By Dan Henderson
The long hours worked by residents are somewhat unique, but their vulnerability to fatigue is perfectly common. In fact, because of this propensity of people to defy the limits of sleep-deprivation, I was almost never born.
Many years ago, my father (then just a twenty-something North Carolinian named David) was at the wheel of his family’s Skymist Blue 1962 Ford Falcon headed for Elkins, West Virginia. He had worked a 14-hour shift at a hardware store the evening before, and then endured a white-knuckle drive through the mountains of West Virginia. Around two or three in the morning, he was driving along at 55 mph, and realized he was drowsy.
The next thing he knew, the car was stopped in the shoulder of. The engine was off, and for some reason, the clutch wouldn’t budge. The dash was completely lit up, and an acrid scent filled the cabin. What had happened?
He got out, and only then noticed that all of the cars windows were shattered. The roof over the back seat was crushed down to the seatback, and all four fenders were deeply mashed inward. As he described it to me, “The only way to get the damage to the car would have been a flip landing on the roof and a cartwheel. It must have been very dramatic.”
Amazingly, my father was unscathed, except a headache and an otherwise unintimidating dab of blood on his forehead. No doubt, the small splotch conveyed a powerful message: “Consider yourself lucky - and get some sleep!”
Recently, I was asked to offer a medical student’s view on the impact of fatigue caused by long hours worked by residents. Even after a move to regulate hours in 2003, residents still work 30 hour continuous shifts, and 80 weeks. Often, evidence shows, they work much more, but simply report it to be within these limits. AMSA and its allies, such as the Committee of Interns and Residents (CIR) want to change this, but it seems it’s not just us who care about this issue. Last week, over 40 consumer safety and patient advocacy groups came together to push for better policies to promote safe schedules. Among them was Helen Haskell, who founded Mothers Against Medical Error after a tired resident’s mistakes led to the death of her 15-year old son in 2000.
Led by the famed consumer watchdog, Public Citizen these groups gathered to announce the launch of a new campaign, and a new website, www.wakeupdoctor.org, to send a message to the Accreditation Council on Graduate Medical Education (ACGME), the group that oversees America’s residency programs.
It was exciting to see the energy and support mobilized by these groups. Consumers and patients are two powerful constituencies, publicly and politically.
Work Hours: Part 2 will be posted soon!