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."

Comments

Develop a test

[StripedCow]

Why not develop a test (perhaps a video game) which a surgeon should pass before entering the surgery room?

Re:Develop a test

[Toth]

Ten or so years ago, our trucking division experimented with such a program. It ran on a PC and had a controller with a single knob which could be rotated left or right.

You used the knob to keep the cursor in the center spot on the screen. The cursor would become more difficult to control during the test (about 30 seconds)

Drivers would sign in for the first time and establish a baseline for themselves by taking the test multiple times until the program indicated that a baseline was established. (About a dozen attempts, I think)

Once a baseline was established, a driver had to pass the test before starting his shift. If he failed, he had to see a supervisor.

I tested it on myself. After two (unmeasured) shots of vodka, I would have had to see a supervisor were I a driver.

An additional advantage was that you would also fail the test if you had the flu, were sleep-deprived or emotionally unfit to drive.

The program never went into full production at our place. Currently drivers are tested when hired and after any accident or delivery process incident.

I forget what it was called (I tried googling). I thought it was "fair". If you couldn't pass the test, you probably shouldn't drive a truck that day.

If you smoked a joint a week ago, it wouldn't affect the test but if you were up all night watching movies, you'd likely fail.

Re:Develop a test

[FatalChaos]

Part of the problem with this is that any video game (or other) test that is reasonably quick is going to be reaction based. Surgery is not about quick reactions. I've watched open heart surgery, and it took a good 4-5 hours to complete. Surgery is about slow, slow precision, and by the time you could test for that, the patient is probably already screwed. Think of it this way: go to a hospital, and ask who are there best surgeons. You'll find out a lot of them are at least in their 40s, if not 50s and 60s. When was the last time you found ANY 40, 50, or 60 year old who was a legit gamer?

Re:Develop a test

[uglyduckling]

The problems do apply to nurses, but on of the real issues for junior doctors in the UK is that we move around departments and even hospitals/trusts every 3-6 months. The longest job I've done has been for a year. So although nurses do have a rough time, there's a lot more scope for them to figure out how to have a workable life/work balance because they stay in a dept. for a long time and figure out the system. For junior doctors, it's like starting 2-4 new jobs every year. Having said that, most juniors are better paid than most nurses.

Re:Develop a test

[MMC Monster]

The problem is that most of the best surgeons are in their 40s or higher.

This is because the younger ones don't get the sheer number of cases required to be a great proceduralist. Why not? Well, it's mostly because they're required to go off shift after 24 hours, or 12 hours if they're on for a 24 hour shift the next day, etc. Who scrubs in on those cases? Well, the hospitals are hiring more physicians assistants to take up the load.

This is what the director of surgery at a major New York City teaching hospital told me earlier today.

Re:Develop a test

[FiloEleven]

Sounds like a form of impairment testing, which is a pretty big win for everyone but has not been widely implemented. Employers who have used it found that it consistently reduced accidents, and employees like it since they don't have to pee in a cup--a demeaning and annoying procedure. It should also be cheaper for employers: even at a couple thousand bucks for the machine and software you used, the payoff in reduced accidents and mishaps along with not having to pay drug testing companies all the time means it'll pay for itself in a very short period of time.

It doesn't unfortunately seem like it's going to catch on anytime soon. Most companies haven't heard of it, and my guess is that most who have are waiting for it to gain a reputation before thinking about making the switch themselves.

Proper rest

[Anonymous Coward]

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.

Re:Proper rest

[couchslug]

I get some great reactions from medical folks when I mention that the Air Force generally enforces a 12-hour shift limit for aircraft maintainers, even in wartime. Tired people fuck up, and anyone who pretends otherwise is full of shit.

The medical world should borrow two things from military aircraft maintenance. Limit shifts to 12 hours except in emergencies where manning is insufficient, and CHECKLISTS.

Pilots, who are at least as studly and narcissistic as physicians, KNOW ignoring checklists is a great way to fuck shit up. That's why it is PUNISHED.
They also know, even with training, that no one can remember every detail of every complex task they have to perform. From maintainers to aircrew to the folks in the control tower, checklists are considered orders to be obeyed.

Physicians have little time to see each patient, so they have to match symptoms with their concept of a "template" for a particular malady. Checklists are ideal for this sort of thing.

As to the civilian custom of working interns to exhaustion, that's just stupid. The military can train enough folks for wars, the civilian side of the house should "militarize" medical care (including quality control and open chain of command for complaints) and get shit done.

Re:Doctors/Nurses do not get speeding tickets

[neapolitan]

This is simply not true.

If you are legitimately speeding (safely) to perform an urgent operation, the police may escort you to the hospital, enter with you, verify you are about to do an operation, then leave you without a ticket (it happened to several of my colleagues, usually late at night.)

Just being pulled over and showing your hospital badge / white coat is not going to help you 99+% of the time. *Especially* if you were driving in a dangerous fashion. One of my friends has a funny story on how he tried it after being pulled over, and his ID says:

".... ..., MD
DERMATOLOGY"

The police officer laughed and gave him the maximum fine.

an institutional illness

[tverbeek]

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.

Some doctors in my hospital do cancel elective sur

[olddoc]

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.

Re:This is just another waiver

[countertrolling]

Truck drivers have more sensible rules.

But a doctor can usually only kill one person at a time. Depending on the cargo, a truck driver can take out a pretty large area.