Doctors should be forced to tell patients they are seriously impaired from lack of sleep before they operate
S. L. Baker, features writer
The editorial presents a compelling case that these sleep-deprived physicians should not be allowed to perform elective surgery unless their patients give informed, written consent agreeing to be operated on by an impaired doctor. "This approach would represent a fundamental shift in the responsibility patients are asked to assume in making decisions about their own care and might prove burdensome to patients and physicians and damaging to the patient-physician relationship," the authors wrote. "This shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas."
So just how dangerous is it to be operated on by a doctor who is sleep-deprived? A 2009 study in the Journal of the American Medical Association found a significant increase in the risk of complications in patients who underwent elective daytime surgical procedures performed by surgeons who hadless than a six-hour opportunity for sleep during a previous on-call night. What's more, doctors who are sleep-deprived are often not able to accurately recognize how severely they are impaired.
"Sleep deprivation affects clinical performance. It increases the risks of complications. And it is clear from survey data that patients would want to be informed if their physician was sleep deprived and that most patients would request a different provider," Michael Nurok, M.D., Ph.D., an anesthesiologist and intensive care physician at Hospital for Special Surgery who is first author of the editorial, said in a press statement. "We think that institutions have a responsibility to minimize the chances that patients are going to be cared for by sleep-deprived clinicians."
The editorial concludes that sleep-deprived physicians should be required to inform patients of their condition; it also argues that patients have the right to be told of the potential hazards that can come from surgery performed by sleep-impaired surgeons. And patients should be given the opportunity to go ahead with the procedure, proceed with a different doctor, or reschedule for another time.
If patients decide they want to go ahead with a planned operation performed by a sleep deprived doctor, Dr. Nurok and his co-authors believe they should be required to sign a consent form on the day of the procedure in front of a witness to show they understand the potential risks. Although it would seem like a no-brainer that patients have a right to know a surgeon they are trusting their bodies and lives to is not impaired, the editorial authors say there are many barriers to the idea of this informed consent.
Not surprisingly, one of the biggest problems is based on the fear that when patients learn doctors are impaired from lack of sleep, there will be financial consequences for hospitals and physicians. Some doctors will lose cases and have a drop in income and medical centers will lose money if patients reschedule and go elsewhere for their surgery. However, Dr. Nurok and his colleagues counter that by giving patients the facts and true informed consent, any income lost by docs and hospitals will be offset by improved surgical outcomes and reduced complications.
"There has been widespread discomfort with the idea that patients are having procedures performed by physicians who are fatigued," Dr. Nurok concluded. "New policies are needed."
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