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Tweaking of Rules on Medical Resident Hours Still Leaves Excessive Risk of Errors Caused by Fatigue

Sleep deprivation leads to drastically diminished performance. The evidence keeps coming in on that subject. A fatigued motor vehicle driver is a more dangerous driver, more prone to errors. The same is true of fatigued physicians. Doctors who are short on sleep are more likely to make mistakes and commit medical malpractice.

This issue has been widely known for at least forty years, since the New England Journal of Medicine published a study showing that doctors who were short on sleep made double the number of errors reading electrocardiograms as doctors who were properly rested.

Today, there are some limits on the hours that medical residents can work. Under new rules that took effect in July, medical school graduates beginning their internships are limited to shifts of 16 hours. But after that first year, residents in second or subsequent years are still allowed to work shifts of up to 28-hours with practically no sleep.

This heroic, Herculean task is beyond the reach of mere mortals. Abundant evidence shows that it creates an environment in which medical errors can happen all too easily.

The Institute of Medicine examined the issue closely in 2008 and concluded that "the scientific evidence base establishes that human performance begins to deteriorate after 16 hours of wakefulness." The institute also pointed out that residents need to be better supervised.

The long shifts for residents have historically been a rite of passage for young doctors. But such shifts should not be used just because residents are a source of cheap labor. Especially when the evidence keeps accumulating that excessively long hours for doctors lead them to make too many mistakes.

Source: "Limiting resident physicians' work hours to save lives," Los Angeles Times, 7-1-11

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