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Do Sleepy Surgeons Have a Right To Operate?

timothy posted more than 2 years ago | from the ahm-purrrfecly-ffffine dept.

Medicine 332

Hugh Pickens writes "BusinessWeek reports that a commentary from the New England Journal of Medicine calls on doctors to disclose when they're deprived of sleep and not perform surgery unless a patient gives written consent after being informed of their surgeon's status. 'We think that institutions have a responsibility to minimize the chances that patients are going to be cared for by sleep-deprived clinicians,' writes Dr. Michael Nurok, an anesthesiologist and intensive care physician. Research suggests that sleep deprivation impairs a person's psychomotor skills — those that require coordination and precision — as much as alcohol consumption and increases the risk of complications in patients whose surgeons failed to get much shuteye."

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Develop a test (3, Interesting)

StripedCow (776465) | more than 2 years ago | (#34729612)

Why not develop a test (perhaps a video game) which a surgeon should pass before entering the surgery room?

Re:Develop a test (1, Funny)

Anonymous Coward | more than 2 years ago | (#34729640)

Here in the UK that would make the NHS hard pressed to find anyone medically competent enough to pass the test ever, meaning no healthcare would take place. Much as usual.

Re:Develop a test (5, Informative)

Dr_Barnowl (709838) | more than 2 years ago | (#34729970)

Please don't diss NHS doctors. Having been in exactly that position, a junior doctor too tired to do a proper job, I can tell you that the major reason the NHS is in such a world of pain originates from the top down, not the rank and file.

The NHS has for some time been dependent on the goodwill and vocational motivation of it's healthcare professionals, because they sure as hell ain't motivated by the working conditions, pay, and benefits.

The real problems in the NHS stem from multiple sources, including the increasing cost of healthcare consumables (increasingly expensive technology and pharmaceuticals), the costs of revolting profiteering (aka the "Private Finance Initiative"), targets set by politicians, an excess of managers, a decrease of basic common sense and an increase of feelings of entitlement amongst the UK population (I've seen people turn up in A&E (ER) depts for things as basic as a cold or a knee graze).

Yet despite all this, we still achieve better health outcomes than the USA despite spending a quarter per-capita what they do on healthcare. Does this mean we are more than four times as competent?

The story itself is from the New England Journal of Medicine - so has originated from doctors themselves, trying to improve the care that patients receive by fighting against the market forces that increasingly try to reduce medical professionals to the same depth as any other druge worker stuck in a poverty trap.

Re:Develop a test (1)

WasteOfAmmo (526018) | more than 2 years ago | (#34730180)

Being indirectly involved with a Canadian health region and its workers I can say that the first three paragraphs of your post describes the situation here also. Not only for doctors but also for nurses. I'm curious if you see the same situation you describe applied to the nursing staff also.

Re:Develop a test (2, Interesting)

uglyduckling (103926) | more than 2 years ago | (#34730564)

The problems do apply to nurses, but on of the real issues for junior doctors in the UK is that we move around departments and even hospitals/trusts every 3-6 months. The longest job I've done has been for a year. So although nurses do have a rough time, there's a lot more scope for them to figure out how to have a workable life/work balance because they stay in a dept. for a long time and figure out the system. For junior doctors, it's like starting 2-4 new jobs every year. Having said that, most juniors are better paid than most nurses.

Re:Develop a test (0)

Anonymous Coward | more than 2 years ago | (#34730592)

feelings of entitlement amongst the UK population

Well, health care is a fundamental right. A right is something you are entitled to.

(I've seen people turn up in A&E (ER) depts for things as basic as a cold or a knee graze)

At times when there's no other clinic or pharmacy open, where else should they go? Not everybody is able to treat themselves.

Re:Develop a test (1)

Gordonjcp (186804) | more than 2 years ago | (#34730516)

Part of the problem with the NHS is that too much of it is privately run. Now, while that all sounds like a big happy capitalist love-in, the difficulties start when money begins to get tight. Oh, we're not showing enough growth this year? Well, lay off a few doctors and a few dozen nurses. The rest can pick up the slack. Wait, we're spending *how* much on cleaning? Oh, I'm sure the wards are just fine as they are, let's not pay for such an expensive cleaning company.

Even at that the NHS manages to do far better than private healthcare, because at least not all of the money is being eyed up by profit-hungry shareholders. I would never even consider going private, because you pay more to get the cheapest possible "care".

Re:Develop a test (5, Interesting)

Toth (36602) | more than 2 years ago | (#34729936)

Ten or so years ago, our trucking division experimented with such a program. It ran on a PC and had a controller with a single knob which could be rotated left or right.

You used the knob to keep the cursor in the center spot on the screen. The cursor would become more difficult to control during the test (about 30 seconds)

Drivers would sign in for the first time and establish a baseline for themselves by taking the test multiple times until the program indicated that a baseline was established. (About a dozen attempts, I think)

Once a baseline was established, a driver had to pass the test before starting his shift. If he failed, he had to see a supervisor.

I tested it on myself. After two (unmeasured) shots of vodka, I would have had to see a supervisor were I a driver.

An additional advantage was that you would also fail the test if you had the flu, were sleep-deprived or emotionally unfit to drive.

The program never went into full production at our place. Currently drivers are tested when hired and after any accident or delivery process incident.

I forget what it was called (I tried googling). I thought it was "fair". If you couldn't pass the test, you probably shouldn't drive a truck that day.

If you smoked a joint a week ago, it wouldn't affect the test but if you were up all night watching movies, you'd likely fail.

Re:Develop a test (5, Interesting)

FatalChaos (911012) | more than 2 years ago | (#34730016)

Part of the problem with this is that any video game (or other) test that is reasonably quick is going to be reaction based. Surgery is not about quick reactions. I've watched open heart surgery, and it took a good 4-5 hours to complete. Surgery is about slow, slow precision, and by the time you could test for that, the patient is probably already screwed. Think of it this way: go to a hospital, and ask who are there best surgeons. You'll find out a lot of them are at least in their 40s, if not 50s and 60s. When was the last time you found ANY 40, 50, or 60 year old who was a legit gamer?

Re:Develop a test (1)

Anonymous Coward | more than 2 years ago | (#34730056)

give it 20 years and there will be loads of them

Re:Develop a test (1)

Anonymous Coward | more than 2 years ago | (#34730412)

> When was the last time you found ANY 40, 50, or 60 year old who was a legit gamer?

There might be more than you suspect! Hell, I'm 52 and I'm a gamer. On FPSs I'm pretty competitive with some 18 year old friends. There's a 34 year old friend who's better than I am, but he plays a LOT more than I do and is competitive on a national level. Anyway, I won't claim I'm as good as the best people out there, but very few folks are. With your run of the mill average gamer though? Us old folks can hang in there pretty well when we try.

