Your Doctor Needs a Nap

Your doctor needs a nap, according to a recent Institute of Medicine report titled Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. The authors conclude that residents working a 30-hour shift should have a mandatory 5-hour sleep break after working for 16 hours.

As one of the National Academies of Sciences, the IOM is a nonprofit organization tasked with issuing evidence-based advice on issues related to medicine and health. This report is but the latest high-profile publication to weigh in on the challenge of balancing two equally compelling goals: the need for young physicians to see and do as much as possible during their formative years and the need to protect patients from medical mistakes which occur because those caring for them are making decisions while impaired from lack of sleep. Numerous studies have reported that the effects of overnight call—a fact of life for most residents during the three-seven plus years of their post-graduate training—can produce impairment similar to that of mild alcohol intoxication. In part, such findings were behind a national change instituted in 2002 that restricts medical residents of all specialties to an 80-hour week.

Now this recent IOM report ups the ante. Will hospitals start to follow such recommendations? If residents are released from duty for nap time, where will the estimated $1.7 billion it will cost to continue patient care come from? Will fewer patients be harmed? Will the same number of patients be helped?

These are not easy question to answer. VQR alumna Pauline Chen, a transplant surgeon by training and author of the bestselling essay collection Final Exam takes a look at this issue in her recent “Doctor and Patient” column in the New York Times.  If a parent has a heart attack, none of us want to think that the resident who sees her in the emergency room is too tired to see straight. However, it is equally true that if calamity strikes in the form of a late-night car accident, we all want the trauma surgeon paged at 2 A.M. to be able to save her life anyway.

As I walk home from an overnight shift at the hospital as part of my medical school training, I can’t help but wonder. I have been awake for more than 24 hours and I have to be back and ready to go in my scrubs in less than 10. Somewhere in there I’m supposed to study, eat, try to talk to my family and friends occasionally, and—oh yeah—sleep. Every day when my alarm clock goes off, I wake up tired, but I also know that I have never felt more alive. And in the middle of the night when the resident asks me something about one of the patients I have been following, I know the answer because I have been there to learn my patient’s story. Part of me wants to cheer at the thought of mandated nap time and yet the part of me that is learning to become a physician also sees with a clarity that fatigue will never touch that caring for sick and injured people cannot be learned in a year or two or in 40 hours a week.

I am still too junior in the medical pecking order to shoulder the responsibility of independently caring for a patient, but that time is rapidly approaching with a speed that both thrills and terrifies me. When it arrives, when my classmates and I are turned loose to continue our training as residents, I know that we will face the same juggling act between personal needs and professional responsibility as those who have preceded us. I just hope that the way in which we learn will continue to reflect the complex, upside-down, never predictable way in which patients make their way to the hospital.

Is there a perfect solution? I don’t know. I plan to sleep on it.