefor this seems completely pointless.
I
Killed five people while she was at it. Good for her! Now she has a shitty BMW to show for it!
Your relationship with your doctor is based on trust and consent - you don't ask your taxi driver to submit to a breathalyzer before he drives you home, so why should you ask your doctor how he's sleeping? If you don't trust your doctor to be operating on you in good condition, you need to find yourself a different doctor.
You know, in a country where even truck drivers have regulations requiring proper rest, you'd think there'd be some sort of standard for medical practitioners of any kind. Of course, if any politician ever tries it those AMA campaign donations will dry up like the Gobi Desert.
"Doctors Urged to Admit Fatigue Before Performing Surgery"
I wish we had something similar in my previous company.
"Developers Urged to Admit Fatigue Before Fixing Bugs"
This is the same policy used in the US military. You're supposed to get people involved if you're too tired to do your job. This responsibility should be completely on the shoulders of the doctor to speak up. I think it's likely that some doctors have used a "sleep deprivation" excuse when being reviewed for a botched procedure. This seems like some bean counters are pushing for a way to reduce the hospital's liability in those matters.
It is because of their profession. Doctors/nurses are allowed to speed and police officers will usually be more lenient on them. Whether this is warranted or not is a similar question as it puts other people in direct danger (in contention with the purpose of their line of work.)
Once you start despising the jerks, you become one.
Seriously; the fact that surgeons / residents are so overworked that they have to operate while sleepy is a symptom of a much larger problem. Mainly that there are not enough surgeons. The AMA artificially restricts the number of doctors in the field, thereby endangering the lives of the patients the are supposed to be protecting.
Things that can be done to correct the disaster that is U.S. heath care:
1)Eliminate the AMA.
2)Eliminate Insurance companies.
3)Eliminate Malpractice lawyers / insurance.
These three things would restore market forces to the medical industry. People decry Obamacare, when they don't realize that we have a defacto socialized system now. The consumers(sick) no longer pay for their product(medical care). We instead throw in artificial barriers (insurance companies) whose sole goal is to PROFIT.
At first, you think it's obvious that people who are responsible for other peoples' lives should be required to be 100% alert.
However, the problem with that is that this by necessity means that you will need more doctors to man places up, thus increasing costs (not to mention that I don't think that there are that many superflous doctors just ready to jump in).
And here's the thing, in most cases, doctors do get to work reasonable hours, the times they don't get to is related to when there is a current crisis.
This means that instead of saving peoples lives with a risk of doing a clumsy job the get to go home to sleep and the person dies anyway.
Not a good result if you ask me.
The one solution I can see is having a consultant doctor pool which only help out in situations of need.
That does sound quite expensive however.
And, yes, while I hate to be a money-grubber when it comes to lives (regardless of species), it's a fact that people die every day due to lack of resources, therefore you need to prioritize.
How about ensuring doctors work humane shifts as opposed to trying to squeeze every penny out of the system?
This is not just a problem with the US btw. I've spoken to doctors from lots of different countries, including Sweden, the US and England.
In general they are overworked, get little time to recover between shifts, and are expected to work overtime as part of the job description.
That's not going to be good for either doctor or patient.
I don't know how it's there in US, but here in Europe professions such as long-haul truck and tourist bus drivers are regulated so that they are not allowed to drive for, say, 36 hours w/o sleep, and it's enforced by monitoring their shift schedules.
Patient 'consent' wouldn't be a solution, but hospitals definitely could enforce rules that no surgeon can get a shift for more than x consecutive hours without having a break in between that would allow for proper full night sleep.
This sounds all roses and sweetness but the reality is, surgery involves volatile hours. Some degree of predictability may be known, for example weekend nights probably have a greater probability of road accidents, but for the most part, surgeons have to perform at a moment's notice to save lives.
Whilst you could simply employ more staff to ensure there's a healthy buffer of refreshed and well slept surgeons, I'd hazard a guess this is far more costly than most hospitals could afford or would want to cut into profits.