Many folks who are now in their mid or late 40's were the first generation who grew up with video games in the 1970's. They just never stopped playing. Their parents were not gamers in their 40's, but they are, because of the explosion of video games in the 70's.

Re:Develop a test (1)

Anonymous Coward | more than 2 years ago | (#34730588)

When was the last time you found ANY 40, 50, or 60 year old who was a legit gamer?

I take it that your definition of "legit gamer" means "plays games and doesn't have a job." And I got bad news for you, sonny, there's quite a few "legit gamers" out there in this economy!

Posted AC in case hungover whippersnappers are modding today.

This is just another waiver (5, Insightful)

santax (1541065) | more than 2 years ago | (#34729628)

Come on, so you get into the ER, need treatment right away, you're gonna tell the only doc available to first get some sleep? Don't think so. The hospital/doc should have made sure that the staff is fit enough to even be on watch. This will just mean: yes sir we are very sorry you lost your kid due to bad handling from are doctor, but look here: that is your signature. So you can kiss that lawsuit goodbye. Hospitals shouldn't have people who are sleepdrunk on the watch. Simple as that.

Re:This is just another waiver (1)

Anonymous Coward | more than 2 years ago | (#34729828)

Pilots, truck drivers, and nuclear reactor operators have work hour controls to ensure that fatigue is managed. The same should be true with doctors.

Re:This is just another waiver (5, Informative)

nbauman (624611) | more than 2 years ago | (#34729878)

I agree. If the surgeon's abilities are impaired for lack of sleep, he shouldn't operate, and it's the responsibility of the surgeon and the hospital to enforce that rule.

They can't dump the responsibility on the patient, especially by shoving an informed consent form under his hand in the 15 minutes before surgery. The patient isn't qualified to evaluate that risk.

This wasn't a BusinessWeek article, btw. It was a HealthDay rewrite of a New England Journal of Medicine article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 [nejm.org] [free]. The NEJM article more clearly made the important point that hospitals shouldn't get into these situations in the first place by letting surgeons schedule elective surgery after a night of being on call. Here's the hypothetical case from the original article:

A surgeon on overnight call responds to an 11 p.m. call from the hospital, where a patient has presented with an acute abdomen. After working up the patient for several hours, the surgeon decides to call in an anesthesiologist and perform a bowel resection. By the time the procedure is completed and the operative note has been dictated, it is time for morning rounds. The surgeon has not slept all night and is scheduled to perform an elective colostomy at 9 a.m. Does the surgeon have an obligation to disclose to the patient the lack of sleep during the past 24 hours and obtain new informed consent? Should the surgeon give the patient the option of postponing the operation or requesting a different surgeon? Should the hospital have allowed the surgeon to schedule an elective procedure following a night he was scheduled to be on call? Should it allow a surgeon to perform elective surgery after having been awake for more than 24 hours? What potential unintended consequences of disclosing a clinician's sleep deprivation should be considered?

Re:This is just another waiver (2)

bill_mcgonigle (4333) | more than 2 years ago | (#34730224)

Should the surgeon give the patient the option of postponing the operation or requesting a different surgeon?

Both of these are problematic - in first case because the patient has scheduled a work vacation for the surgery and in the second case, because the primary surgeon is familar with the case and has spent time doing pre-operative planning. You don't just throw in another surgeon at the last minute unless it's an emergency.

The correct answer, as mentioned previously, is to consider on-call time as utilized and to not schedule the surgery after on-call hours. Truck drivers have more sensible rules.

Elective Surgery (1)

archer, the (887288) | more than 2 years ago | (#34729898)

According to a report on TV, this is would only be for Elective surgery. The BusinessWeek article doesn't mention Elective until the last sentence.

Re:This is just another waiver (1)

Kilrah_il (1692978) | more than 2 years ago | (#34730064)

And now us doctors will have another reason to be afraid of lawsuits: "Your honor, evidence shows that the defendant was awake for 16 hours straight and did not inform the patient. Thus, he should be found guilty of malpractice!"
Of course we shouldn't have tired doctors (nurses, technician, etc.) working and treating patients, but as long as the system demands it (because of shortage of staff [and money, of course]), you can't put the blame on doctors and open up another avenue for lawsuits.

Re:This is just another waiver (1)

The Snowman (116231) | more than 2 years ago | (#34730430)

And now us doctors will have another reason to be afraid of lawsuits: "Your honor, evidence shows that the defendant was awake for 16 hours straight and did not inform the patient. Thus, he should be found guilty of malpractice!"

If we can quantify standards for sleep deprivation, and if someone such as the AMA comes out with standards, then you need not worry. Find that magic number, which may need to be low to accommodate varying age groups and personal abilities, and then you have a golden standard. If a physician does not have enough sleep according to a defined standard, then he would be obligated to follow a certain procedure. Example: awake more than 16 hours or had less than 6 hours of sleep: inform the patient and offer to reschedule or perform surgery anyway. Awake more than 24 hours or less than 4 hours of sleep: inform the patient that surgery cannot proceed.

If you have a published medical standard or even the force of law behind it, that should be sufficient to protect against lawsuits. The same thing holds true for drunk driving. There is a defined limit, and it works fine in courtrooms all over the nation.

Re:This is just another waiver (1)

Kilrah_il (1692978) | more than 2 years ago | (#34730578)

In general, I agree with you. One important difference needs to be pointed out: In order to prevent drunk driving, we are measuring a substance (alcohol) that has some (albit, not perfect) corrolation with drunkness.
We have no way to measure sleepiness. Some people need just 6 hours of sleep to be wide awake. Me? I can manage with 6, but 8 is ideal for me. Also, if I had a few tiring days, even 8 isn't enough, and I may crush and need 10 hours. The same is true if I drank the night before.
I think you catch my drift. Saying: He has worked 16 hours straight and thus he is too tired, is simplistic. I argee it is better than what we have now, i.e. no rules whatsoever, but it is far from ideal.

Re:This is just another waiver (1)

Anonymous Coward | more than 2 years ago | (#34730596)

Agreed. This is another example of a bunch of doctors being idiots towards other doctors. Who is going to do the surgery? Someone who didn't work up the patient? Great idea, only most medical errors occur with hand offs. Brilliant. I am a doctor, and I always get sick of these moronic ideas by other doctors. Who needs lawyers when you have other physicians?

Re:This is just another waiver (2)

mfh (56) | more than 2 years ago | (#34730212)

It'd be nice to see a cure for the requirement of sleep in human beings. This is a bad flaw. Not to mention it cuts back on my WoW time.

Do Sleepy Surgeons Have a Right To Operate? (1, Insightful)

Anonymous Coward | more than 2 years ago | (#34729632)

Silly question. Surgeons never have a right to operate on people, any more than anyone else has a right to cut people open and poke around inside. Surgery must always be based on consent, now that can be complicated by circumstancses - an unconscious patient can't say yes or no and depending on the circumstances in which they were found and the consequences of waiting then reasonable assumption may have to be made as to what they would want. However, ensuring as far as possibel that they are able to give informed consent is the right thing to do, and that does mean providing information like "the surgeon's drunk" or "the surgeon is sleep deprived". Putting it in terms of a "right" to perform surgery is absurd.

