How often do you face with the unpleasant task of waking a sleeping patient during your busy rounds? It happens frequently to many clinicians during their inpatient rounds in the hospital.
But it happens even more often when nephrologists go to outside dialysis clinics to round on their dialysis outpatients. Many patients sleep during their hemodialysis (HD) treatment.
Not infrequently the physician feels compelled to wake the patient for a variety of important reasons, such as obtaining the most current information on the patient’s state of well-being and to fulfill the medicolegal requirement of a documented face-to-face visit with a real-time interview and physical examination. We tend to believe that this is practicing good medicine.
When was the last time you felt better when somebody interrupted your sleep? Would you have appreciated this if you were sick and yet people would constantly come to wake you up? In the hospital this happens under different circumstance, including checking patient’s blood pressure or measuring capillary blood sugar, pill intake calls, and blood draws early in the morning (in some hospitals as early as 5 a.m.). This ongoing sleep deprivation leads to daytime naps, which are constantly interrupted by many other activities including doctors’ rounds.
Sleep is a fundamental requirement for health maintenance. Evidence suggests that chronic lack of sleep is linked to a predisposition to upper respiratory and viral infection, diabetes mellitus, heart disease, mental disorders, and obesity. Sleep is a quiescent period during which many organ systems, including the immune system, readjust their activities.
A sick patient usually needs adequate sleep. There is virtually no disease condition where sleep deprivation or sleep interruption is considered favorable. In particular, dialysis patients are chronically ill people who would definitely benefit from some more sleep including during their three to four hours of HD treatments. How can we call ourselves the healing advocates if we practice the opposite and interrupt the sleep of our patients?
Each week, I round on 60 to 70 dialysis patients in different dialysis clinics and encounter many sleeping patients. Sometimes I round on these patients during the last 20-30 minutes of their HD treatment so that I can let them sleep longer without interruption.
I instruct dialysis clinic staff to avoid doing anything that can disturb patients’ sleep, no matter which shifts they attend. There are other alternatives to meet the medico-legal requirements of the face-to-face patient encounter other than waking up a sleeping patient. Let’s adhere to our sworn principle of “first do no harm,” and let patients sleep well.
Dr. Kalantar-Zadeh is Medical Director, Nephrology, for Renal & Urology News.