Declaring sleep deprivation might make some academic journal tingle inside, but how will that affect lives? You get a disclaimer and a law suit potentially sidelined. But the patient then must wait for a suitable surgeon to perform. In many locations, that simply might not be an option.
Part of the problem is the medical profession's method of "training" physicians by putting them through an extended period of hazing: working around the clock, being awakened at random intervals, etc. Many of the ones who get through it develop the delusion from it that they can do the work properly under any conditions, especially sleep deprivation. It's a badge of honor for them, and they will engage in all sorts of denial and rationalization to keep at it.
http://alternatives.rzero.com/
Should sleepy Nazi Stoßtruppen have been allowed to fight during the Kristallnacht?
That brings me to an interesting point, / . is just "the ramblings of socially-inept, technology-literate news-mongers".
Surgery while impaired is malpractice. Not surgery while impaired and then having an accident.
According to a report on TV, this is would only be for Elective surgery. The BusinessWeek article doesn't mention Elective until the last sentence.
Do hospitals have the right to work their resident doctors for such long hours.
(And also for other health care facilities that mandate overtime...)
IANAD (BIAANA)
I am an anesthesiologist. When I am on overnight call I am always off the next day. Our group of Anesthesiologist strongly believes this is the right thing to do. On overnight call I don't come in until 3pm because 24 hours it too tiring. The motto of the American Society of Anesthesiologists is "Vigilance" You can not be vigilant if you are sleep deprived. On several occasions I have seen heart surgeons who are up at night with emergencies call off scheduled, elective cases in the morning. Perhaps we just have a good bunch of surgeons here, but all of the OR team (nurses, perfusionists, Anesthesiologists...) think it is the right thing to do.
Power tends to corrupt, and absolute power corrupts absolutely.
You talk about penny pinching, which is great, but who is going to pay for the increased costs? I'm all for great health care, but the truth is health care does not exist in a vacuum, and having money to spend on laptops, mp3 players, etc, is great. If you believe that health is priceless, that's fine, but just know that health care costs would shoot through the roof is money was not an issue. For a great example, just look at MRIs and CAT scans. MRIs are pretty much universally better and a lot safer (no radiation), but CAT scans are still used a lot. Why? MRI's cost a shitload of money. Plus, even if you do want to increase spending on health care, are hospitals or doctors even the best way to do it? I've taken a couple of health policy classes, and one thing that seems well agreed upon is that preventative measures are the best, which at its most basic level is about having a population eat health and get enough exercise. This has more to do with making sure everyone has access to fresh fruits and veggies, safe and convenient places to work out, health education, etc.
It'll be a hard situation.
The surgeons are on call at night to care for unexpected emergencies, like gunshot or traffic accidents, which can last all night long.
So you've been waiting for 5 months on the list for your hernia repair. On the day of your surgery, your surgeon happened to have not slept much, and your surgery is pushed off, for another 2 months.
I would be pissed off it his happens - either way - to be operated by a sleep deprived surgeon or have to wait another 2 months for my surgery.
It's 4am,
you have just arrived at emergency stabbed by a random stranger at the bus stop.
doc: "That looks pretty bad, your bowel is cut open, and your blodd vessel is heavily bleeding inside. I need to take you to the surgery right away."
you: "Sure doc. Have you been sleep deprived?"
doc: "As a matter of fact, no, cuz I was busy cleaning up another gunshot wound. Per hospital policy, I need to disclose that to you"
you: "Well I don't want a sleep deprived doc to operate on me"
doc: "You are right, I need to catch on some sleep. By the way, I am the only doc in town that can fix your bowel and vessels. Or you'll need to be transferred to another hospital 5 hours away."
This is a common misconception but is not true. Which imaging modality to use depends on the clinical scenario. MRIs have the downside of taking a long time, requiring the patient to be relatively still during this time, and being in an enclosed space (which some patients refuse to go into - hence the development of "open" MRI patients). And yes, they are expensive. CTs in contrast (pardon the pun) are quick, much cheaper, and do an excellent job of visualizing things like blood which is important in stroke management, trauma, etc...In the acute setting, your patient might die in the MRI machine while a CT scan would give you all the information you need in a much timelier fashion.
