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Sleep Deprived Doctors should Tell Patients before Surgery

Kathleen Blanchard's picture

Doctors should tell patients if they are sleep deprived and obtain written consent before proceeding with elective surgery, suggests physicians writing in the New England Journal of Medicine.

According to the authors, new policies are needed to protect patients who might face surgery from the hands of a fatigued and impaired surgeon.

Without a patient’s informed and written consent, a doctor lacking sleep should not be allowed to care for the patient.
Disclosure of a doctor’s sleep status would place more responsibility on hospitals to protect patients from impaired physicians whose self-assessment may not always be accurate. Additionally, patients would have the option of requesting another surgeon if their doctor tells them they are tired from lack of sleep.

Michael Nurok, M.D., Ph.D., an anesthesiologist and intensive care physician at Hospital for Special Surgery who is first author of the editorial says, “We think that institutions have a responsibility to minimize the chances that patients are going to be cared for by sleep-deprived clinicians.” He says surveys show most patients want to be informed, and would request another provider.

A 2009 study in the Journal of the American Medical Association showed lack of sleep could cause the same level of impairment as alcohol intoxication from decreased motor skills and thinking. The findings showed higher rates of surgery complications when surgeons failed to get at least 6 hours of sleep the night before and then performed daytime elective surgeries.

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Obtaining consent for surgery and informing a patient when their surgeon is sleep-deprived, …”would represent a fundamental shift in the responsibility patients are asked to assume in making decisions about their own care and might prove burdensome to patients and physicians and damaging to the patient-physician relationship.”

Ultimately, hospitals would shift their efforts to restrict doctor’s on-call the night before from scheduling daytime elective surgeries and other invasive procedures to protect patients from facing the dilemma of having a procedure performed by a tired doctor.

Dr. Nurok says, “This is going to be a policy issue that develops. Elective surgery is the low hanging fruit because there is no urgency to doing it and it can be rescheduled – ideally as a priority with institutional support. It’s a nice place to start to think about policy approaches.”

He notes some hospitals are already taking steps, but also says informing patients their doctor is sleep deprived and discussing the risks will not be popular. For instance, patients would need to make alternative plans and reschedule their procedures. Hospitals and physicians could lose income and doctors may lose patients to other providers.

N Engl J Med 2010; 363:2577-2579