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The Lawrence Firm Blog

New rules to let medical residents work up to 28 hours in a row

In 2011, medical schools adopted rules restricting how many hours a medical resident could work without a full break. The rules allow young doctors to work up to 16 hours in a row, but then they must take a break of at least 8 hours. This is meant to allow them sufficient time to sleep.

Insufficient sleep among medical residents has been shown to increase the number of serious errors residents make in diagnosis and prescribing medication. It also increases the residents’ own risk of injury from needle sticks and car accidents.

A sleep specialist interviewed by WBUR described her own experience with sleep deprivation during medical school. In the first month of her fellowship she fainted twice — once during a medical procedure. She also got a needle-stick from a patient who was positive for both HIV and hepatitis C. She stressed that residents who lack sleep are much more likely to make errors, “whether it’s a misdiagnosis, misreading an EKG or an X-ray.”

With a seeming mountain of evidence that medical residents need sufficient sleep, it’s surprising that the Accreditation Council for Graduate Medical Education is considering changing the rules to allow medical residents to work up to 28 hours straight with no break long enough for sleep.

To support this surprising recommendation, proponents of the change point to a study of surgical interns. That study found that patient outcomes were no worse when surgical interns were allowed to work up to 28 hours in a row. Opponents criticize the study as being “designed in such a way as to virtually guarantee” no difference could be detected.

There may also be internal politics at work. According to a contributor to WBUR’s CommonHealth blog, medical residents are already being forced to work longer than 16 hours in a row, simply due to the sheer volume of work and paperwork. Routine violations of the work hours rule threatens their programs’ accreditation, however, so many residents feel compelled to underreport their time. Under the new rule this wouldn’t be an issue.

Inadequate sleep is not healthy. Sleep-deprived people make mistakes, and when those people are doctors the mistakes could be life-threatening. As the WBUR contributor points out, it seems as if medical educators are willing to sacrifice physician health and patient safety if it allows them to avoid making meaningful changes.


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