-- The Genesis project? What's that?
After breaking 2 bones in my left hand, a sleepy surgeon informed my guardians of his sleep deprivation due to another longer surgery, obtained their consent, and accidentally implanted a longer implant than what was necessary. Fortunately after many months after the surgery another orthopedist discovered this anomaly and removed the implant before it caused permanent damage.
I think me & my guardians ought to have the right to accept treatment from a sleepy surgeon. No sarcasm intended. This is because in many places specialists are surgeons are in shortage.
I've had times at the end of the month where I've played online poker when I was really tired so that I could get the points I needed before the month was over.
I was so tired that I'd be dozing off between hands and waking up when the buzzer alerted me it was my turn. In some of the easier games I was still able to keep 10 tables going and usually be profitable (didn't really matter since the points/bonus I was working for made up for the reduced win rate) I was making some really horrible decisions.
When you get that tired your brain just kind of goes on auto pilot and you can instinctively do things you've done so many times before but in tricky spots I would do something and then 2 seconds later realize how stupid it was. Unfortunately by that point it's too late.
I try not to play when I'm that tired I can't imagine literally taking someone's life in your hands in that condition.
So sleep-deprived doctors should all perform emergency surgery now? Wonderful prospect.
They've had sleep deprivation tests for YEARS that the insurance industry has tried unsuccessfully to get installed into cars (you wouldn't be able to start the car if you are over tired.) Simply install one of these devices at the hospitals time clock. No one in a hospital should be working while sleep impaired.
The real problem comes into play when the Doctors group OWNS the MR or CT machine and drives patients to their imaging equipment to capture revenue that might otherwise go to a hospital with the same, and perhaps better equipment.
I live in an area where we see countless orthopedic injuries, and Ultrasound is a fantastic modality to evaluate many of these (rotator cuff for example) but since both ortho groups have their own MR machines, the patients get an inferior exam for 3-4 times the price. Not only is this financially wasteful, it has become an impediment to developing superior imaging procedures at our facility, which is in total contradiction to one of our goals, to provide superior service to our patients. This is a smaller, yet obscenely modern non-profit hospital at the base of a ski area in NA.
Makes total sense, right?
Boy you hit the nail right on the head. I read MR's and CT's frequently to prep for ultrasound examinations and how anyone could look at an MR and say it's superior must be wearing beer goggles. Sure, it's great for soft tissue, but most emergent cases are not soft tissue injuries, but rather cardiac or cerebral emergencies and the CT w/ contrast is money when it comes to time savings. Heck a 30 minute MR is replicated in 2 min in a CT, and with incredibly superior resolution.
MR has it's place (soft tissue, brain), but if it was sufficient, efficient and mission critical it'd have supplanted CT long ago given the lack of ionizing radiation. It hasn't. MR should be considered for specialized examinations in a non-emergent situations. Hell, that's why our MR techs have a 1 hour response time on call, MR isn't a rush.
Plus who the fuck wants to listen to that damn thing all day. Bing, bing, bing, bing, dun, dun, dun, bam, bam, bam, bam, repeat...
If a surgeon is tired, they shouldn't be cutting anyone open. What possible "right" could there be to perform a surgery on someone? If the surgery is elective, it shouldn't be performed that day. If it's not elective, they need to find another surgeon to do the surgery. And screw the consent form. If a hospital puts doctors under such a burden that they have to do their surgeries fatigued, then they shouldn't get to be protected by a piece of paper. Let them suffer the consequences of their decisions. I don't see what the controversy is.
I am an anesthesiologist. When I am on overnight call I am always off the next day. Our group of Anesthesiologist strongly believes this is the right thing to do. On overnight call I don't come in until 3pm because 24 hours it too tiring. The motto of the American Society of Anesthesiologists is "Vigilance" You can not be vigilant if you are sleep deprived.
