Should Sleepy Surgeons Disclose Fatigue to Patients?


Health Care System Presents Barriers to Disclosure

The many demands placed on surgeons and other health care providers make the prospect of having to reschedule elective surgery very daunting.

"The patient may have rearranged their life to take time off from work, arrange child care, etc. The surgeon may have booked the case and follow-up period long in advance or around other obligations," said Cronin. "The operating room schedule would become unmanageable if cases started to be canceled on a more frequent basis. The cost of health care may actually increase."

The medical community has taken some steps to address the problem of extreme fatigue among doctors. The Accreditation Council for Graduate Medical Education recently restricted first-year medical residents to a maximum of 16 hours of work a day, followed by at least eight hours off. But some physicians say this policy has been counterproductive for surgeons.

"I think it is clear from the resident work-hour regulation experience that fewer work hours does not translate into more sleep or more study," said Dr. David Euhus, a professor at the University of Texas Southwestern Medical Center in Dallas. "In the current environment, residents are prohibited from coming to a patient's aid if they have already used up their hours, so more and more of this falls to the staff surgeon alone."

Surgeons Should Be Trained to Spot When Sleep Deprivation Poses Risk

In an accompanying editorial, the American College of Surgeons agrees that sleep deprivation can have an adverse effect on clinical performance, but it says that rather than institute mandatory policies that require disclosure or prohibit surgeons from working if they haven't clocked enough zzzzs, surgeons should be trained to recognize when a fatigue poses a risk to patients.

"Surgeons should be trained to understand how fatigue degrades their mental and physical capabilities, wrote Dr. Carlos Pellegrini, a professor and chairman of the department of surgery at the University of Washington at Seattle, and co-authors. They should learn to use this knowledge to determine whether they should disclose their condition to their patients, whether operations should be rescheduled and whether they should seek assistance."

Pellegrini and his co-authors also believe that sleep-deprived surgeons can easily perform simple surgeries, so there doesn't need to be a restriction on those types of procedures.

But Nurok said routine surgeries can pose risks if surgeons haven't had enough sleep.

"It's usually routine and highly overlearned tasks that are susceptible to sleep deprivation and decreased performance," Nurok said.

"We need to address it as a society," he said. "There are no 'one size fits all' ways to deal with this."

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