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Diagnosing in Their Sleep

New federal legislation seeks to limit medical residents' work hours

THURSDAY, Dec. 6, 2001 (HealthDayNews) -- Your emergency operation may be a real yawn to your doctor. Literally.

According to proposed federal legislation just introduced on Capitol Hill, medical residents -- the doctors who most often staff emergency rooms across the nation -- are worked to the point of exhaustion, which is dangerous for them and their patients.

"Studies done on virtually every profession show that sleep deprivation is one of the quickest routes to errors on the job. Yet medical residents, who do the bulk of the work in hospital emergency rooms and clinics, are working up to 130 hours a week with shifts that easily last 36 hours without even a nap," says Rob Levy, director of Legislative Affairs for the American Medical Students Association, an organization that helped draft the new legislation.

The new bill introduced by Rep. John Conyers, D-Mich., seeks to limit a medical resident's work week to 80 hours, a shift to no more than 24 consecutive hours, and an emergency room shift to 12 hours. The bill would also make hospitals give residents 10 hours off between shifts, one day off after every seven on, and one weekend off each month. On-call shifts, which can now run nightly, would be limited to every third night.

Even more important from a patient's standpoint, the bill calls for public disclosure of hospitals who violate this work code and allows for anonymous complaints by residents who are being forced to work longer hours than the legislation allows.

A similar resolution was recently adopted by the Massachusetts Medical Society, and reports say plans are underway to propose state legislation that would force all hospitals in Massachusetts to play by these same rules proposed in Washington.

New York is now the only state that has laws governing a resident's work load. In 1987, at the urging of a grand jury investigating the death of a New York Hospital patient who was reportedly treated by overworked residents, the Bell Commission was formed to examine the problem of work overloads. In 1989, its recommendations to limit residents' work hours, called the Bell Code, were signed into law.

But without federal legislation, patients in most other states are still in the hands of doctors who, on any given night, may simply be too tired to do their job.

For Terre Hall, executive director of the Center for Patient Advocacy, this is an unacceptable risk.

"We simply can't continue to ignore the threat to all our health and safety posed by these long work hours for residents," says Hall.

By contrast, she says, American truckers are allowed to drive for only for 10 hours at a time, and their shifts are limited to 16 hours. Also, federal regulations limit the work loads of airline pilots to 16-hour shifts, with eight hours of rest in between.

"Doesn't it stand to reason that doctors, who hold the fate of our lives in their hands, should also be bound by similar restrictions? It seems implausible not to have this legislation in place," says Hall.

Medical studies support her position. A report in the November British Medical Journal revealed that simply being on night call impairs a doctor's ability to perform a laparoscopy. This is a relatively uncomplicated procedure that involves inserting an instrument about the diameter of a fountain pen in a small incision. The instrument is both a light source and a camera that allows the doctor to look inside the body.

In the BMJ study, the researchers used virtual reality training devices to measure the performances of 11 male and three female medical trainees, both with and without adequate sleep.

The result: The trainees were slower and less accurate when they didn't get enough sleep. On top of that, the emergency work load, stress and emotional demands may all increase the effects of sleep deprivation, note the authors.

The American Academy of Addiction Medicine (ASAM), which publicly supported the proposed legislation, believes residents' long work hours also contribute to a series of unhealthy behaviors that affect both doctor and patient.

"Included among these is the use of addicting drugs, taken as aids to stay alert or to lessen the tension of the long stressful hours of caring for patients, [which involve] sometimes working up to 36 hour shifts," writes Dr. Andrea G. Barthwell, president of the ASAM, in her letter to Congress.

In a similar letter endorsing the new act, Dr. Neal Barnard, president of the Physicians Committee for Responsible Medicine, said: "The medical community has had decades to fix this problem on its own, but has chosen not to do so. The time for federal intervention has come."

AMSA notes that while physicians always advise their patients of the dangers of overwork and lack of sleep, most established doctors are among the least likely to sympathize with the residents' cause or support the bill.

"They can't recognize the same problems in their own profession that they diagnose in other professions every day," says Levy.

The new federal bill, introduced in November, has been endorsed by only 12 other members of Congress so far.

What To Do

Want to learn more about how residents' work hours directly impact your health? Visit the American Medical Students Association fact page found here. Or get a quick summary of the congressional bill itself, H.R.3236 Patient and Physician Safety and Protection Act of 2001(PSPA), right here.

For more information on sleep deprivation, and the health effects of poor sleep habits, click here.

SOURCES: Interviews with Rob Levy, Legislative Affairs Director, American Medical Students Association, Reston, Va.; Terre Hall, Executive Director, Center for Patient Advocacy, McClean, Va.; Legislation #H.R.3236 Patient and Physician Safety and Protection Act of 2001; November 2001 British Medical Journal
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