Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Should surgeons tell patients how much sleep they had?

Kevin Pho, MD
KevinMD
December 30, 2010
Share
Tweet
Share

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.

The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.

As summarized in the WSJ’s Health Blog, the perspective piece argues for more regulation for tired surgeons:

… self-regulation is not sufficient. Instead, “we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived,” they write. For example, elective procedures wouldn’t be scheduled for the day after a physician is due to be on all-night call.

And the authors suggest that patients be “empowered to inquire about the amount of sleep their clinicians have had the night before such procedures.”

It’s a noble goal, and indeed, data does show that fatigued surgeons tend to make more errors.  Patients, once confronted with a choice of being operated on by a tired surgeon, may choose to postpone surgery.

The counter-arguments, predictably, from the American College of Surgeons, also raise come compelling points:

… surgeons are smart and professional enough to learn to “have a conversation with yourself” when they are short on sleep and assess their preparedness for surgery. Or, they can consult other members of the surgical team for guidance, he says.

“No one wants an exhausted surgeon to operate,” says Britt. But he says there’s no clear-cut way to define fatigue, and that “mandatory disclosure” based on some arbitrary threshold isn’t appropriate. If doctors are supposed to disclose their sleep patterns, what about other things that might affect performance, such as financial worries or a fight with a spouse?

Whether surgeons can self-police their own tiredness is debatable, but I can see merit in the slippery slope argument.  In addition to the concerns raised above regarding a surgeon’s financial and marital stresses, should we also ask critical care physicians or hospitalists to disclose their fatigue?  After all, there are studies that also show an increase in medical errors in the intensive care unit when these doctors are fatigued.  Should patients be allowed to refuse care from a tired intensivist as well?

And finally, if tired physicians aren’t allowed to operate, who’s going to pick up the slack?  Already, there’s a shortage of general surgeons, and the effect of these regulations will only extend wait times.

Of course, everyone wants to reduce medical error.  And it’s reasonable to start with combating fatigue.  Doing so, however, requires more doctors who can take over for their tired colleagues.

And that’s going to cost more money, which is a fact that’s conveniently excluded from the discussion.

ADVERTISEMENT

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

Prev

Health care economics and the relationship between doctor and patient

December 29, 2010 Kevin 51
…
Next

Hospital meals make it difficult to control blood sugars

December 30, 2010 Kevin 22
…

Tagged as: Patients, Surgery

Post navigation

< Previous Post
Health care economics and the relationship between doctor and patient
Next Post >
Hospital meals make it difficult to control blood sugars

ADVERTISEMENT

More by Kevin Pho, MD

  • Surgeon General’s warning: the dark side of social media on children’s mental health

    Kevin Pho, MD
  • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

    Kevin Pho, MD
  • Is FDA-approved Veozah a game-changer in menopause hot flash treatment?

    Kevin Pho, MD

More in KevinMD

  • The Spandex dilemma: Does size still matter?

    Janet L. Cray
  • Surgeon General’s warning: the dark side of social media on children’s mental health

    Kevin Pho, MD
  • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

    Kevin Pho, MD
  • Is FDA-approved Veozah a game-changer in menopause hot flash treatment?

    Kevin Pho, MD
  • Remembering Heather Armstrong: the tragic loss of the “Queen of Mommy Bloggers” sparks a global conversation on mental health

    Kevin Pho, MD
  • Celebrating 2 million downloads of The Podcast by KevinMD!

    Kevin Pho, MD
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 10 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Should surgeons tell patients how much sleep they had?
10 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...