On several occasions I have seen heart surgeons who are up at night with emergencies call off scheduled, elective cases in the morning. Perhaps we just have a good bunch of surgeons here, but all of the OR team (nurses, perfusionists, Anesthesiologists...) think it is the right thing to do.
Respectfully... the reason why anesthesiologists need stricter work hours, "breaks" during their cases, etc., is because their job is so f'ing boring that even the well-rested often fall asleep at their anesthesia consoles.
=)
Fair enough, but it's my understanding that even in cases that aren't extremely time sensitive and where MRIs imaging capabilities are appropriate, CTs are often used for cost purposes. I like the pun, but I'm curious if more patients refuse to get into the MRI machine or refuse to drink the contrast. The contrast used at hospitals near me is downright nasty, and I've seen a few cases where the patient refused to finish the contrast.
Although, I suppose after a few cycles of this, they'd have to operate 24/7 to pay their alimony....
Given the dangers that terrorists could wreak by infiltrating hospitals and tiring out surgeons, I call on the TSA to expand its Historic Mission and install body scanners and breathalysers at the entrances to all hospitals operating theaters. Not only would that ensure the safety of the sick and injured who have to enter, it would also allow the TSA to stop the free flow of sharp pointy-cutty knives that are so dangerous in enclosed spaces.
Just asked my wife: She said her hospital has a rule that a doctor cannot accept patients after being awake 24 hours. Instead, someone else has to see the patient.
The AMA artificially restricts the number of doctors in the field, thereby endangering the lives of the patients the are supposed to be protecting.
Is not correct. The AMA is responsible for accreditation of medical schools that issue MD degrees. They make sure that schools that issue those degrees meet certain standards, which include student-to-teacher ratios. They have accredited additional schools in the past 10 years that did not exist prior.
Furthermore, you can also attend a medical school in other countries (certain Caribbean nations are currently popular for this) and earn your MD there, and then come to the US for your boards and practice medicine here. You can also attend a DO program which in the US results in you having the same rights as an MD. You could also enter medicine through a PA or NP program as well.
So in other words, you are simply wrong in your assumption that the AMA "artificially restricts the number of doctors in the field".
Unfortunately your next suggestion after "eliminating the AMA" isn't much better:
Eliminate Insurance companies.
While you will be hard pressed to find someone who is more opposed to the for-profit system of health care than myself, eliminating insurance companies and replacing them with nothing is not going to improve the situation, either. Currently with the existing system we see that our country gets health care delivered along lines of ability to pay. If insurance goes away then the ability to pay is taken away from many middle-income patients and health care becomes a product that only the wealthy can afford. Basic care goes down, life expectancy goes down with it. Basically if half of our country can't afford to see a doctor ever (and we aren't that far short of that number already) we quickly see our economy deteriorate.
You then follow up with a fun boogey-man:
Eliminate Malpractice lawyers / insurance
While indeed the malpractice insurance costs have a huge impact on the cost of medicine in the US, eliminating the lawyers and the insurance agents that drive it won't help us much, either. We do need at least some basic accountability because we are talking about human lives here. Now of course if our physicians were to form something analogous to a trade union to manage their risks within their own pool, we could perhaps arrive at a more reasonable alternative. However, tossing all of that out with no replacement won't answer the problem.
These three things would restore market forces to the medical industry
No, actually it wouldn't. For that matter, the malpractice bit is all about market forces; those costs are driven up to "whatever the market can bear".
People decry Obamacare, when they don't realize that we have a defacto socialized system now.
First of all, there is no such thing as Obamacare. The bizarre bill that went through was written by conservatives and has no resemblance to what Obama or any actual democrat would have actually wanted. Blaming this pile of failure on him makes as much sense as blaming the Challenger disaster on GWB.
That said, there is nothing "socialized" about the current system. Socialism implies equality and state control, neither of which exist in the current system.
We instead throw in artificial barriers (insurance companies) whose sole goal is to PROFIT.
