Does Your Doctor Seem Tired?

So we changed our clocks last night; lost an hour of sleep or an hour of our day. It’s Sunday, so at least most of us don’t have to go to work today, giving us a day to adjust. All day long we’ll look at the clock and think it seems weird. For many of us, the toughest part will be when the alarm goes off tomorrow morning, when we have to get up for work and feel like we…just…didn’t…get…enough…sleep…

For those of us who work or manage families (or both)… we never seem to catch up on sleep anyway. Most of us get some sleep every night, even if it never seems enough.

So imagine if you were a young doctor, just out of medical school, in the midst of your hospital residency, and you faced a 16 hour workday. From your own point of view, it’s exhausting just to think about it!

Now what if you learned that the accreditation body for graduate medical students (the ACGME) has just raised the number of hours a student doctor might work from those 16 – to 28? Yes – student doctors will now be working 28 hour shifts in the hospital before they can go home to sleep. Then, eight hours later, they’ll be expected back in the hospital to work another 28 hours; up to 80 hours in a week.

That makes me angry!

Because while those young doctors will pay the price by feeling exhausted all the time, the real penalty will be paid by the patients who won’t get the sharper minds and honed skills of a rested doctor. I wonder how many patients will get sicker, or die because of it?

In 2010, the Institute of Medicine issued a report citing the safety concerns of long hours for student doctors, and recommended their hours be reduced. In response, the ACGME, did reduce the hours – to 16.

But too many old-school doctors wanted their students to suffer as they had – called by one report “the hazing ritual of exhaustion.”

Add that to the fact that hospitals love student doctors because their paychecks are only a fraction of those more experienced doctors, and because they aren’t responsible for the students’ malpractice insurance (which is paid by the medical university) – and you’ll understand why we will begin to see more exhaustion on the faces of those who treat hospital patients. As always, follow the money.

So what can you do to improve the chances you’ll get the right care from a sleep-deprived doctor?

Smart patients and caregivers know they need to ask questions to get the care they need. Just like you might ask hospital personnel to wash their hands to prevent an infection, or to double check your identity before they give you your prescribed drug, if your hospital employs student doctors (most do), then take steps to find out how much sleep they’ve gotten, too.

Be polite, but be assertive enough to get the information you need. You want to determine first whether they are students, and then if necessary, whether they are rested. In some states, the law requires they wear a nametag with their level of experience. In others, you may have to ask directly, “Have you been a doctor for long?” If you determine the doctor is still a student, then don’ be afraid to assess their sleep patterns. You might simply quip, “I hear you never get enough sleep!” and see what follows. Or more specifically, “I read somewhere that they make you work 28 hours in a row. How do you manage that?” They’ll think you’re asking about their own welfare when, in effect, you’re figuring it out so you know what to do next.

If you determine they’ve been sleep deprived, and therefore you question at all whether their recommendations and orders are the right ones for your health, then you may want to ask for someone more experienced to step in. For that you can ask the nurse.

Graphic: If they've been sleep deprived and you question whether their recommendations are right for you, then ask for someone more experienced to step in.

Or… we know it’s difficult to be so forthright when you’re the one in the hospital bed. And that’s yet another reason why having a patient advocate by your side is the best answer. Your patient advocate is interested only in YOUR well-being and can help you assess whether you’re getting the best treatment and the best advice by qualified, well-rested doctors and nurses.

Don’t be the victim of a doctor’s sleep-deprivation. Take steps to be sure you’re getting what you need from someone who has the wherewithal to provide it. When in doubt, call on a patient advocate to take care of it for you.