The problem of drowsy doctors may get worse, a medical journal editorial warns.
Last year, researchers reported higher rates of surgical complications if a surgeon had less than six hours of sleep the night before.
"The problem may only be getting worse," Drs. Noni MacDonald, Paul Hébert, Ken Flegel and Matthew Stanbrook wrote in an editorial in Tuesday's issue of the Canadian Medical Association Journal.
Medical care is more complex, as patients with life-threatening conditions now survive thanks to medical innovations, drugs and technologies that weren't an option in past decades, the editorial noted.
The greater complexity at both the bedside and in the operating room not only affects surgeons but also doctors who stay up all night assisting at a birth or dealing with a patient in crisis, they said.
"We doctors ourselves are part of this problem," the editorial said. "We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride. Instead, we must admit that working while impaired from sleep deprivation is neither normal nor acceptable."
A previous study suggested that sleep deprivation from an overnight call can cause a similar degree of impairment in judgment and motor performance as having a blood alcohol level above 0.05 per cent.
But solving the problem could be costly. A U.S. study in 2009 estimated it would take a 71 per cent increase in the physician workforce and a 174 per cent jump in the number of residents to apply the aviation industry's strategy of restricting work hours to ease fatigue in the medical system.
Some hospitals, departments and practices have used innovative strategies such as:
- Adopting strict policies on going home after call.
- Refraining from booking procedures or clinics the day after call.
- Reorganizing schedules to allow for more coverage by doctors.
- Moving to shift work.
Ultimately, licensing, accreditation, insurance and governments need to establish standards on minimum uninterrupted sleep hours and best practices, they concluded.