Re:Do Sleepy Surgeons Have a Right To Operate? (0)

Anonymous Coward | more than 2 years ago | (#34729644)

Surgeons never have a right to operate on people, any more than anyone else has a right to cut people open and poke around inside.

Yes, but AFAIK, normal people don't have that right, even with consent.

Re:Do Sleepy Surgeons Have a Right To Operate? (0)

Anonymous Coward | more than 2 years ago | (#34729826)

Rights, privileges, powers?? Whats with all the nit picking man, I'm just trying to communicate!

Re:Do Sleepy Surgeons Have a Right To Operate? (2)

Kilrah_il (1692978) | more than 2 years ago | (#34730170)

I, as a doctor, have the right to operate people, as part of my license, under the condition that I have been given informed consent.

Re:Do Sleepy Surgeons Have a Right To Operate? (1)

Kijori (897770) | more than 2 years ago | (#34730496)

It's not a silly question. Surgeons do in fact have a special right to operate that isn't available to ordinary people. If you perform elective surgery and make mistakes such as they are killed you would not be able to rely on them having given consent in order to escape liability for manslaughter. A surgeon would be able to and any liability would sound only in negligence. The question here is whether there should be an additional requirement that the surgeon be in a fit state to perform the surgery before this protection would arise.

Well, of course, it should be the other way around (1)

JamesP (688957) | more than 2 years ago | (#34729652)

Doctors should get a good night of sleep before a surgery, and it should be their responsibility.

Of course, the hospital should take care of not overworking him.

Re:Well, of course, it should be the other way aro (1)

Anonymous Coward | more than 2 years ago | (#34729668)

Doctors should get a good night of sleep before a surgery, and it should be their responsibility.

Of course, the hospital should take care of not overworking him.

It's not just the hospitals. I know a surgeon that not only works her job, but also moonlights at other hospitals.

Her first year after passing her boards, she wrote a 6 figure check and paid off her student loans - then bought a high end BMW.

Re:Well, of course, it should be the other way aro (4, Insightful)

Anonymous Coward | more than 2 years ago | (#34729678)

Killed five people while she was at it. Good for her! Now she has a shitty BMW to show for it!

an institutional illness (5, Interesting)

tverbeek (457094) | more than 2 years ago | (#34729854)

Part of the problem is the medical profession's method of "training" physicians by putting them through an extended period of hazing: working around the clock, being awakened at random intervals, etc. Many of the ones who get through it develop the delusion from it that they can do the work properly under any conditions, especially sleep deprivation. It's a badge of honor for them, and they will engage in all sorts of denial and rationalization to keep at it.

Re:an institutional illness (5, Informative)

Kilrah_il (1692978) | more than 2 years ago | (#34730196)

I can assure you that most doctors I know, me included, know that the long hours endager our patients. We do not take pride in taking someone to the OR at 4AM while barely being able to tie our shoelaces correctly. It is not pride, but necessity.
The present situation is that doctors need to work a lot. Why? Lack of personnal, lack of money lack of resources (Actually, it can all be summed up in: Lack of money). The reason is not important. The bottom line is that a doctor needs to operate a patient. Ideally, he should be wide awake. Unfortuntly, sometimes this is not the situation, even for elective surgeries.
We shouldn't point the blame at the doctors, but at the system.
Yes, it's nice to tell horror stories of what I have to do in the middle of the night after 20 hours of working without a minute of sleep. But every doctor I know will have the situation changed to 8 hour shift at the first chance possible.

Re:an institutional illness (0)

Kludge (13653) | more than 2 years ago | (#34730284)

Actually, it can all be summed up in: Lack of money

Yeah, because we all know that doctors are poor and can't make good money.

Re:an institutional illness (3, Informative)

Kilrah_il (1692978) | more than 2 years ago | (#34730346)

First of all, I was talking about the medical system. I order to have doctors working shorter hours, you need to have more doctors -> more money.
Secondly, in the US doctors might make a lot of money, but in Israel (where I am from) and many other countries, the doctors' salary isn't so lucrative. I am not saying I am starving, but considering how much I work, it's pretty disgracing. If I wanted to have a good salary, I would have gone to IT (yes, you read that right).
I will make good money, but only 15 years from now, when/if I have a private clinic, otherwise my salary will be above-average but I will not be making as much as you might guess.

Re:an institutional illness (0)

Anonymous Coward | more than 2 years ago | (#34730604)

Try not to be so fucking stupid. He's talking about lack of money to hire enough doctors (and other qualified staff).

Re:an institutional illness (2)

ShooterNeo (555040) | more than 2 years ago | (#34730542)

The health care system in the USA gets a larger share of the richest economy in the world than any other health system anywhere. If the problem is lack of money, I must ask...where is the money going, then?

Re:an institutional illness (1)

Kilrah_il (1692978) | more than 2 years ago | (#34730584)

Mostly? New technologies and medications, they are the biggest drivers of increased healthcare spending.

NO (3, Informative)

zero.kalvin (1231372) | more than 2 years ago | (#34729660)

Any other question ?

Would Patient Consent Work? (2)

Major_Small (720272) | more than 2 years ago | (#34729666)

I like the idea of patient consent, but it wouldn't always be possible. I just got into a motorcycle a few months ago and had surgeries, chest tubes, intubations, and couldn't even breathe on my own for a bit. I wouldn't have been able to consent to any of this, but it was necessary to keep me alive.

I work a night shift in a hospital. If you've never worked one before, know that some nights you will be absolutely exhausted. I'm sure most night-shifters have fallen asleep at work before, if not on a regular basis. Doctors are not above this. Our hospitalists have on-call rooms to sleep in every night. If you code in a hospital overnight, chances aren't bad that one of the doctors that shows up was woken up by your code seconds before he showed up in your room.

My point is, hospitals are open 24/7. There is a night shift. Those people are usually tired. Also, emergencies happen 24/7. Sometimes patients can't consent to anything.

Imagine this: A patient shows up at 2am with an injury that would kill the patient before the morning shift came in. All the surgeons are asleep. You'd have to wake up an entire surgical team. All of them will be tired when they come in. The patient, however is unconscious. Bringing this patient back to alertness would risk their life and put them in so much pain they wouldn't be able to sign or agree to anything. What now? (

I think attention should be paid to organizations overworking clinical professionals, but it should be kept in mind that sometimes work that a patient may not even want to save their life has to be performed by people who are incredibly tired and just woke up just to keep the person alive. That's just how it is.

Re:Would Patient Consent Work? (3, Funny)

kyrio (1091003) | more than 2 years ago | (#34729680)

That must have been a really big motorcycle in order to get into it!

