Everyone knows about the hazards associated with falling asleep at the wheel of a car. Workers are told not to operate heavy equipment if tired or impaired. We all have first hand experience with the effects of sleep deprivation on clarity of thought and reaction time. Would you knowingly put your life in the hands of someone who is at the end of a 30-hour shift? Would you feel confident in the judgments of a young doctor in training who has just put in an 80 hour work week? Well, if you have received treatment at a major teaching hospital in Massachusetts or anywhere in the country, you probably have already done this.
You have probably already seen this reality depicted on popular television shows like Grey’s Anatomy or ER showing the impossibly long shifts and adrenaline-pumping situations medical residents must face each week. Of course the show’s writers throw in a lot of extra drama, but real medical residents do typically work 80-hour weeks that include 30-hour shifts–sometimes with little or no sleep.
Medical residency programs are designed to be rigorous, to prepare doctors for difficult situations and to expose them to as many medical procedures as possible over their 3-7 years in residency. There are teaching hospitals throughout Massachusetts, including Boston, Worcester, Springfield, Cambridge, Waltham, and Framingham.
Now a new report by the Institute of Medicine of the National Academies says that residents are not just tired, they are fatigued. And this fatigue is leading to preventable mistakes–medical mistakes that sometimes lead to wrongful death.
In 2003, the Accreditation Council for Graduate Medical Education limited the number of hours a resident could work to 80 hours per week. The new report is not looking to decrease this number, simply to regulate how the hours are carried out.
IMNA’s report offers several concrete recommendations that will improve patient care and prevent many fatigue-related medical mistakes.
- Residents working a 30-hour shift should have at least a five-hour break after 16 hours of work.
- When residents “moonlight,” or take on additional paid health care work, these hours should count toward their 80-hour cap.
- Experienced physicians should more closely supervise residents.
- The number of mandatory days off each month should be increased.
- When scheduling residents, an overlap period should be included between shifts to increase communication.
However, implementing these suggestions means that teaching hospitals would need an additional $1.7 billion in funding each year. This fact alone may keep the recommendations from becoming a reality, even though the cost would most likely be offset by the decrease in fatigue-related errors and medical malpractice claims. Costs aside, the people suffering are the patients who are receiving sub-standard treatment.
We’ll just have to wait and see what happens to the IMNA’s recommendations. For the time being, residents are still working while fatigued, which means that fatigue-related errors and injuries are occurring all the time.
If you have suffered an injury due to a resident’s fatigue or any medical malpractice, contact the medical malpractice lawyers at Breakstone, White, and Gluck, P.C. We have years of experience in medical malpractice claims and our attorneys would be happy to discuss your case with you. Our toll free number is 800-379-1244, and there is no charge for our consultation.
Resident Duty Hours: Enhancing Sleep, Supervision and Safety, Institute of Medicine, November 2008.