Hospitals should not allow surgeons to perform elective procedures on patients if they have been awake the previous night taking calls, a trio of physicians argued in Thursday's edition of the New England Journal of Medicine.
Until hospitals institute rules to keep potentially sleep-deprived doctors away from operating rooms, they said, surgeons at least owe it to patients to let them know when they have had fewer than six hours of sleep and give them the opportunity to postpone their procedures.
The consequences could be complicated and expensive — how hard will it be for patients and doctors to reschedule and who will pay for operating room downtime? — but those costs could be offset by reduction in medical errors, the authors wrote.
"It's always struck me that there's something wrong with patients having elective procedures when it's known the surgeon has been up all night," said lead author Dr. Michael Nurok, an anesthesiologist and medical ethicist at the Hospital for Special Surgery in New York. "There's an ethical obligation to inform patients."
Research has shown that there is an 83% increase in the risk of surgical complications for patients who undergo elective daytime procedures performed by surgeons who hadn't slept at least six hours the previous night while they were on call, Nurok and colleagues noted. A recent survey showed that 80% of patients would request a different doctor if they knew that their surgeon had been awake for 24 hours.
Dr. Charles Czeisler, a sleep expert who co-wrote the essay, has argued for years that doctors' inhuman sleeping habits endanger patients. But getting physicians to change their work culture has been nearly impossible — in many hospitals, all-nighters remain a badge of honor.
In a letter that appears in the same edition, three members of the American College of Surgeons argued that mandatory disclosure of sleep deprivation is "unwarranted" and that "surgeons should instead be trained to identify and address" their fatigue. The group also suggested that many surgeons could successfully complete simple procedures "with or without a good night's sleep."
Nurok said that neither argument made sense because chronic sleep deprivation makes people less likely to recognize their own sleep-loss impairments and because fatigued doctors are most likely to make mistakes doing routine tasks.
"We're hopeful that patients and patient advocacy groups will take this up," he said.