Re:Would Patient Consent Work? (1)

hedwards (940851) | more than 2 years ago | (#34729944)

Indeed, last summer I had a heat stroke combined with dangerously low sodium levels, I was only able to get 911 called by failing to be able to communicate to the security officer there. Fortunately he figured out to call 911 for medical help rather than police.

I was in no condition to be consenting to anything. Fortunately, the stay was covered, which was lucky because my insurance company only covers one of the local hospitals for things which aren't trauma care or preapproval.

Re:Would Patient Consent Work? (3, Insightful)

TapeCutter (624760) | more than 2 years ago | (#34730242)

"Fortunately, the stay was covered, which was lucky because my insurance company only covers one of the local hospitals for things which aren't trauma care or preapproval."

As an Aussie who enjoys cheap and effective universal health care, I cannot for the life of me understand why Americans are not outraged by that sort of bullshit.

Re:Would Patient Consent Work? (-1)

Anonymous Coward | more than 2 years ago | (#34730440)

We americans would rather pay for our crappy healthcare than get penal colony quality care

Re:Would Patient Consent Work? (1)

nbauman (624611) | more than 2 years ago | (#34729964)

I work a night shift in a hospital. If you've never worked one before, know that some nights you will be absolutely exhausted. I'm sure most night-shifters have fallen asleep at work before, if not on a regular basis. Doctors are not above this. Our hospitalists have on-call rooms to sleep in every night. If you code in a hospital overnight, chances aren't bad that one of the doctors that shows up was woken up by your code seconds before he showed up in your room.

My point is, hospitals are open 24/7. There is a night shift. Those people are usually tired. Also, emergencies happen 24/7. Sometimes patients can't consent to anything.

Imagine this: A patient shows up at 2am with an injury that would kill the patient before the morning shift came in. All the surgeons are asleep. You'd have to wake up an entire surgical team. All of them will be tired when they come in.

All that is true. Doctors often have to perform emergency surgery after inadequate sleep. But the point of the NEJM article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 [nejm.org] was that doctors shouldn't schedule elective surgery the day after they're on call. Some hospitals already have that policy. They argue that if they don't adopt that policy, they should at least inform the patient. I think it was more of a way to embarrass doctors and hospitals into adopting the policy rather than a serious solution to an ethical problem of informed consent.

There's a culture in medicine of working heroic hours. The fundamental solution is to change that culture. Surgeons have a culture of working long hours and making lots of money. The sleep research suggests that their outcomes would be better if they worked fewer hours (and made less money). I don't know how you can change that culture. Have woman surgeons?

Trust a doctor (4, Insightful)

pehrs (690959) | more than 2 years ago | (#34729674)

Asking me to sign a waiver should a surgeon about to cut me open be tired seems only like a CYA policy. I can't make an informed decision, and I am most likely in distress and need of the surgery and saying no would delay it.

I am already putting a huge amount of trust in his abilities, and that includes him being able to decide if he skilled and in shape to do the operation or not. If I can't trust my doctor to make that decision I can't trust him to operate at me anyway. Therefor this seems completely pointless.

I

Re:Trust a doctor (1)

jimicus (737525) | more than 2 years ago | (#34729906)

You know how you can be feeling fine, running on adrenaline long after you should have got some sleep? Thinking "This is great, I'm the king of the world"? Then it suddenly hits you and you're ready to collapse.

Now, how do you feel about your surgeon hitting that wall when he's up to his elbows in your guts?

Re:Trust a doctor (1)

nbauman (624611) | more than 2 years ago | (#34729980)

Asking me to sign a waiver should a surgeon about to cut me open be tired seems only like a CYA policy. I can't make an informed decision, and I am most likely in distress and need of the surgery and saying no would delay it.

Exactly. I don't think the authors were seriously concerned about the patient consent problem. They wanted to change the scheduling policy.

I think they just wanted to drop a hot potato into the laps of doctors and hospitals that do perform elective surgery after a night on call: "If you insist on doing this, then you have to inform the patient."

What doctor or hospital is going to give a patient an informed consent form that says, "My abilities may be impaired because I didn't sleep last night"?

Re:Trust a doctor (1)

Dr_Barnowl (709838) | more than 2 years ago | (#34730032)

I think the point is that doctors are being pressured by management into working excessive hours that negatively impact patient care.

By making the patient aware of their tiredness, they are living up to their ethical responsibilities. By making the patient responsible for the choice, they are avoiding the pressure that would otherwise be deployed by their management, because they cannot operate on the patient without informed consent. If management pressures them to stop informing patients of their exhaustion level, that manager can be rightfully censured for reducing the quality of patient care.

So this a dual win - conditions for the medics improve, and so does patient care.

Re:Trust a doctor (0)

Anonymous Coward | more than 2 years ago | (#34730226)

"I think the point is that doctors are being pressured by management into working excessive hours that negatively impact patient care."

"I can operate on you, but I must advise you that the hospital did make me work me for hours straight, during which I got 2 naps of 20 minutes, if you find that dangerous for your case, please complain at the management, I give you my phone and dial for you."

this is just dumb (5, Insightful)

Triv (181010) | more than 2 years ago | (#34729684)

Your relationship with your doctor is based on trust and consent - you don't ask your taxi driver to submit to a breathalyzer before he drives you home, so why should you ask your doctor how he's sleeping? If you don't trust your doctor to be operating on you in good condition, you need to find yourself a different doctor.

Re:this is just dumb (2)

hedwards (940851) | more than 2 years ago | (#34729958)

Well, perhaps you should require a taxi driver to submit to a breathalyzer. Drunken driving is a killer.

People, in general, do not have the knowledge necessary to figure out the difference between a surgeon that's competent and safe and one that just presents well. Likewise, the anesthesiologist is every bit as important and one really doesn't have any good way of knowing if they're up to it.

Re:this is just dumb (1)

jimicus (737525) | more than 2 years ago | (#34729978)

The whole point about establishing procedures like "At least 8 hours between shifts" is because nobody - not even a surgeon - is immune to making silly mistakes, particularly when tired.

Even with all the disclaimers in the world, deaths don't reflect well on hospitals.

Re:this is just dumb (1, Informative)

gclef (96311) | more than 2 years ago | (#34730112)

On the other hand, your taxi driver isn't taking regular shots of vodka as part of his job. Sleep deprivation is considered routine for hospital doctors.

Proper rest (4, Interesting)

Anonymous Coward | more than 2 years ago | (#34729710)

You know, in a country where even truck drivers have regulations requiring proper rest, you'd think there'd be some sort of standard for medical practitioners of any kind. Of course, if any politician ever tries it those AMA campaign donations will dry up like the Gobi Desert.

Doctors/Nurses do not get speeding tickets (0)

pizzach (1011925) | more than 2 years ago | (#34729756)

It is because of their profession. Doctors/nurses are allowed to speed and police officers will usually be more lenient on them. Whether this is warranted or not is a similar question as it puts other people in direct danger (in contention with the purpose of their line of work.)

