IMAGINE WORKING 30 HOURSWITH LITTLE OR NO SLEEP AND….

“Resident fatigue, depression, and injury are not the worst effects of unsafe work hours. The most heinous fall-out of long work hours and sleep deprivation is hidden and corrosive, when exhaustion and sleep destroy caring and concern for patients, when sleep trumps life.”

-Family physician, Los Angeles, California

YOU are entrusted with the complex care of sick patients.

Every day, thousands of resident physicians across the U.S. are working 24- to 30-hour shifts, approved by the organization that oversees medical education.

Here are some of their stories.

“When I have been up all day working, I don’t feel too bad until about my 16th hour of work. At this time, I start to think about sleep. When things are really busy and I don’t even have time to call my two-year-old daughter and wish her goodnight, I start to wonder if it’s all worth it. When I have to sleep at home during the time I should be spending with my family, I really begin to resent my decision to become a physician.”

-Pediatric resident, San Antonio, Texas

“Over the years, consistently long work hours take a big toll on health, personality and personal relationships. With no time to take care of myself, I am not the same perky, happy, personable person I once was. Lack of sleep and constant stress has made me a short-tempered and easily irritable person. Having no time to connect with family and friends has negatively impacted so many close relationships. I’ve found that these constant long work hours make it very challenging for residents to meet normal life milestones involving marriage and kids. A stressful work environment where everyone is living on the edge makes it impossible to have normal relationships with colleagues. And there are, of course, innumerable instances of missing significant life events, celebrations, and being a part of loved ones’ joys and sorrows. I’ve always wondered why pilots, police officers and engineers can be trained in a sane way, but doctors cannot.”

-Obstetrics & Gynecology resident, New York, New York

“During my trauma surgery rotation, the senior residents were so tired that no matter how many times we paged them, we couldn’t wake them up. The junior resident and I had to admit more than one trauma on our own that night. It was only luck that neither of the patients ended up needing surgery.”

-Fifth year medical student/MPH student, Arizona

“What’s it like to work 30 hours without sleep? For me, after about the 15th hour, I become unproductive, although I am still able to per-form basic tasks. One area that I find as a sur-geon that suffers is the ability to carry out pro-cedural tasks to the same efficiency as when awake and fresh. Post-call, I tend to feel con-fused in the morning, and very ‘slow’, and I of-ten have to ask people to repeat themselves. I generally have a headache, and my body becomes hypothermic. My eyes ache to close. Yet it is expected that you will work just as well you did pre-call. In the past, I have made numerous errors in the operating room while post-call. I operated too slowly, and it delayed cases for the attending surgeon. Recently, while post-call, I pulled the wrong chest tube from a patient after thoracic surgery.”

-Surgery resident, Baltimore, Maryland

“I drive 30 minutes on a busy expressway to get home after 27-hour shifts when I may have slept anywhere between 20 minutes and 4 hours. I am embarrassed to admit that I’ve fallen asleep at the wheel and by some miracle snapped myself awake before getting into an accident. This has only happened a few times, and it has happened less as I do it more often, but it scares me because it seems totally out of my control. No matter how loud I blast the music or how far I roll the windows down, my body wants what it wants. I am embarrassed because I should know better; as a physician I understand that driving with no sleep is as bad, or worse, than driving drunk. And I am embarrassed because I’ve seen patients devastated by injuries obtained in motor vehicle accidents. I realize it is irresponsible to put myself and other drivers at risk. But time becomes so precious during residency that you’ll take risks for it.”

-Pediatrics resident, Bronx, New York

“On surgery call, I was assisting on an exploratory surgery at 4 in the morning. I almost put my face in the patient’s open wound when I nodded off.” -Third year medical student,

New England

“I want to be as productive as possible, however, it is difficult after being up all night. I feel patient care is not optimal given my level of fatigue in the morning. It can be difficult performing procedures in the morning when necessary. Infrequently, I have seen other residents place orders for one patient in another patient’s order set, which can be dangerous. The pressure to complete all your tasks is high, and is made worse if your night is busy. Often, this tiredness extends beyond the work day. I am unable to carry on social activities on my post-call day. Sometimes, it takes a few days before my fatigue wears off. This has put strain on my marriage at times.”

-Internal Medicine resident, Honolulu, Hawaii

“I was covering the medicine wards as an intern when a very sick patient arrived from the nursing home around 3 in the morning. I had been up all night running around the hospital attending to the usual concerns on a busy hospital service — admissions every few hours, elevated blood pressures, refill pain medications, follow-up on CT scans done overnight. I was mentally and physically exhausted.

My team and I wheeled her up to the ICU. Her pulse disintegrated and we began resuscitation. It was then that my emotional exhaustion washed over me. I wished that my new patient would die. At that moment, I cared nothing for my patient, her family, her life. Her living got in the way of my sleep. She was one more name to go on my patient list, one more life to attend to, countless hours I wouldn’t spend in bed.

Absolute exhaustion elicited by a demanding and disjointed health care system brought out a dark side of me I never want to meet again. That’s the side of a doctor no patient should have to face.”

-Family physician, Los Angeles, California

What does the public say about the long hours that resident physicians are scheduled to work? Most people are unaware that 30 hour shifts are a fact of life today in U.S. teaching hospitals.

The prestigious Institute of Medicine issued a report in 2008 calling for shifts of no more than 16 consecutive hours, as well as increased supervision of resident physicians. A coalition of public interest and patient safety organizations has launched a campaign to educate the public and to let the Accreditation Council on Graduate Medical Education (ACGME) know that they support these common sense recommendations to improve the safety of patients and the resident physicians who care for them.

THIS BROCHURE WAS PRODUCED BY

TAKE ACTION

GO TO:www.WakeUpDoctor.org

“Something I have found remarkable about residency is how much it has eliminated the joy I once had for the practice of medicine. In medical school, I thought delivering a baby was incredible. Now, at 4 am, after 20 hours without rest, I find I that I have lost all sense of compassion towards my patients, just wishing they would ‘deliver the baby already’, and I always find myself shocked the next morning at how insensitive sleep deprivation made me.

In my exhaustion, I have forgotten to see patients that I was consulted on in the emergency room, I have confused medication orders, I have fallen asleep while standing up, and I once stuck myself with a contaminated needle on the 24th hour of my shift. I also never expected the physical toll that residency would take on me: the middle of the night nausea and chills, the post-call headaches. I don’t understand why doctors are expected to risk their health and the health of their patients in order to learn medicine.”

-Obstetrics & Gynecology resident, New York, New York