Published on Wednesday, February 13, 2002 in the Detroit News
Don't Overwork Physicians, Imperil Public
by Amer Ardati
While our roads and skyways are kept safe by prudent labor regulations, hospitals are rife with what one surveyed pediatrician calls "delirious physicians." Resident physicians are new doctors who train in hospitals and facilitate the majority of physician-patient interactions.
Sadly, the medical community has abused these doctors by subjecting them to work weeks upwards of 100 hours with frequent 36-hour shifts. With little time for recuperation and relaxation, residents experience higher rates of depression, motor vehicle accidents and pregnancy complications. Patient care suffers as chronically fatigued physicians are less able to perform technically challenging procedures and more likely to suffer lapses of judgment and memory.
Such working conditions result in acute and chronic sleep deprivation. Long work-hours undoubtedly breed poor medical practice and contribute to errors, endangering the lives and well-being of patients.
A 1997 study in Nature found that after 24 hours of wakefulness, cognitive function deteriorates to a level equivalent to having a 0.10 percent blood alcohol level, 30 percent higher than the legal limit for driving in Michigan. Can we accept a situation in which it is considered unsafe for a person to drive while an equally impaired physician is allowed to perform demanding surgery?
Tired residents are acutely aware of their inability to deliver good quality medical care when overworked. Sixty percent of obstetrics and gynecology residents claim that long work hours hinder patient care, according to an article last year in Obstetrics and Gynecology. In a case study of residents at Columbia Presbyterian Hospital, a young physician bluntly admitted that "if you're on two nights in a row, you want to do as little as possible. You give bad care."
While most medical students enter the world of medicine to serve, long work hours erode the ideals of young physicians, making them resent their own patients.
The residents often bear the brunt of work hour abuse. Chronic sleep deprivation places an immense burden on residents and contributes to their alarming 30 percent of clinical depression during their residencies. Women residents have been shown to be twice as likely to have pre-term labor and other life-threatening pregnancy complications, exacting a huge toll on the physician and her family, according to articles in the New England Journal of Medicine (1990) and the Journal of the American Medical Association (1991).
Furthermore, all residents suffer a significantly higher number of motor vehicle accidents after working long shifts. In fact, emergency room residents are seven times more likely to have a motor vehicle accident due to falling asleep at the wheel during their residency than before it, according to a 2000 article in Academic Emergency Medicine.
Past efforts to regulate the number of resident work hours have failed. The Accreditation Council on Graduate Medical Education (ACGME), the national body responsible for regulating residency programs, has issued a set of voluntary work hour guidelines. Enforcement of these guidelines is weak and hindered by the lack of any meaningful punishment.
Recent reform efforts within the ACGME have resulted in an institutionalization of dangerously long work hours. Just this week, an ACGME task force made recommendations that would allow residents to work an average of 104 hours a week, with provisions permitting 125-hour weeks once a month.
In response to the lack of effective regulation and increasing patient and physician harm, Rep. John Conyers has introduced legislation that would limit residents to an 80-hour work week. The Patient and Physician Safety and Protection Act would ensure safe patient care while guarding the health of our residents. In addition, medical students, consumer advocates and unionized residents have co-petitioned the Occupational Safety and Health Administration to implement resident work hours similar to those in the proposed legislation.
It is time for the community to take a stand for quality health care. We deserve competent health care from well-rested physicians.
Amer Ardati is a third-year medical student at the University of Michigan and a trustee of the American Medical Student Association, which helped craft Rep. Conyers' legislation and a Research Fellow at the Public Citizen Health Research Group. E-mail: firstname.lastname@example.org