Re:Doctors/Nurses do not get speeding tickets (4, Interesting)

neapolitan (1100101) | more than 2 years ago | (#34729794)

This is simply not true.

If you are legitimately speeding (safely) to perform an urgent operation, the police may escort you to the hospital, enter with you, verify you are about to do an operation, then leave you without a ticket (it happened to several of my colleagues, usually late at night.)

Just being pulled over and showing your hospital badge / white coat is not going to help you 99+% of the time. *Especially* if you were driving in a dangerous fashion. One of my friends has a funny story on how he tried it after being pulled over, and his ID says:

".... ..., MD
DERMATOLOGY"

The police officer laughed and gave him the maximum fine.

Re:Proper rest (5, Interesting)

couchslug (175151) | more than 2 years ago | (#34729860)

I get some great reactions from medical folks when I mention that the Air Force generally enforces a 12-hour shift limit for aircraft maintainers, even in wartime. Tired people fuck up, and anyone who pretends otherwise is full of shit.

The medical world should borrow two things from military aircraft maintenance. Limit shifts to 12 hours except in emergencies where manning is insufficient, and CHECKLISTS.

Pilots, who are at least as studly and narcissistic as physicians, KNOW ignoring checklists is a great way to fuck shit up. That's why it is PUNISHED.
They also know, even with training, that no one can remember every detail of every complex task they have to perform. From maintainers to aircrew to the folks in the control tower, checklists are considered orders to be obeyed.

Physicians have little time to see each patient, so they have to match symptoms with their concept of a "template" for a particular malady. Checklists are ideal for this sort of thing.

As to the civilian custom of working interns to exhaustion, that's just stupid. The military can train enough folks for wars, the civilian side of the house should "militarize" medical care (including quality control and open chain of command for complaints) and get shit done.

Re:Proper rest (1)

Antisyzygy (1495469) | more than 2 years ago | (#34729994)

I think there would be too many checklists for every type of ailment, although I suppose some diagnostic websites manage to do it. Hell, that almost would remove the need for physicians as anything but a confirmation or surgery role. You could have nurses/medics and some sophisticated check list like a health diagnostic website has and relegate doctors to tricky cases, confirmation, and major surgery.

Re:Proper rest (3, Insightful)

dkleinsc (563838) | more than 2 years ago | (#34730172)

3 cheers for checklists! My sister is studying nursing right now. Those checklists are life-savers.

I also have friends who are or recently have been medical residents. That kind of pressure, with shifts that last well over 12 hours, is quite simply an abusive labor practice.

Re:Proper rest (4, Insightful)

bill_mcgonigle (4333) | more than 2 years ago | (#34730272)

The military has a culture that's designed to take ego out of the decision processes. Perhaps imperfect, but the danger is recognized and dealt with. Now, try working at a hospital...

Actually, it would be interesting to compare military hospitals with civilian and see how they rate on important measures.

Re:Proper rest (1)

Velex (120469) | more than 2 years ago | (#34730280)

Pilots, who are at least as studly and narcissistic as physicians

I don't think you understand the size of most doctors' egos. It took me a while to understand that they literally think they're gods.

They also know, even with training, that no one can remember every detail of every complex task they have to perform.

Doctors haven't figured that out yet. I don't think they ever will because they believe themselves to be infallible and also because most people believe doctors to be infallible.

It's fun when I have to research a call or two (I work at an answering service) because a doctor is throwing a temper tantrum and I catch her in a lie (or two or three). But, for some reason, that never reflects poorly on the doctor, it just keeps the phone agent from being fired.

The other odd thing is they don't ask me to research these things anymore. If we point out to a doctor client's management that one of their doctors lied, they'll call us liars and go off service (despite the recording of the call). So, it's just good business to stroke the doctor's ego and admit fault. They love being right, and they love it when they can cuss someone out.

No, the problem of sleepy doctors, or wrong meds administered, or anything else that goes wrong at hospitals stems from the fact that most doctors are just simply rotten human beings with over-inflated egos who know a bit of biology.

Re:Proper rest (0)

Anonymous Coward | more than 2 years ago | (#34730622)

Curious item, this bit about checklists. Same thiing about tiredness and workscheduling. The research I have seen suggests that the medical profession pushes back hard against checklists. The lists seem to be seen as crimping their creative freedom despite the clear evidence that it reduces errors. Crimping creative freedom -- does this sound familiar to any old programmers?

  And anyone who is in the medical community knows that abusive work scheduling is policy from the top. The PHBs put doctors and nurses routinely in positions where they must follow complex procedures with potentially life-threatening consequences, putting their professional licenses on the line. But their work schedules mean they are permanently jet-lagged and never function properly. My wife, for example, was 'part-time' (like legal part-time) so would be off for a few days, then work a group of three shifts. Two were 12 hour days, one a 12 hour night -- or night, day, night, or some other horrible combination. I have read that changing schedules takes weeks for the body to adapt -- watching her pretend to function was pitiful. Despite all the medical research about body cycles and work schedules it was institutionalized to NOT allow anyone to have a stable schedule. The only doctor one is likely to see who is NOT jet-lagged is the GP with a quiet strip-mall practice. Anyone in a hospital setting is likely wasted by design and it is only by dint of much practice pretending to be alive that they seem normal.

So I am happy that there is yet another bit of research suggesting that tired doctors/nurses/surgeons/whatever is hazardous to your health. But let us not forget that this is deliberate and institutional in scope. The folks on the line are just cogs in an insane machine.

article's title (3, Insightful)

underqualified (1318035) | more than 2 years ago | (#34729714)

"Doctors Urged to Admit Fatigue Before Performing Surgery"

I wish we had something similar in my previous company.

"Developers Urged to Admit Fatigue Before Fixing Bugs"

hospital covering ass (1)

Jaktar (975138) | more than 2 years ago | (#34729728)

This is the same policy used in the US military. You're supposed to get people involved if you're too tired to do your job. This responsibility should be completely on the shoulders of the doctor to speak up. I think it's likely that some doctors have used a "sleep deprivation" excuse when being reviewed for a botched procedure. This seems like some bean counters are pushing for a way to reduce the hospital's liability in those matters.

Why is this an issue? (1)

harrytuttle777 (1720146) | more than 2 years ago | (#34729772)

Seriously; the fact that surgeons / residents are so overworked that they have to operate while sleepy is a symptom of a much larger problem. Mainly that there are not enough surgeons. The AMA artificially restricts the number of doctors in the field, thereby endangering the lives of the patients the are supposed to be protecting.

Things that can be done to correct the disaster that is U.S. heath care:
 


  1. 1)Eliminate the AMA.
    2)Eliminate Insurance companies.
    3)Eliminate Malpractice lawyers / insurance.

