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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."
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.
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.
Slashdotter, ID #101. UIDs are in binary, right?
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/
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.
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?
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.
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.
Your brain is not a computer.