A recent article in the New England Journal of Medicine raises the issue of whether surgeons who become sleep deprived should notify patients who are having elective surgery so that patients can decide whether to postpone the procedure or request another physician.
According to the authors, sleep deprivation can have as much of an impact as alcohol intoxication on psychomotor and clinical performance. The authors point out that while the Accreditation Council for Graduate Medical Education has revised its regulations to ensure that trainees in their first postgraduate year work no more than 16 hours in a row, followed by eight hours off, there are no similar regulations for trained physicians.
According to the article, “in surgery, there is an 83% increase in the risk of complications (e.g., massive hemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by attending surgeons who had less than a 6-hour opportunity for sleep between procedures during a previous on-call night.”
The authors suggest that since it is possible to reschedule elective surgery, patients should be given the option of postponing, rather than having surgery performed by an exhausted practitioner. The article cites surveys indicating that 80% of patients would request another surgeon if they knew that their physician had been awake for 24 hours. However, no regulations exist compelling physicians to inform patients, and concerns about schedules, income, and losing cases may cause clinicians not to involve patients in the decision making process.
The researchers advocate model legislation from the Sleep Research Society that would require physicians who had been awake for 22 of the past 24 hours to advise patients about the safety impact of sleep deprivation and obtain informed consent from patients prior to performing elective surgery.
The authors suggest that patients should be offered the option of rescheduling surgery, proceeding with a different physician, or going ahead with the surgery after signing a consent form acknowledging that they have been informed of the physician’s sleep deprivation and potential consequences but wish to proceed anyway. While there would be costs involved in rescheduling elective surgeries, the authors believe that the savings from improved patient outcomes and fewer malpractice suits would more than compensate.