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Drunk Doctoring
Medical residents are made to work incredibly stupid hours, and now a study out of the University of Michigan gets into exactly how stupid they are:

The sleep deprivation of overworked residents impairs their neurobehavioral performance to the same degree as a blood alcohol concentration of .04 to .05, researchers here say.

In simulated driving tests, residents who had worked a heavy call rotation had similar reaction times and rates of attention lapses, omission errors, and crashes as those who had ingested alcohol, reported J. Todd Arendt, Ph.D., of the University of Michigan, in the Sept. 7 issue of the Journal of the American Medical Association.

..."Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters," the study authors advised.

While the study findings are "notable" and cause for concern, the study did not directly evaluate residents' performance on medical tasks, said Drew Dawson, Ph.D., of the University of South Australia in Adelaide and Phyllis Zee, M.D., Ph.D., of Northwestern University in Chicago.

In an accompanying editorial, they noted the caveats of a quick fix. "Despite the appeal of restricting working hours, it is important to consider potential negative ramifications," they wrote. "In some scenarios, limiting working hours may increase risk to patients and physicians. For example, restricted working hours may lead to restricted access to health care practitioners through a reduction in the labor supply, insufficient clinical preparation for the 'real world,' increased sleep restriction in senior physicians, or increases in error rates due to work intensification."

Worse yet, it's not just residents who work the insane hours -- it's the doctors doing the big jobs, like a friend of mine who's a liver transplant anesthesiologist. I guess you just have to hope you get the doctor who's been on 10 hours, not 14 or more.

Posted by aalkon at September 13, 2005 8:46 AM


I think the worst part about residents' inhumanely long hours is that it's not done that way because it's the only - or even the best - way to train doctors. It's largely because those who design their training view it as a character-building rite of passage - the same reason that lawyers are trained by Socratic method. The attitude is "Yeah, it's hell - but we had to go through it, and we survived, so suck it up."

Posted by: Melissa at September 14, 2005 2:39 PM

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