Doctor fatigue hurting patients

Too many 24-hour shifts worked by hospital interns cause medical mistakes that harm and may even kill patients, according to a new Harvard Medical School study.

Doctors in training who fall asleep during surgery or while examining patients make four times more errors that cause deaths than their better-rested colleagues, the research reveals.

Young doctors also suffer from their mistakes with emotional problems that can haunt them for years. They admit that their distress includes fear, guilt, anger, humiliation, and decreased compassion. What’s more, the distress coupled with reduced empathy can increase the odds of more medical errors and even alcohol and drug abuse.

“The evidence demonstrates that academic medicine is failing both doctors and patients by routinely requiring exhausted doctors to work marathon shifts,” says Charles Czeisler, Baldino Professor of Sleep Medicine. “The human brain simply does not perform reliably for 24 consecutive hours without sleep.”

Czeisler and his colleagues conducted a national survey of serious medical errors and their consequences as described by 2,737 interns in all medical specialties. Using a secure Web site, the interns – those in their first year of medical training – reported on their medical mistakes, fatigue-related and not, once a month for 11 months. They also answered questions about how many shifts of 24 consecutive hours or more they worked in a week.

Their answers showed that those who worked more than five marathon shifts in a month were seven times more likely to report significant medical errors than those who worked no extended shifts. Interns who put in between one and four extended shifts reported that potentially harmful errors were three times more likely than when they were well rested.

Interns who put in more than five 24- to 30-hour shifts in a month were involved in 300 percent more fatal errors than when they did not work extended shifts. They were also more likely to fall asleep during surgery, while examining patients, during hospital rounds, and during lectures or seminars. The latter “presents a grave risk to patients with whose care they are entrusted,” Czeisler comments.