These three things would restore market forces to the medical industry. People decry Obamacare, when they don't realize that we have a defacto socialized system now. The consumers(sick) no longer pay for their product(medical care). We instead throw in artificial barriers (insurance companies) whose sole goal is to PROFIT.

Re:Why is this an issue? (1)

nbauman (624611) | more than 2 years ago | (#34729816)

Things that can be done to correct the disaster that is U.S. heath care:

 


  1. 3)Eliminate Malpractice lawyers / insurance.

These three things would restore market forces to the medical industry.

So you think that the problems with the U.S. health care system would be corrected if we eliminated the right of patients to sue when they were needlessly crippled by an incompetent doctor.

Re:Why is this an issue? (1)

hedwards (940851) | more than 2 years ago | (#34729974)

Indeed. We had an initiative to cap damages it failed to pass. I think it had to do with the cap being ridiculously low. Non-economic damages were going to be capped at 300k whether or not there was a legitimate reason for giving a higher award. 300k sounds like a lot of money, but if the malpractice left a person as a single parent that's not going to cover the cost of replacing the spouses help in raising a child let alone the other help they likely provided.

Re:Why is this an issue? (1)

nbauman (624611) | more than 2 years ago | (#34730268)

Medical malpractice costs aren't really a serious problem, they're just a hot-button issue for (mostly) conservatives.

Malpractice premiums are about 2% of health care costs. Insurance company administrative costs and profits are 15-20%.

Re:Why is this an issue? (1)

harrytuttle777 (1720146) | more than 2 years ago | (#34730602)

300K is a lot of money. It is more money than I am worth. Much of the world's population will never make even 100K over their entire life.

If a doctor screws up. They should admit they are sorry, and pay to fix their mistake. If they cut off the wrong arm. They should pay for a prosthetic arm.

This sound harsh, but we all make mistakes. Doctors are no different. We all do the best with what we have. Nobody is going to live forever. You have no right to live free forever, free of all pain and injury.

If we had more doctors there would be less mistakes like this made. IMHO

Re:Why is this an issue? (1)

harrytuttle777 (1720146) | more than 2 years ago | (#34730570)

Lawyers don't sue for altruistic concerns. They sue to make obscene amounts of money. Try to get a lawyer to represent you, against a doctor when large amounts of money aren't on the line.

This country operated for years without the glut of lawyers that we have now. We must do so again in the future if we are to have a future.

Re:Why is this an issue? (1)

bsDaemon (87307) | more than 2 years ago | (#34730232)

Health Care is perhaps the one area where I'm not particularly thrilled with "market forces" taking over. That, and I think world would have been generally far better off had AT&T not been broken up, but that's not really relevant.

Market forces are responsible for cheap chinese crap of low quality, where warranties are a joke because you know they're just long enough to last until they know the product is going to crap out from normal usage, forcing you to buy a new one. I don't want the crappy, Chinese knock-off doctor doing me surgery. For example, over the summer my mother and I both had similar surgeries performed -- simple cyst removals -- by different doctors. My surgeon had gone to Columbia, Dartmouth and Stanford for his education. My mothers, I believe, had been to a State school for undergrad and then to MCV, which is an alright medical school, but nothing really to write home about in the grand scheme of things.

My surgery was performed faster, with better accuracy, and healed much, much faster than my mother's, and was almost completely painless while it healed, despite having been on my right forearm, and me being right handed (weird place to get a hard cyst, too). My surgery was also less expensive than my mothers, despite my insurance not wanting to cover any of it because i was new on the plan and they decided it was a "pre-existing condition" (queue spooky sounds and wavy, ghost-story hands).

Being able to get higher-quality service from a superior provider for less money is a lot more like Bell vs bullshit MCI back in the 80s, after all. Fuck free trade medicine. Think I'd go to a doctor who went to some Caribbean medical school because they couldn't get into an American medical school? Hell no.

The AMA and state medical boards are just like any other professional organization -- they set the minimum standards necessary to be considered elegable to practice a profession. You may call it "barrier to entry," but I disagree. I don't want to go to a doctor that other doctors wouldn't consider fit any more than I'd want a guy who read the law in his spare time to be my defense attorney or to drive on a bridge by someone who failed to get the PE stamp. The rest of the world isn't IT and self-education isn't going to cut it when death is on the line.

Re:Why is this an issue? (2)

harrytuttle777 (1720146) | more than 2 years ago | (#34730534)

It sounds like your doctor was a great doctor. I don't knock that. It also sounds like market forces are askew if your doctor was cheaper than your Mother's. You should give out your doctor's name here so other people can go to him, and he could charge more.

As for your contention that the AMA is a certifying agency that ensures doctors are qualified, I could point out numerous counter examples, where the AMA has hurt patients. We all want the best qualified doctors. However, I would rather have an excess of slightly less qualified doctors that could be seen in under 10 minutes, vs. a few ultra qualified doctors, who need an appointment 2 months in advance and just may flat out refuse to see me if I do not have the right condition/ amount of money.

Casebook example of too few doctors killing someone [associatedcontent.com]

Here the women died because she could not be seen in a timely manner.

I also think there should be some standards. However there is something seriously wrong with those standards if have interns working 80 hours a week, and doctors operating on the wrong side of the body because they are so overworked.

A simple example from my medical history. I received a tick bit in Mass. Not wanting to risk a case of Lyme disease, I went to the emergency room after gnawing the tick that tried to eat me. I already knew I needed a dose of doxyclyclene. I told the front desk secretary this. The hospital would not just give me a prescription for doxy. I could not just go to the pharmacy because in the USA this is illegal without a prescription. Apparently there are a lot of doxycyclene heads that are shooting up doxycyclene all the time, so the state has to regulate this drug. Instead I had to wait 2 hours for a doctor to see me, and administer the Doxy. I do not have insurance, so I was concerned over the cost. The attendants could not tell me what the cost would be. Apparently they need a team of highly paid economics majors to calculate the price of treatment. When I expressed my concerns the attendant said not to worry because, if I could not foot the bill, the state would, as that health care was mandatory in this state. It ended up costing the state over $250.

Everything that is wrong with this could have been fixed if market forces had been involved. First off. I could have just gone to the pharmacy, and picked up my own drug. Secondly It would not have taken so long to see the physician. Thirdly costs would be less.
Lastly the hospital would have actually cared about what things cost.

Tougher question than it seems (1)

Andtalath (1074376) | more than 2 years ago | (#34729786)

At first, you think it's obvious that people who are responsible for other peoples' lives should be required to be 100% alert.

However, the problem with that is that this by necessity means that you will need more doctors to man places up, thus increasing costs (not to mention that I don't think that there are that many superflous doctors just ready to jump in).
And here's the thing, in most cases, doctors do get to work reasonable hours, the times they don't get to is related to when there is a current crisis.
This means that instead of saving peoples lives with a risk of doing a clumsy job the get to go home to sleep and the person dies anyway.

