Thursday September 10, 2009
Sleep Deprived Residents Featured on WCBA Season Debut
Between med school and becoming a grown-up doctor is something called residency. Residents are med school graduates who are training in hospitals to become everything from family physicians to neurosurgeons.
When you're admitted to a teaching hospital, your hospital bracelet gives the name of your attending physician -- the grown up who is nominally in charge of your care. Chances are, the doctor who keeps you alive at night is a resident. The age old deal between residents and attending physicians is hard work and brutally long hours in return for being taught the tricks of the trade. In the bargain, in addition to working Monday to Friday from as early as 6 am to as late as 7 or even 8 pm, residents are expected to take turns on-call at the hospital. Usually, that means staying up all night looking after sick patients. All of which adds up to chronic sleep deprivation and medical mistakes.
Here are some research-proven facts about sleepy residents and their effect on patient and resident well being:
* A sevenfold increase in the incidence of preventable medical errors
* They are 35% more likely to commit a serious medical error
* They double the likelihood of having a motor vehicle accident during their post-call commute
* Their performance is so impaired it's similar to subjects with a blood alcohol level of 0.05%
Join us for our Season Opener of WCBA on CBC Radio One this Saturday, September 12 at 10 am (10:30 am in Newfoundland) with rebroadcast on September 14 at 1130 am (noon in Newfoundland).
Meanwhile, to get a taste of the life of a sleepy resident, check out an interview we did with Heather Wilson back in 2007. At the time, Wilson was a 5th year resident in general surgery at Dalhousie University in Halifax.
Previous Comments (6)
Excellent show re medical error.
I am completing a Masters in Patient Safety and suggest you contact Dr Sidney Dekker to discuss patient safety and Just Culture.
I welcome an opportunity to speak with Brian to ask his opinion of how to move our execs in health care to not forget patient safety in place of financial deficits.
As a teacher, I wonder what is the scientific basis for believing that sleep deprivation leads to increased learning. Clearly there is no basis in learning theory. I wonder why truck drivers are limited in how many hours they can work, but residents are not. I believe there are 2 reasons this happens. First, is the macho environment that doctors, especially surgeons live in. Second is financial. It will cost more to have residents working fewer hours. We will need to increase the number of medical students. This will be a small price to pay for better And in this regard, I mean better trained in terms of knowledge, skills and attitudes.Peter Driedger, September 12, 2009 12:47 PM
I would like to say that I was shocked by the revelations of verbal, physical and drug abuses, endured and administered by medical residents and their supervisors. However, I cannot.
Nor was I surprised to hear the evasive answers given by doctors when asked to give specific examples of abuse or other types of "errors" common to the profession.
What did surprise me, was that the current medical establishment has no interest in changing any of the pathological behaviours or views which result in fatigue on the part of overworked residents and death in the case of the unwitting patients.
With such an outlook and dismal attitude would it be presumptuous of me to say that these medical professionals would do better in a career like butchery and intern on the kill floor of a slaughterhouse?Bartosz, September 12, 2009 2:10 PM
What a strangely ironic way to end the show! After preaching the harms of residents overextending themselves and the need for restrictions in their working hours, you have two staff docs discussing how they get by working a night shift and then having a busy day to be awake for, and their conclusion: take Modafinil. Perhaps the attending physicians need to have government imposed restrictions on THEIR work hours...for the sake of the patient, and themselves...of course then it will affect the doctor's almighty wallet, which I guess it what is motivating them to go the extra mile (with the help of those observant nurses picking up their mistakes)...
Brian, how many reports of Stevens-Johnson-Syndrome have occured with coffee? Did you mention that people with hypertension, heart disease, and arrhythmias may want to avoid Modafinil? Before you allow your show to become a soapbox for the pharmaceutical companies (I'm sure shift workers everywhere are now going to be hitting up their GPs for this "wonder-drug"), perhaps a little research into the side-effects would be warranted, and a mention that it's definitely NOT for everyone. And perhaps you and your friend should take your own advice and limit your own work hours, insteading of needing to pop pills to get through the day.Chuck Hansen, September 13, 2009 3:16 PM
I applaud Dr. Brian Goldman and the CBC for addressing this issue. However, I do believe a fundamental component of the discussion was overlooked.
I expect medical doctors to lead by example when it comes to health issues. When a physician tells a patient to quit smoking, I do not expect that physician to do so with a cigarate hanging out of his or her mouth. When a physician tells a patient to eat a healthier diet, I do not expect that physician to do so while eating a Big Mac. So why is it acceptable for our doctors to disregard their own health by depriving themselves of sleep?
As the program has pointed out, one solution is to treat the lack of sleep with pills. Perhaps our medical system would not be in the peril it is, if doctors lead more by example and trade in the pills for some preventative medicine.Ben Phillips, September 14, 2009 11:17 AM
Yet Canada has patient quotas and surgeries are cancelled. So what do we do? The problem is less so in the States because they have a free healthcare system which pays doctors more then our centrally planned system,
One problem common to both countries is the monopoly of AMA and CMA doctors. This monopoly with strict licensing reduces the number of doctors and it eliminates professions such as mid wives or the procedures performed by chiropractors , pharmacists, registered nurses without supervision, etc. The presumption is you get a brilliant doctor or a quack but there are lots f people who I would not want poking around my heart or brain but would be proficient surgeons for many simple routine surgeries, saving money and saving the best surgeons to perform open heart surgeries.
In India there are lots of doctors and specialists because people pay out of pocket and they don't have a monopoly.
I think the solution is to have a free healthcare system driven by self interest and competition and where licensing is done by facility not professional.Brett Knoss, September 15, 2009 1:03 AM