Some doctors speak out against 28-hour resident shifts

woman asleep with makeup on
A proposal would leave doctors-in-training more sleep-deprived, critics say.

A number of doctors—remembering their own exhaustion—are speaking out against a proposal to increase the length of shifts for residents to 28 hours.

The Accreditation Council for Graduate Medical Education (ACGME) has proposed changes to its rules governing first-year residents that would allow them to work 24-hour shifts—a third longer than they are currently allowed to workplus up to four more hours to manage transitions in care

Doctors have taken up their pens to say they think it's a bad idea to have residents work so many hours in a row. As a third-year medical student, Dr. Daniel Barron, a resident physician at Yale University, recalls his rotation through a sleep clinic, where he used a scale to screen patients for sleep disorders.

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When he answered the questionnaire himself one day, he was shocked when he scored worse than many of his patients, including one who had narcolepsy, writes Barron in a blog post on Scientific American. When he showed the score to his attending, the doctor chuckled and told him, “You probably don't have sleep apnea. You probably are just a medical student,” Barron says.

A rule that would make residents even more sleep-deprived makes no sense, with so many physicians, including residents, already suffering from depression and thoughts of suicide, Barron writes.

Elizabeth Poorman, a primary care physician in Massachusetts, agrees the proposal is bad for doctors and patients.

“Why should you care, if you're not a doctor in training? I see many reasons for both doctors and patients to be wary of this plan. Studies have shown that long work hours lead to more serious medication and diagnostic errors. Residents are also more likely to suffer from needle-stick injuries and to crash their cars when working longer shifts,” Poorman writes on CommonHealth.

Writing in The Atlantic, Dr. James Hamblin recalls working 30-hour shifts as a medical intern, which he described as a “mix of panic, inadequacy, and exhaustion that I wish on no person.” He says he isn’t convinced by the ACGME’s arguments for increasing the hours for first-year residents.

Both physicians and consumer groups have criticized the ACGME proposal, according to a report in the Los Angeles Times. “This is deeply troubling,” Charles Czeisler, M.D., Ph.D., of Brigham & Women’s Hospital in Boston and a professor at Harvard Medical School, who has studied what happens as residents work extended hours, told the newspaper. 

“It is very well established that staying awake for 24 hours severely degrades performance.”

The ACGME was accepting comments on its proposal though yesterday and is expected to take a final vote in February.

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