That part you are correct on. Indeed the insurance companies don't give half a shit about any of their customers, as long as they still make money. And as we can see they do that quite well.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
... is the distribution of medical care in the US. If you were to find yourself injured or gravely ill in a remote part of our country and in need of immediate surgery, you might not have the luxury of waiting for a well-rested specialist. There are hospitals in this country that still have very few surgeons of any discipline available for emergency surgery, and if the patient's life is on the line wouldn't it be better to have a drowsy surgeon than none at all?
After all if the chief of surgery is the only surgeon at that hospital who is qualified to do the needed procedure, and his shift ended 5 hours ago but you need to be operated on now, wouldn't you rather he be there than not?
This isn't automatically an issue of a "god complex" or outdated training regimens that are associated with doctors and surgeons in the US. This is, in the end, a matter of patient's lives. And if the life of you or your loved one was on the line before the surgeon arrived, you might feel differently about the doctor's rest.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
ABCs of anesthesia: Airway, Break, Coffee.
I wonder if informed consent is possible just before surgery. Even if the patient is alert, (and often elective surgery involves giving a sedative before surgery) can he observe the doctor long enough to decide he is sleep deprived? How much before surgery can informed consent be made? If the time delay is sufficiently long, the doctor might cross the line of being sleep deprived but the patient saw him an hour before surgery and decided he was not sleep deprived? Also, some surgeries are long affairs, the surgeon might cross the line sometime during surgery. I think informed consent in this case is worthless. It's just like the driver that had been drinking and starts driving just before he gets drunk. He wasn't drunk when he started driving but he soon will be.
"Respectfully... the reason why anesthesiologists need stricter work hours, "breaks" during their cases, etc., is because their job is so f'ing boring that even the well-rested often fall asleep at their anesthesia consoles.
=)"
I was just reading an article about how anesthetics puts someone something much closer to a coma than into 'sleep' (http://www.scientificamerican.com/article.cfm?id=general-anesthesia-coma) and that many things have to be regulated when someone is in such a state, from the article:
"Inducing a coma-like state does require careful monitoring, breathing and temperature support as well as a delicate balance of "hypnotic agents, inhalational agents, opioids, muscle relaxants, sedatives and cardiovascular drugs," Brown and his colleagues noted in their paper."
Perhaps twisting knobs etc is boring but it seems to be that it just isnt a matter of sitting there watching and is thus less boring perhaps than the parent suggests. Perhaps grandparent has an opinion on how boring it is.
I have an unrelated question. I have surgery sometime next year to do a surface EEG grid which involves buzzsawing a door in the skull and draping a net of wires across the surface of the cortex. They put the door back in, and analyze the voltages of the wires for a week with EEG equipment. Then they saw the door back open again, and pull the wires out, possibly scooping something else out before they close the door back up or good.
This is supposedly done while they're constantly harassing you to stay awake, and they keep doing weird things while they're in there messing around like flip flash cards of donkeys and apples and squares to ask you what's on each card. It sounds like they use local anesthesia, in conjunction with only partial global anesthesia; I was wondering if it's a good idea to bring in a doob so we can just pass it around during surgery. "Hey dude wake up, it's your turn. Do you think this looks like a moon or a banana? I thought it was a banana myself but I'm probably just hungry."
It's always boggled my mind that while other, supposedly 'easier' profession like being a pilot, driving a truck etc. have restrictions on excessive work hours and wakefulness, medicine, by and large, does not. In many medical schools, extreme sleep deprivation is expected (to prepare students for real life no doubt). As a profession, how can medicine claim to be a career hard enough to require a decade worth of training but easy enough that one need not be awake/alert to practice?
Certainly the fault lies partly with those who organize working schedules and budgets...but I also imagine there are many doctors who want to play superman (and expect that of their students/residents). The physicians, too, need to speak up for change; silence condones this unsafe environment.
A man is about to die and the only surgeon available who is dead on his feet does a rescue surgery. We would not have it any other way. Conversely a greedy butcher who takes on way to many patients and works insane hours kills a healthy man on the table during minor surgery. This is an area that leads into that zone of immense hazard concerning judgement of motives. Although it needs doing opening that door to evaluation of motives really will create some really awful judgements and punishments.
