If you knew your surgeon had only gotten five hours of sleep the night before performing your scheduled hip replacement, would you ask for another doctor or change your surgery date?
For some patients, the answer is yes. So doctors writing in the New England Journal of Medicine this week are calling for surgeons to be required to inform patients before performing an elective surgery whether they’ve had inadequate sleep the night before.
While researchers haven’t pinned down exactly how many patients would request a different doctor if they knew theirs was tired, sleep deprivation is an ongoing problem for physicians, said Dr. Michael Nurok, an anesthesiologist and intensive care physician at the Hospital for Special Surgery in New York City, and one of the authors of the editorial.
“Working while fatigued has been part of the culture of medicine for a long time,” Nurok told MyHealthNewsDaily. “We now know that there are risks to patients when they are cared for by fatigued physicians.”
Why disclosure is needed
Patients face an increased risk of surgical complications when their surgeon slept less than six hours the night before, a 2009 study in the Journal of the American Medical Association showed.
These complications include organ injuries and bleeding, Nurok said.
The Accreditation Council for Graduate Medical Education requires eight hours of off-duty time between shifts for medical residents (doctors in training) in order to cut fatigue risk. But no such requirement exists for doctors once they’ve completed their residency, Nurok said.
To be sure, there are challenges in requiring doctors to disclose their sleep-deprivation statuses to patients. Some doctors may be reluctant to share details about the amount of sleep they got with patients, saying it’s personal and private information, Nurok said. Others may argue that it is a psychologically and logistically burdensome for patients to decide whether to proceed with surgery on the scheduled day, he said.
And for emergency procedures, the benefits of a fatigued doctor operating would likely outweigh the risks of not operating at all, Nurok said.
But in elective procedures, patients have a fundamental right to understand the risks, benefits and alternatives to surgery, he said, and no competing interests trump that right.
“Institutions should take steps to minimize the chance that elective surgery is scheduled on a day that there is a likelihood of a physician being sleep-deprived ,” Nurok said, though he added that creating a system to properly address the issue of doctor fatigue would inevitably raise administrative costs.
But ‘there are so many variables’
Others are not convinced that requiring sleep disclosure is the solution.
“The biggest problem is trying to legislate rules and regulations, where one size fits all, because there are so many variables,” said Dr. Michael Marks, an orthopaedic surgeon at Norwalk Hospital in Connecticut, who was not involved in the editorial. “What we really need to do is make sure surgeons are fully trained to understand how fatigue can degrade physical and mental capabilities.”
Marks, who is a member of the American Academy of Orthopaedic Surgeons, said patients should take advantage of their right to ask their doctors about their potential sleep deprivation.
But aside from sleep, there are also a host of factors that can affect a surgeon’s ability to function, he said.
“Financial problems, marital problems, child problems — it’s all-encompassing,” Marks told MyHealthNewsDaily. “The most important thing is ensuring standards of professionalism and ethical behavior, so we can do what’s in the patient’s best interest, which is in doctor’s best interest.”
In Marks’ practice, surgeons’ schedules are arranged so that they won’t operate if they’ve been on call the night before. A doctor scheduled to operate on a Friday is almost never on call on a Thursday night, he said.
“These are the things we should be encouraging: Behavior modification, and instructing physicians in what to avoid to get yourself into trouble.”
Pass it on: Some doctors are calling for surgeons to be required to disclose their sleep deprivation status to patients before performing elective surgery.
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