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There has been an increasing interest in the impact of sleep deprivation (SD) on doctors performance. Sleep deprivation can result in cognitive impairment and may also impair performance in tasks that require vigilance, decision making, and memory planning, which are commonly required in shift work (e.g., doctors and health care workers). Two articles deal with the issue of sleep deprivation. The New England Journal of Medicine (NJEM) published an article about the effect of medical care provided by surgeons, post being on call the night before and the lack of impact on the short term outcomes of their scheduled elective procedures performed during the day, while the British Columbian (BC) Medical Journal produced an article supporting the evidence that indicates the loss of sleep caused by long term work hours can have an effect on the health of physicians and patient safety. The articles gave different types of results from different kinds of data with different degrees of definiteness.
First, the article produced by the BC Medical Journal states that based on the study performed in this article, no significant difference in short term outcomes for patients treated by a doctor who performed a overnight shift, as compared with patients who were treated by the same doctor by after a night of no clinical work. The study outlined in the BC article showed concluded that sleep loss resulting from the provision of overnight medical care did not measurably affect the short term outcomes of elective procedures performed the next day by attending surgeons (2). The paper published in the NEJM gave a similar situation based on long shift patterns, however this article showed that a correlation does exist between long shift patterns and the risk of serious medical errors. Dr Eddy states that patients may also be put at risk according to a recent comparison study between doctors who have worked a 24 hour day making significantly more serious medical errors than those restricted to a 16 hour shift (1).
A recent study showed that people who has been awake for the last nineteen hours had scored the equivalent of a person with a blood alcohol level of 0.08 (the legal limit in America) on performance and alertness tests. In other tests, people who had slept four hours a night, scored lower and made more mistakes on judgement, response time and attention tests. One of the most important characteristics of emergency physician performance is clinical decision making (ref), an aspect of behavior that forthcoming evidence supports is significantly impacted by sleep deprivation. Decisions involving unexpected events, innovative and lateral thinking, keeping track of changing situations and developing and revising plans, appreciating the complexities of clinical situations in the face of competing distractions, and those requiring effective communication are all impacted by sleep deprivation (23).
Another area of comparison is the method in which each article obtained its data. The population based, retrospective, matched cohort study outlined in this paper allowed the authors the choice of reporting their findings based on selective, administrative data on short term SD and could not quantify the number of hours that a doctor was deprived of sleep. The paper is also deemed as methodologically flawed and lacks standardization and controls. This may have allowed a margin of bias to skew the evidence and provide conflicting results to the other paper. The limited measurements of resident’s sleep and work hours does not comprehensively quantify doctors’ sleep. On the other hand, the article on SD in physicians based its conclusion on the results of several well designed studies and legislation based on enforceable law in Europe. The international reporting of legislation cases in various hospitals and institutions around the world eliminated some of the biasness that crept into the BC Medical journal’s paper. Finally, the articles differed on their on their degree of conclusiveness.
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