Surgeon Sleep Deprivation: The Case for Informed Consent

Sleep deprivation has been shown to adversely affect clinical performance and impair psychomotor function. It can be challenging for medical systems to ensure that physicians are not fatigued from sleep deprivation because continuity of care and around-the-clock coverage of clinical services are often competing needs. The Accreditation Council for Graduate Medical Education has revised its regulations on resident work hours to restrict trainees in their first postgraduate year to a maximum of 16 hours of continuous work, followed by a minimum of 8 hours off duty. “Unfortunately,” says Michael Nurok, MD, PhD, “there are no such regulations for fully trained physicians.” There are many reasons why fatigue from sleep deficiency occurs, including long work shifts, long work weeks, sleep disorders, or personal circumstances (Table 1). “Researchers have documented the adverse effects of sleep deprivation and sleep disorders on individual performance,” says Dr. Nurok. “In surgery, the risk of complications (eg, massive hemorrhage, organ injury, or wound failure) is thought to increase in patients who undergo elective daytime surgery when these procedures are performed by attending surgeons who have less than a 6-hour window for sleep between procedures during previous on-call nights. Performing elective surgery under these circumstances cannot be rationalized in the context of patient safety.” Elective Surgery & Rescheduling Unlike other practice areas, elective surgery is potentially amenable to rescheduling. However, many competing interests influence the possibility for rescheduling, even when all parties stand to gain by avoiding errors and complications (Table 2). “When no policy exists to facilitate rescheduling or to prohibit sleep-deprived physicians from working, the burden of deciding to proceed with operations or reschedule them...