28 October 2004

--- Study Confirms What We've Long Suspected

Let me ask you something:

If your life or the life of someone you love depended on it, will you trust it to someone very exhausted and who hasn't slept decently for the last two weeks?

I think the obvious answer is a loud "NO!"

For many years, the true mettle of a young doctor or intern is measured by how many hours he can keep his eyes open and his mind operating decisively. If Medicine were a fraternity, the initiation rites begin when clerkship and internship begins. It is practically multi-tasking on turbo mode. You are NOT allowed to commit mistakes. Reality however tells us that is not what happens. You will wonder HOW MANY LIVES WERE LOST because the doctor who attended was too sleepy and tired.

Friend and classmate doctors of mine have long deduced that if we handle such a critical and fragile thing as life and death, why are we then subjected to schedules that spell nothing but exhaustion and lack of sleep? That question remains unanswered ten years after I graduated, and there is still no answer today, except maybe for the lame answers like: "It's tradition," or "That was how it was before, so what do you expect?"

Today's issue of the New England Journal of Medicine carries a study that measures the effects of sleep deprivation on medical errors:

Interns made 36 percent more serious medical errors during a traditional work schedule than during an intervention schedule that eliminated extended work shifts. These included significantly more serious medication errors and 5.6 times as many serious diagnostic errors. As a consequence, the overall rates of serious medical errors were significantly higher during the traditional schedule than during the intervention schedule.

The Institute of Medicine's report "To Err Is Human" was notably silent regarding the issue of sleep deprivation, largely because data directly linking sleep deprivation and medical error have been lacking. Our study helps to fill this knowledge gap and provides data suggesting that the sleep deprivation associated with the traditional extended shifts of 24 hours or more worked by interns may contribute to the high risk of medical errors in critical care units. [New England Journal of Medicine, Oct 28 2004]

For an illustration of the comparison of the traditional and intervention schedules proposed in the study, click here.

I had a medical classmate and best friend who's intelligent (graduated on top of his premed classes) and who quit medical school exactly for these reasons. He quit because he did not like the schedules and bowing down to tradition. But he is good. He just wanted to spend more time with the sick patients and to have more time to study their cases. Up to this day, I believe he was a loss for Medicine. He could have been one good doctor.

The arguments presented by senior doctors are always based on the premise that if they were able to do it, why can't the interns and the clerks? In retrospect, however, I believe the decision whether to amend doctors' schedules in order to minimize sleep deprivation should --- must --- be based on our concern as healers for patient safety.

Minimize errors! No room for mistakes! YES to these, but give the doctors the right amount of sleep. They are humans too. They need it to think clearly. Besides, as I said, many lives depend on it.

When I was an intern, I remember going on duty for 64-hours straight. What I can't keep straight was the way I walked....but, kidding aside, I survived it. But that's not the point. The point is, it could have been better.

Again, I must be dreaming. The study above was done in America. Here, sleep deprivation among doctors is a minor problem no one thinks about. There's also salary, the medical malpractice bill, and yes, the massive plight of doctors-turning-to-nurses leaving for greener pastures abroad.

We have a long way to go. I wonder what my friends Julsitos and ManangKu will say.

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