I read about this airport (might have been in NZ, not sure). They had one tower controller on duty and he does a six hour shift. When that shift ends he is not licensed to operate until he takes a rest. I think it is one shift on and two shifts off. The guy for the next shift is on his way but he gets stuck in traffic and doesn't make it in time.
The controller on duty cancels departures, diverts incoming aircraft, shuts down the tower and drives home. He does that because thats the established procedure and its better to let the pilots solve their own problems than to have a badly functioning air traffic controller on the job.
http://michaelsmith.id.au
Just track the time since the last decent night of sleep and correlate it with the incidence of complications. That's not rocket science.
Do this anonymously and as a matter of course for a year.
Actually it's so obvious that I'm sure it's been done and the results were such that they had to be swept under the carpet.
thegodmovie.com - watch it
The biggest problem with the medical system is greed.
Everyone would be better off if we had more doctors, making less money per-capita, working more regular hours (as opposed to working 3 days straight then taking 2 days off).
Medical vendors shouldn't be raping the system with outrageous prices. Same goes for pharmaceuticals.
The system is the problem. I know for a fact that in some countries doctors make as much money as software developers, and the latter make 80k max. Generic drugs are prevalent.
There is no good reason for medical prices to constantly increase. If anything they should be getting cheaper like they do in other industries.
Maybe you all forgot that sick patients just don't respect the clock or the calendar.
Oh, I'm sorry Mr Smith. Your head is crushed in from driving drunk at 2 am this morning, but we can't take you to the OR
because the only neurosurgeon for 20 miles just finished another case, and it will take another two hours to defrost a fresh
one from the deep freeze.
Sleep deprivation? Have you ever heard of amphetamine?
I really think it is up to the industry to decide on safety levels and then enforce them. If there is a concern to the point of wanting me to sign something then maybe they just shouldn't.
Am I also going to get a form that says the surgeon had a fight with his wife or is worried about his investments and so might be distracted?
Do the research, pick an amount of sleep, then enforce the rules.
The US medical establishment cannot survive without the scut work[1] that newly minted doctors provide for menial wages, at 48, 72 hours shifts. Medical residents are fodder to be used and abused, and periodically the AMA will fight tooth and nail when some congressman wants to overhaul the status quo system. So forget about interns or full fledged doctors that resident that's digging around your guts, or your child's brain is on a multi-day shift, all the time, for years on end.
{1] "SCUT = Some Common Useless Task
A task of no educational value that keeps you from doing something that you might learn from or related to your residency or med school education.
[To wit,] being told to do the work of an orderly or ward clerk."
Sure, if there's only one guy available you get that guy.
However, it's also the case that residents are commonly required to work 24hr (or greater) shifts, and there *is* a common expectation that medical professionals will work when tired. There's also a common expectation that medical professionals will also work when sick--to the detriment of their patients.
It needs to be a workplace standard that healthcare providers will work reasonable shifts, will book themselves off when tired, and will stay home when sick. Until this is the norm and not the exception, people will continue to suffer avoidable harm.
Surgeons have the permission to operate, which is based on trust.
A person has the right to acquire the skills to become a surgeon; by doing so, he does not acquire the right to operate on anyone.
I'm a surgeon, and often work long hours. Lots of my colleague do too. I have always only needed 4-5 hours of sleep per night - just wake up after 5 hours, even without an alarm. Many of my surgical partners are the same, but just not as much. Surgery seems to attract people who tend not to need much sleep, and are driven.
I have never heard of a surgeon, nor seen, a mistake, or poor outcome, due to someone being tired
If someone can show a higher complication rate for surgeon, who are sleepy, then I'd consider the above proposal, otherwise it's just over reactionary crap.
I've had plenty of times like the above "scenario" where I've been a bit tired. No mistakes, no complications, no extra time - everything turned out perfectly. If I'm tired, then I'll do something about it. I've delayed 2 cases until the next day in 5 years (thats' 2 cases out of 1750 cases because of being tired).
