For years is has been understood that doctors take call and could have been up the night before you have an elective surgery the next day. During training I would go days in a row with minimal sleep and I just considered it the norm. I knew it affected my work, but as a resident we just pushed through. Now there are increasing guidelines for training programs making sure that residents have enough sleep.
The real problem is that there are no regulations for surgeons in private practice. Most surgeons are required to cover the ER call on a rotation basis. There is a good chance that a surgeon could be up most of the night and still have a full day of elective surgery the next day. The question is….. “Does being sleep deprived affect the surgeon’s performance?”
This is the question you should be asking as either you or family members come in the morning of surgery for an elective procedure. A recent study in the American Journal of Surgery (http://www.americanjournalofsurgery.com/article/S0002-9610(11)00616-7/abstract) showed that surgeons who don’t get enough sleep can still do the learned tasks as well as rested surgeons. However, their brains had to work much harder to accomplish the same task. What this means is that as long as the procedure went as planned everything was the same between rested and sleepy surgeons. But when an unexpected problem arose, then the tired surgeons had an increased difficulty adapting to the changing circumstances.
Likewise in a recent JAMA article(http://jama.ama-assn.org/content/302/14/1565), is was shown that there are actually more complication when surgeons have less than 6 hours of sleep the night before. This is in line with studies showing that pilots, truck drivers and train conductors also have impaired reaction times when tired.
So what are we to do. Surgeons are still required to take call. Patients want their procedures at the scheduled time as they have made multiple arrangements to adjust their lives for that day and the post op period. Moreover, the surgeon doesn’t want to constantly reschedule his practice when he has to unexpectedly work the night before.
It’s a real problem!! I think as the patient, you have the right to ask your surgeon if he/she had a good night’s rest. If not, remember the procedure is often elective and you can reschedule for another day. It is also the surgeon’s responsibility to have the patient’s best interest at heart. If he/she is too tired to work at their best, they can also make the decision to postpone the procedure to another day.
Even though working with fatigue has been part of the culture of medicine for many years, it’s time to take a long look at what we can do to ensure that surgeons have enough rest prior to performing elective cases. The more we learn about the effects of lack of sleep, the more we can hopefully prevent unnecessary complications. Once again we see how important sleep is and how much it can affect every aspect of our daily lives!!