Patients to Know of Doctors' Sleep Deprived Status Before Elective Surgeries

Doctors in training have to abide by regulations that restrict their hours of working, but no such rules exist for fully trained physicians. An editorial in this week's New England Journal of Medicine argues that sleep-deprived physicians should not be permitted to proceed with an elective surgery without a patient's informed, written consent.According to the authors, "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." They further write that "this shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas." Studies have shown that sleep deprivation impairs psychomotor performance as severely as alcohol intoxication. A 2009 study in the Journal of the American Medical Association showed a significant increase in the risk of complications in patients who underwent elective daytime surgical procedures performed by attending surgeons who had less than a six-hour opportunity for sleep during a previous on-call night. Further complicating the matter, people who are sleep-deprived are often not able to accurately assess their degree of self-impairment. Surveys have also revealed that the majority of patients undergoing elective surgery would request a different provider if they knew that their surgeon was sleep deprived. "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," said Michael Nurok, M.D., Ph.D., an anesthesiologist and intensive care physician at Hospital for Special Surgery who is first author of the editorial. "We think that institutions have a responsibility to minimize the chances that patients are going to be cared for by sleep-deprived clinicians."

Source:MedIndia