Not a good result if you ask me.

The one solution I can see is having a consultant doctor pool which only help out in situations of need.
That does sound quite expensive however.

And, yes, while I hate to be a money-grubber when it comes to lives (regardless of species), it's a fact that people die every day due to lack of resources, therefore you need to prioritize.

Re:Tougher question than it seems (1)

hedwards (940851) | more than 2 years ago | (#34729986)

I doubt that it would be that expensive. Doctors wouldn't be able to clock as many over time hours and there'd be fewer claims of malpractice. Some of the money would come from not paying over time and some of the money would come from a reduction in malpractice insurance premiums.

Here's a crazy idea. (5, Informative)

BlueParrot (965239) | more than 2 years ago | (#34729792)

How about ensuring doctors work humane shifts as opposed to trying to squeeze every penny out of the system?

This is not just a problem with the US btw. I've spoken to doctors from lots of different countries, including Sweden, the US and England.
In general they are overworked, get little time to recover between shifts, and are expected to work overtime as part of the job description.

That's not going to be good for either doctor or patient.

Re:Here's a crazy idea. (1)

Antisyzygy (1495469) | more than 2 years ago | (#34729932)

Thats not the only problem. Hospitals also try to charge you for more expensive tests like a CT scan when a simple X-ray or Ultrasound will do. The whole system is a joke, its not limited to squeezing pennies out of surgeons and doctors.

Re:Economics vs Health (1)

FatalChaos (911012) | more than 2 years ago | (#34730078)

You talk about penny pinching, which is great, but who is going to pay for the increased costs? I'm all for great health care, but the truth is health care does not exist in a vacuum, and having money to spend on laptops, mp3 players, etc, is great. If you believe that health is priceless, that's fine, but just know that health care costs would shoot through the roof is money was not an issue. For a great example, just look at MRIs and CAT scans. MRIs are pretty much universally better and a lot safer (no radiation), but CAT scans are still used a lot. Why? MRI's cost a shitload of money. Plus, even if you do want to increase spending on health care, are hospitals or doctors even the best way to do it? I've taken a couple of health policy classes, and one thing that seems well agreed upon is that preventative measures are the best, which at its most basic level is about having a population eat health and get enough exercise. This has more to do with making sure everyone has access to fresh fruits and veggies, safe and convenient places to work out, health education, etc.

Re:Economics vs Health (5, Informative)

chooks (71012) | more than 2 years ago | (#34730264)

MRIs are pretty much universally better

This is a common misconception but is not true. Which imaging modality to use depends on the clinical scenario. MRIs have the downside of taking a long time, requiring the patient to be relatively still during this time, and being in an enclosed space (which some patients refuse to go into - hence the development of "open" MRI patients). And yes, they are expensive. CTs in contrast (pardon the pun) are quick, much cheaper, and do an excellent job of visualizing things like blood which is important in stroke management, trauma, etc...In the acute setting, your patient might die in the MRI machine while a CT scan would give you all the information you need in a much timelier fashion.

Re:Here's a crazy idea. (1)

Nimey (114278) | more than 2 years ago | (#34730088)

I don't see it getting truly better without a great deal of pain for everyone. First thing is that we've got to get enough doctors to treat every patient without doctors having to stand crazy shifts.

But how do we do that? We sure don't want to dumb-down med school so that more people can pass and get their MD.

Re:Here's a crazy idea. (1)

Velex (120469) | more than 2 years ago | (#34730194)

we've got to get enough doctors to treat every patient without doctors having to stand crazy shifts.

You know why the AMA won't ever do that, right? It would drive wages down for doctors, and we can't have that.

We sure don't want to dumb-down med school so that more people can pass and get their MD.

That's not what the problem is. No one's flunking out of med school. The AMA won't let med schools take in more students.

Most people assume that doctors are thoroughly educated, dedicated, and intelligent individuals. Go work at an answering service for a year or two and you'll find out something else.

Re:Here's a crazy idea. (2)

chooks (71012) | more than 2 years ago | (#34730292)

Another issue is that residency training (which is basically where doctors learn to take care of people) is funded for the most part via Medicaire. Without that money (which is substantial) hospitals cannot afford to train doctors. So even if there were sufficient medical students in the system, under current licensing laws (which require at least 1 year of post-graduate residency training) the bottleneck would be on residency positions and funding.

Re:Here's a crazy idea. (5, Informative)

bill_mcgonigle (4333) | more than 2 years ago | (#34730254)

There are several things that need to be done. They're mostly interdependent, so in no particular order:

1) stop the hazing culture in medicine
2) striate the practices. The concept of an Uber-doctor is antiquated. (LPN's and PA's are starting to help here). Cooperating teams is the smarter approach.
3) decrease doctors' hours
4) decrease doctors' salaries
5) get the government out of licensing doctors and medical schools (the chronic shortage is purposeful)
6) get the AMA out of dictating government policy for licensing doctors and medical schools (the chronic shortage is purposeful)
7) destroy the third-party payer system
8) get the States out of regulating insurance
9) privatize medical charities (the Shriners are a great example)

The current system is not designed to produce the best patient care, and that's all that needs to be said. In most industries we praise the "customer first" approach, even for ultimately stupid and inconsequential stuff. We know by experience that if the customer is placed first that the rest of the business succeeds, but somehow fear that approach when it comes to one of the most essential industries.

Re:Here's a crazy idea. (1)

Velex (120469) | more than 2 years ago | (#34730458)

1) stop the hazing culture in medicine

Mod parent up. I've listened to some doctors who would put Gny. Sgt. Hartman to shame. It's disgusting, childish, and completely unprofessional. Sure, we all think it's cute when Dr. House says something surly, but the reality of the situation is that the culture in medicine needs to change.

4) decrease doctors' salaries

You're playing with fire, sir, to suggest such a thing, but I wholeheartedly agree. The inflated wages of the US doctor are a sign our system is broken, not a sign that our doctors are somehow better than other doctors.

Most people want to believe that doctors are all-knowing, all-caring investigative scientists and researchers with the patient's well-being in their heart. The truth is that most doctors are little better than overpaid car mechanics. (Yes, that's hyperbole, but doctors really are not better people than the rest of us, and a lot more people need to realize that before change will ever happen.)

Just like truck drivers? (1)

Peeteriz (821290) | more than 2 years ago | (#34729802)

I don't know how it's there in US, but here in Europe professions such as long-haul truck and tourist bus drivers are regulated so that they are not allowed to drive for, say, 36 hours w/o sleep, and it's enforced by monitoring their shift schedules.

Patient 'consent' wouldn't be a solution, but hospitals definitely could enforce rules that no surgeon can get a shift for more than x consecutive hours without having a break in between that would allow for proper full night sleep.

