On February 22nd, 2013, the Wall Street Journal tackled an important question. The question was whether medical residents are dangerously exhausted. Our Winston-Salem injury attorneys were very interested in the analysis and information presented in the article because we know that medical residents are often overworked and not given sufficient time to sleep. Sleep deprivation can compromise your faculties and cognitive abilities, and these overtired residents may, therefore, be dangerous if they are not equipped to provide reasonable patient care due to their fatigue.
The Rules on Medical Residents and Rest Periods
Before the year 2003, there were no laws, rules or regulations in place that set limits on the number of hours that a medical resident could work. This means that residents could theoretically work straight through all night and into the next day and could be kept working even as they grew more and more tired. The author of the Wall Street Journal article indicated he had experienced this himself, remaining awake for as long as 36-hours-at a time as a medical resident and becoming so tired by the time he left work that he fell asleep at stop lights on his ride home.
This situation was, of course, untenable since a doctor who is falling asleep on his feet is unlikely to provide the best quality of patient care. In 2003, the Accreditation Council for Graduate Medical Education took action and imposed an 80-hour-per week work limit for residents. Because this Accreditation program is in charge of determining which U.S. medical residency programs are accredited, this essentially created a de facto industry standard rule imposing a maximum 80-hour work week.
In 2011, the Accreditation Council decided that the 80-hour limit wasn't sufficient to protect the public from an overtired doctor. As such, they mandated that first year interns/residents could not work overnight or 24-hour shifts.
All of these limitations are, hopefully, going to help save lives. It is very clear that being awake for too long can be seriously impairing (in fact, this is why truck drivers have maximum drive time limits and why drowsy driving has become such a major concern). If limits are imposed on other professionals like truck drivers to avoid fatigue, it stands to reason that limits should be imposed to ensure that those who perform life-saving medical treatments don't do so after getting no sleep.
Unfortunately, as the Wall Street Journal author points out, there are costs to imposing limits like this as well. One issue is that handoffs from one doctor to another can be dangerous as crucial information vanishes in each shift. In some cases, it is even possible that the actual patient will become lost in the shuffle and may not get the necessary care.
The Wall Street Journal author also argues that the residents who are limited in their work time may not get sufficient exposure to the medical procedures they are expected to perform and the concepts they are expected to learn.
These are very valid concerns, and should be dealt with through appropriate policy adoptions including having strict guidelines on the handoff procedure and taking concrete steps to ensure that residents get real hands-on experience. It is clear, however, that having an overtired hospital worker is not good for anyone and could put the patient at risk. Every solution needs to be considered in light of what it takes to keep a patient safe from medical negligence or medical malpractice that causes harm.