To sleep, or not to sleep? For residents, that is the question

When it comes to resident hours and whether they should be required to get more sleep, few, if any, can come to a consensus. Case in point, a recent article in the Los Angeles Times that compares the viewpoints of two doctors who essentially have agreed to disagree. 

Dr. Robert Wachter, chief of hospital medicine at the University of California, San Francisco, argues that imposing any more limits on resident hours would be a mistake. He maintains that the frequent hand-offs that take place because of such rules increase the number of medical mistakes that ultimately occur, calling the hand-offs "the main reason it is impossible to find evidence that patients have become safer since we implemented the 2003 duty-hour limits."

Dr. Charles Czeisler, a sleep medicine specialist with Brigham and Women's Hospital, counters by pointing out that in a 2004 test, physicians who worked traditional, 30-hour shifts (and stayed with their patients throughout) made nearly six times as many "serious diagnostic mistakes" as physicians who worked a maximum of 16 straight hours. 

"Today, people in countries all over the world have gone to jail because they drove a car after being awake for 24 hours and killed someone," he writes. "Yet we require resident physicians to work 30-hour shifts twice per week. It just doesn't make sense." 

Czeisler also argues that tired physicians end up costing the healthcare system more money due to that higher risk for adverse events. Wachter, however, points out that replacement costs for physicians who work less hours can be crushing; at his hospital alone, he says, it costs more than $10 million per year to hire hospitalists and nurse practitioners to fill in the gaps for doctors. 

"This is money we don't have to invest in preventing medication errors or hospital-acquired infections," Wachter writes. 

To learn more:
- read this Los Angeles Times piece