Re:Just like truck drivers? (1)

TCPhotography (1245814) | more than 2 years ago | (#34730060)

Transit/Transportation drivers in the US have similar rules to those in Europe. It makes it rather weird that a hospital can require doctors and residents to work long hours on very little sleep, but we don't allow a train engineer to do the same. Yes the economic cost of the train engineer screwing up is higher, but it could be argued that the doctor's screwups have a higher personal cost.

Preventing sleep deprivation? (1)

omnibit (1737004) | more than 2 years ago | (#34729810)

This sounds all roses and sweetness but the reality is, surgery involves volatile hours. Some degree of predictability may be known, for example weekend nights probably have a greater probability of road accidents, but for the most part, surgeons have to perform at a moment's notice to save lives.

Whilst you could simply employ more staff to ensure there's a healthy buffer of refreshed and well slept surgeons, I'd hazard a guess this is far more costly than most hospitals could afford or would want to cut into profits.

Declaring sleep deprivation might make some academic journal tingle inside, but how will that affect lives? You get a disclaimer and a law suit potentially sidelined. But the patient then must wait for a suitable surgeon to perform. In many locations, that simply might not be an option.

Re:Preventing sleep deprivation? (1)

couchslug (175151) | more than 2 years ago | (#34729890)

"I'd hazard a guess this is far more costly than most hospitals could afford or would want to cut into profits."

That's the place for rules to take away discretion. If they lack the manning, consolidate surgeries and staff local clinics with the physicians assistants and enough other techs to get those who actually need emergency surgery to a proper facility. Military medical care in the field relies on transport to get this done.

Re:Preventing sleep deprivation? (1)

hedwards (940851) | more than 2 years ago | (#34730008)

ER surgery isn't the only form of surgery. If there genuinely was no other alternative they could make an exemption for ER docs, but I don't think that's really necessary.

It's not true that in some areas they might not be able to get another surgeon. Around here anybody living in the Pacific Northwest in that kind of bad shape ends up at Harborview anyways. That sort of care isn't generally provided elsewhere, making it rather a moot point.

OTOH operating when you're tired is just as dangerous as trying to operate drunk. One of the things which tends to suffer is muscular coordination, along with speech.

Godwin'ed (0)

Antisyzygy (1495469) | more than 2 years ago | (#34729882)

Should sleepy Nazi Stoßtruppen have been allowed to fight during the Kristallnacht?

Re:Godwin'ed (1)

couchslug (175151) | more than 2 years ago | (#34729926)

Analogy fail.

They had ample manning and plenty of civilian auxiliaries to supplement them. Their manning was not artificially held down, and they have goverment support.

Re:Godwin'ed (1)

Antisyzygy (1495469) | more than 2 years ago | (#34729934)

They also had Amphetamines.

It's no different from Drunk Driving (0)

Anonymous Coward | more than 2 years ago | (#34729886)

Surgery while impaired is malpractice. Not surgery while impaired and then having an accident.

This begs the question (0)

Anonymous Coward | more than 2 years ago | (#34729908)

Do hospitals have the right to work their resident doctors for such long hours.

(And also for other health care facilities that mandate overtime...)

IANAD (BIAANA)

Sure, why not require mandatory sleep (-1)

Anonymous Coward | more than 2 years ago | (#34729922)

Just remember that while you bleed to death in the ER because there are no doctors able to operate on you because they all need sleep and no one is able to replace them. Also remember that the massive shortage of medical personnel is due to assholes like you sueing everyone and their mother who makes any mistake on the job. I hope you like where your (non-existant) healthcare is going.

Some doctors in my hospital do cancel elective sur (4, Interesting)

olddoc (152678) | more than 2 years ago | (#34730030)

I am an anesthesiologist. When I am on overnight call I am always off the next day. Our group of Anesthesiologist strongly believes this is the right thing to do. On overnight call I don't come in until 3pm because 24 hours it too tiring. The motto of the American Society of Anesthesiologists is "Vigilance" You can not be vigilant if you are sleep deprived. On several occasions I have seen heart surgeons who are up at night with emergencies call off scheduled, elective cases in the morning. Perhaps we just have a good bunch of surgeons here, but all of the OR team (nurses, perfusionists, Anesthesiologists...) think it is the right thing to do.

hard (0)

Anonymous Coward | more than 2 years ago | (#34730122)

It'll be a hard situation.

The surgeons are on call at night to care for unexpected emergencies, like gunshot or traffic accidents, which can last all night long.

So you've been waiting for 5 months on the list for your hernia repair. On the day of your surgery, your surgeon happened to have not slept much, and your surgery is pushed off, for another 2 months.

I would be pissed off it his happens - either way - to be operated by a sleep deprived surgeon or have to wait another 2 months for my surgery.

patient consent - what a joke (1)

Anonymous Coward | more than 2 years ago | (#34730156)

It's 4am,

you have just arrived at emergency stabbed by a random stranger at the bus stop.

doc: "That looks pretty bad, your bowel is cut open, and your blodd vessel is heavily bleeding inside. I need to take you to the surgery right away."

you: "Sure doc. Have you been sleep deprived?"

doc: "As a matter of fact, no, cuz I was busy cleaning up another gunshot wound. Per hospital policy, I need to disclose that to you"

you: "Well I don't want a sleep deprived doc to operate on me"

doc: "You are right, I need to catch on some sleep. By the way, I am the only doc in town that can fix your bowel and vessels. Or you'll need to be transferred to another hospital 5 hours away."

My story (0)

Anonymous Coward | more than 2 years ago | (#34730324)

After breaking 2 bones in my left hand, a sleepy surgeon informed my guardians of his sleep deprivation due to another longer surgery, obtained their consent, and accidentally implanted a longer implant than what was necessary. Fortunately after many months after the surgery another orthopedist discovered this anomaly and removed the implant before it caused permanent damage.

I think me & my guardians ought to have the right to accept treatment from a sleepy surgeon. No sarcasm intended. This is because in many places specialists are surgeons are in shortage.

Lack of sleep really screws up your judgment (0)

Anonymous Coward | more than 2 years ago | (#34730418)

I've had times at the end of the month where I've played online poker when I was really tired so that I could get the points I needed before the month was over.

I was so tired that I'd be dozing off between hands and waking up when the buzzer alerted me it was my turn. In some of the easier games I was still able to keep 10 tables going and usually be profitable (didn't really matter since the points/bonus I was working for made up for the reduced win rate) I was making some really horrible decisions.

When you get that tired your brain just kind of goes on auto pilot and you can instinctively do things you've done so many times before but in tricky spots I would do something and then 2 seconds later realize how stupid it was. Unfortunately by that point it's too late.

I try not to play when I'm that tired I can't imagine literally taking someone's life in your hands in that condition.

What could possibly go wrong (0)

Anonymous Coward | more than 2 years ago | (#34730536)

Elective surgery is the low hanging fruit

So sleep-deprived doctors should all perform emergency surgery now? Wonderful prospect.

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