30 December 2010

Doctors urged to admit fatigue before performing surgery

Proposed new rules suggest informing patients, requesting consent before procedure.


Proposed new rules suggest informing patients, requesting consent before procedure.

A new commentary 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. 

There currently aren't any rules about the number of hours that fully trained physicians may work. The proposed new rules would change how doctors handle their own fatigue, the authors of the editorial pointed out.

"This approach would represent a fundamental shift in the responsibility patients are asked to assume in making decisions about their own care and might prove burdensome to patients and physicians, and damaging to the patient-physician relationship," the authors wrote in the Dec. 30 issue of the New England Journal of Medicine, adding that "this shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas."

Sleep deprivation

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.

"Sleep deprivation affects clinical performance. It increases the risks of complications. And it is clear from survey data that patients would want to be informed if their physician was sleep-deprived and that most patients would request a different provider," editorial first author Dr Michael Nurok, an anaesthesiologist and intensive care physician at the Hospital for Special Surgery in New York City, said in a news release from the hospital.

"We think that institutions have a responsibility to minimise the chances that patients are going to be cared for by sleep-deprived clinicians," Nurok added.

Some hospitals try to reduce the likelihood that physicians will lose sleep due to their work schedules. However, "a lot of institutions are not going to be able to take that leap immediately, so as an interim step, we believe that patients need to be informed," Nurok said. "This is going to be a policy issue that develops. Elective surgery is the low hanging fruit because there is no urgency to doing it and it can be rescheduled - ideally as a priority with institutional support. It's a nice place to start to think about policy approaches." (HealthDay News/ December 2010)


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