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Sleeping sickness is a resident evil

Truncated sleep ups your risk of almost every known disease, from heart attacks (by pushing up blood pressure), to the common cold (by lowering immunity). Sanchita Sharma writes.

health and fitness Updated: Jun 26, 2011 00:22 IST
Sanchita Sharma

Truncated sleep ups your risk of almost every known disease, from heart attacks (by pushing up blood pressure), to the common cold (by lowering immunity). It turns your brain to mush by lowering its ability to learn and store new information. It makes you irritable, impatient and emotionally fragile. It also causes people to nod off while driving, which is the biggest cause of road accidents after speeding and drink driving.

Sleeplessness, however, is at its most lethal when the insomniac is a doctor or a surgeon taking decisions that can make or break your fever - or your life.

Working for more than 16 hours without sleep results in resident doctors committing serious, preventable medical errors, reported the journal Nature & Science of Sleep on Saturday. While there is no data for India, the US Health and Human Services reports that 180,000 (1.8 lakh) patients die of medical negligence each year in that country.

Work shifts longer than 16 hours increased medical errors by 35.9 per cent while shorter shifts reduced errors, reported Harvard Medical School researchers in the New England Journal of Medicine (NEJM). Following the report, Harvard Medical School announced a 16-hour limit on the time resident doctors can work at a stretch.

In India, resident doctors live in the doctors' duty room 24x7, on call at all hours for any length of time. They routinely do 24-hour shifts, which can go up to 36 hours in departments such as neurosurgery, where emergency cases such as accidents and stroke need immediate attention. By the end of a shift, the fatigue is apparent not only in the dramatically shortened fuses but also in cases needing a second opinion for final diagnosis.

Rising patient load and staff shortages are too blame. While patients at teaching hospitals have more than doubled in the past decade, medical staff strength remains the same. Given the easy access to medication and addictive medicines, addictions are a norm. Apart from smoking, most residents take stimulants or "uppers" to see them through the day. "What are we to do? After MBBS, we do 3-5 years of junior residency and another 3 years of senior residency. Most of the time we are too tired to keep our eyes open," says a senior resident at the All India Institute of Medical Sciences.

The US Institute of Medicine has recommended major changes in residency training programmes, including re-designing training to eliminate dangerously long shifts (over 16 hours without sleep), and reducing residents' workload by focusing on academic training and transferring a lot of the routine things they do - bandaging, drawing blood, filling out paperwork and starting intravenous lines - to nurses and other health personnel.

"It's an abuse of patient trust," says Dr Lucian Leape, adjunct professor of health policy at the Harvard School of Public Health and a co-author of the NEJM report. "Few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double-shift or more with no sleep. If they knew, and had a choice, the overwhelming majority would demand another doctor or leave."

Try as they might, teaching hospitals cannot shorten resident work hours because of financial and staffing shortages. If hours for residents are reduced, other staff - such as teaching faculty and consultant physicians - need to step in, who have to be paid overtime. But given that resident doctors are staffing emergency rooms, an urgent overhaul of hospital work policy is needed. For when it comes to medical errors, saying sorry is not enough.