Why I am Tired of Tired Doctors

http://journals.lww.com/academicmedicine/Abstract/1991/11000/A_review_of_studies_concerning_effects_of_sleep.13.aspx

To sleep, perchance to dream-
ay, there's the rub.

William Shakespeare

I love irony. So when I read the recent editorial suggesting that surgeons be required to tell patients when they were too tired to operate, I just sighed. These writers are the trainees of the very guys who forced me to stay up 36 hours in a row, and then laughed and ridiculed me when I couldn't function.

More importantly, I feel many, if not most physicians are practicing with disrupted sleep patterns or full-on sleep deprivation, which has widespread negative impact on their practice and personal lives.

Almost every specialty requires extensive night coverage during training. Residencies require that young doctors work long and disruptive hours, in part to supply coverage, but also in part to prepare young physicians for the demands of patient care. Sleep is routinely missed, and even when sleep is possible, it is interrupted and far from normal. A fundamental skill learned in doctor training is to overcome fatigue with willpower and caffeine in order to appear to function effectively.

What the article cited today point out is that no matter what the outward appearance or self-delusion of the physician, missing sleep hurts performance, which has a negative impact on patient care. Patients suffer because their doctors are tired.

Unfortunately, even when doctors finish training, the situation does not change. Call may be less frequent, but hours remain long, patients call incessantly and sleep routinely interrupted. The reality is that the poor sleep habits learned in residency persist. Physicians function in a sleep-deprived world. Many have full blown sleep disorders, recognized or not. Chronic fatigue becomes the new normal. We may never know the true impact upon patient care because we may never be able to locate a group of well rested physicians. I did not know how tired I was until I retired.

The impact has implications beyond medical care. Depression, substance abuse, divorce, and early death, are common among physicians, may well be related to the chronic stress of abnormal sleep. Yet another thing you should know before your child applies to medical school.