Let's see some data, as opposed to truck driver, or pilot studies - 'cause surgery isn't anything like those jobs.
..........FULL STOP.
There was a big push, by consultants to have airplane/flight type checklists in hospitals to cut down on mistakes. So far after 2 years, no one has demonstrated any significant change in anything -(wrong site surgeries, poor outcomes, etc), other that wasting everyones time.
Atul Gawande "Massively better results" probably arose from just having people introduce themselves, or might have been third world dependent. A quote from his own paper, cited a study of American surgeon having no significant change in infections, morbidities or mortalities.
..........FULL STOP.
From http://skepticalscalpel.blogspot.com/ An editorial in the this week’s New England Journal of Medicine proposes that sleep-deprived surgeons should tell patients that information and obtain written consent from patients acknowledging that they have been so informed. This article garnered a “hat trick” of coverage as it was featured by Science Daily, Medpage Today and Eurekalert. First, let’s look at the coverage. Understanding that these three sites simply rehash press releases, they do tend to resemble news reports. Only Medpage Today, while publishing a photo [at right] of a seemingly fatigued surgeon, chose to mention a rebuttal to the editorial by the American College of Surgeons [ACS]. One the other hand, CNN Health published a somewhat balanced report that included excerpts from the ACS response but follow-up answers were forthcoming only from one of the editorial’s co-authors and not the ACS spokespersons. I would point out that this sentence from the proposal, “In surgery, there is an 83% increase in the risk of complications (e.g., massive hemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by attending surgeons who had less than a 6-hour opportunity for sleep between procedures during a previous on-call night” is grossly misleading. The JAMA paper cited says no such thing. Yes, there is an increased risk of complications but the paper does not specify exactly which complications occurred. They may in fact have been minor complications. Of course, “massive hemorrhage, organ injury, or wound failure” sounds much more dramatic. Although the rebutting ACS leaders made a decent point that issues such as marital problems, a sick child or financial difficulties might also degrade performance and are not subject to disclosure, the argument that surgeons should be trained to recognize fatigue was extremely weak and was deftly parried by one of the co-authors of the proposal. You can read those comments in the CNN Health article. Now, what do I think of the proposal? In a perfect world, the idea of a surgeon telling patients that he is sleep-deprived would be wonderful. Alas, we don’t live in a perfect world. The reality is the proposal is highly impractical. The example cited in the proposal was that a surgeon who was up all night had an elective colostomy scheduled for 9 a.m. The proposal’s authors would mandate that he inform the colostomy patient that he is sleep-deprived and offer the patient the option to postpone the procedure or have another surgeon perform it. What is involved in postponing the case? The patient may have taken laxatives to prepare the bowel for surgery. She may have had lab work done, taken time off from work, arranged for child care, have important business three weeks later etc. The hospital’s operating room likely would go unused for the two hours originally booked for the colostomy. Having another surgeon operate on the patient would mean loss of a fee for the tired surgeon. [I know that shouldn't matter but it's not a perfect world.] And just which surgeon is going to be sitting around doing nothing that morning and hoping a colleague was sleep-deprived? Assuming another surgeon was readily available, how does the conversation between the patient and the new surgeon go? “Hi, I’m your new surgeon. I’m not sleep deprived. By the way, what’s wrong with you? Oh, you need a colostomy.” Does the patient have a chance to Google the new surgeon? Is the new surgeon on the patient’s insurance panel? What if the patient doesn’t bond with the new surgeon in the 10 minutes she has had to get to know him? Can she ask for a third surgeon to be introduced? Will all of this take so long that the original surgeon might have had a chance to take a nap and now be refreshed? How long of a nap is long enough? Maybe the solution is for every hospital to establish a surgical hosp
It's not just the hospitals. I know a surgeon that not only works her job, but also moonlights at other hospitals.
Her first year after passing her boards, she wrote a 6 figure check and paid off her student loans - then bought a high end BMW.
Either her family had money to begin with or you're just making stuff up. Residency pays squat if you had to take out a quarter of a million in loans for med school.