Mind & Body

For Doctors, Lack Of Sleep Might Be Better Than The Alternative

On average, U.S. doctors work almost 60 hours a week. Younger residents often work up to 80 hours and often endure grueling 24-hour shifts. At first glance, this might seem terribly unfair – delivering medical care is stressful, highly demanding work. But there is a convincing reason why doctors prefer to keep working instead of handing their patients off to another doctor, and it can save lives.

Reducing Work Hours Doesn't Reduce Errors

It turns out that reducing the number of hours doctors can work doesn't necessarily reduce the occurrence of serious medical errors. In 1984, an 18-year-old woman named Libby Zion died after being admitted to the hospital with a high fever. Her father, Sidney Zion, learned that her doctor had been on duty for nearly 24 hours at the time, and sued the hospital. Publicity from the event led to reforms that cut the number of hours that doctors could work throughout the United States. Surprisingly, those reforms did not significantly reduce the occurence of medical errors.

A 2014 study in the Journal of the American Medical Association found that even though doctor-in-training shifts had been slashed by nearly half in many cases, there were no significant differences between the number of errors committed by the well-rested doctors and those committed by doctors two years before shift regulations were put in place. But lack of sleep can produce effects similar to alcohol intoxication, and doctors everywhere want to eliminate medical errors regardless of the cause. As of 2019, trials are still underway to identify the ideal relationship between work hours, shift policies, and sleep policies alongside personal commitments to practice good sleep habits.

Patient Hand-Offs Introduce Risk

One of the major reasons for this is the risk that  changing a patient's doctor poses. This routine known as a "patient handoff" in the medical profession. Handoffs require a lot of clear communication on every detail about a patient's condition, prognosis, and treatment. When multiplied by the number of patients usually under a doctor's care, it's virtually guaranteed that details get lost without a robust and organized method in place for communicating them. Up to 80% of serious medical errors can trace their origin to miscommunication during patient handoffs.

At the time of the Libby Zion reforms, there was no standardized protocol for patient handoffs in play, so doctors had to develop ad-hoc ways of describing the conditions and prognoses of multiple patients. Sleep-deprived doctors who have first-hand experience working with a particular patient are less likely to make serious errors than alert doctors who were never told about a patient allergy or other complicating factor. Today, hospitals typically enforce strict patient handoff procedures and implement their own fatigue mitigation strategies, which can include scheduling planned naps, strategically using caffeine, and keeping staff involved when designing work schedules.

Organized Communication Reduces Medical Errors

According to a 2018 CNBC report, medical errors represent the third highest cause of death in the United States, right behind cancer and heart disease. These errors often have complex causes. Human beings make mistakes. Inadequate training, undiagnosed medical complications, and technological problems can set events in motion that harm patients. Sleep deprivation can play a major role as well, but healthcare data siloing – the difficulty doctors have accessing patient medical data from other doctors and third-party providers – represents an even greater threat in an era where patient data can literally be of life-and-death importance.

Preventable Medical Errors

Medical errors are a big problem. Here's a rundown of how they're counted and what we're doing about them.

Written by Ashley Hamer & Austin Jesse Mitchell December 9, 2016

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