A tired physician can make for sloppy patient care. Currently, there is a sixteen hour shift cap for first year medical residents to ensure that an adequate amount of rest is given to physicians and assistants. However, the Accreditation Council for Graduate Medical Education (ACGME) is seeking to lift the ban, citing the need for more consistent patient care, less tradeoff between doctors and preparing them for the medical world that awaits them post-graduation.
"Residents must develop the skills and the confidence to manage challenging situations, under supervision, and must learn to care for patients over extended hours, and during night-time hours, because these are circumstances they will encounter," the ACGME argues. What isn't mentioned is the risk for medical error due to sleep deprivation.
This risk often turns deadly in the hands of inexperienced, exhausted residents and interns.
In fact, the president of the National Patient Safety Foundation has cited that they refer to "patient harm" as the third leading cause of death in the United States. This is unacceptable-preventative medicine should not be preventing the continuation of life.
Why does the sixteen hour shift cap exist?
In previous years, physicians were used to working for twenty four to twenty eight hours straight, with little to no room for breaks. Recognizing the risks this posed for both the practitioner and patient via a study by the Institute of Medicine concluding that "...the committee finds considerable scientific evidence that 30 hours of continuous time awake, as is permitted and common in current resident work schedules, can result in fatigue, and that adjustments to the rules are needed."
In 2011, the ACGME instituted the sixteen hour limit for first year residents; now that set of requirements is in danger of being lifted. With little or no time for sleep, residents are instead left with fatigue and its bodily effects; the perfect setup for medical errors that too often result in malpractice.
As quoted in an article by NPR, the director of public Citizen's Health Research Group Dr. Michael Carome has spoken on this issue, stating: "Sleep-deprived residents are more likely to injure themselves while doing procedures such as drawing blood, inserting intravenous lines or suturing wounds."
If the residents are a danger to themselves, this means that the patient is at incredible risk for injury, or even death. Should the proposition pass, potential patients are putting their lives in the hands of clinical staff who may not even be awake enough to properly care for them.
Sleep deprivation for over 17 hours can affect the body and mind in the same way as being under the influence of alcohol. Patients need medical care from clearheaded providers, and should settle for nothing less.
What are the risks for patients?
Both the patient and the resident physician are at substantial risk with these potential revisions to the sixteen hour shift policy. Sending a pilot on a flight with less than ten hours of sleep isn't allowed per the Federal Aviation Association due to the indisputable connection between dangerous flying and error and lack of sleep.
Like pilots, physicians may have many lives in their hands. So why is extending their hours an option when it can lead to premature loss of life? Medical error and malpractice leads to the death of over 250,000 Americans per year and is argued to be the third leading cause of death in the US. Medical resident fatigue is a toxic additive to an already potentially lethal combination.
A physician's mental health has a large chance of being impacted during the course of his/her career. In a recent study performed by the Journal of the American Medical Association, twenty-nine percent of residents were screened for depressive symptoms with positive results. Furthermore, according to the American Foundation for Suicide Prevention, 300-400 residents take their own lives each year.
An unstable state of mind affects patient care. Sleep deprivation impacts the performance of clinical staff, making them a potential hazard to their patients.
Examples of potential malpractice due to this new ruling include, but are not limited to:
- Misadministration of medication, as in the lethal 1984 case of Libby Zion
- Misdiagnosis, leading to inappropriate treatment of a false condition
- Detrimental effects on the residents' own mental health
- Lack of empathy for patients stemming from depression, resulting in less quality medical care.
How often do these medical errors occur? How fatal can they be?
A medical professional operating on insufficient sleep can be potentially dangerous to their patients' health. Besides Libby Zion's case, one that resulted in her death from misadministration of medication, too many other fatal medical errors have been admitted to.
For example, a 2006 survey of interns and residents working long hours showed that fatigue related deaths were entirely preventable but the amount of incidents (fatal and not) soared almost past the 300% mark by interns and residents who worked extended hour shifts.
Human sleep requirements deem that healthy adults need between 6 and 10 hours of sleep in one twenty-four hour period. If someone is working for twenty four hours, this need obviously cannot be met adequately. Facilities have proposed (and sometimes executed) the use of exercise and caffeine intake in order to prompt better alertness in their interns, but those are simply not comparable to being able to repay a sleep debt and ensure quality of care.
When it comes to malpractice, nothing can repay the debt of lost wages, lost time from work and family, and potentially lost quality of life. Thankfully, peace of mind can be given with the knowledge that legal professionals adept in the realm of medical errors can help restore faith in the ability to heal and, most importantly, be compensated for losses.
Who fights for the victims of fatigue-induced medical error?
The standards of proper medical care should not be a guessing game for the patient, nor should medical care end in injury, emotional distress or the death of the patient. Medical errors due to these new shift regulations are preventable and should not leave patients with the dismal feeling that they have nowhere to turn to. Especially in the event of a loss of life, patients and families may feel isolated, hopeless, and cast away from the justice system.
The affected parties need time. Time to grieve, time to consider their options and whether they want to seek justice in the form of adequate compensation for the actions of a faulty medical system.
Experienced in delivering results in malpractice cases , the JONATHAN C. REITER LAW FIRM, PLLC offer a supportive environment where victims can seek adequate compensation for their serious injuries or death of family members.
Contacting Attorney Jonathan C. Reiter can begin the healing process for those suffering from the wrongdoing of big medicine. Beginning with a free case evaluation, innocent victims who've fallen prey to incidents of medical malpractice can stop waiting, stop worrying, and aggressively seek compensation.