Doctors of the old school tend to be rather proud of how hard they worked when they were young, and to attribute their current enormous technical competence as well as the magnificence of their character to the long hours that they then endured. They were not much fun at the time, perhaps, but it made them what they are.
I remember those long hours well, and how at the end of a forty-eight hour shift my head felt as if it contained nothing but lead shot, as if it might just fall off my body. Leaving the hospital was like leaving prison after a long sentence; the starving man dreams of food, but the sleepless man dreams of bed.
It has long been suspected that such exhaustion cannot be good for patients; no one in his right mind would wish to be flown by a pilot who had gone two days without sleep, for example. Why should doctors be immune from the normal effects of fatigue on performance?
A study in a recent edition of the Journal of the American Medical Association attempted to demonstrate the effects of a protected sleep period on interns and residents when they were obliged to work shifts longer than 30 hours. On some such shifts they were given five hours, between 12:30 am and 5.30 am, when they could not be interrupted except by the direst emergency, and when they were given the opportunity to sleep. This might not be what most mothers would call a good night’s sleep, but it was better than what was normally available to such interns and residents.
The subjects of the experiments acted as their own controls: half the time they had protected sleep periods, and half the time they hadn’t. Unsurprisingly, they got more sleep (about an hour more per night) when they were given such a protected period rather than when they were not. They were more alert, both subjectively and objectively, when they had slept 3 hours a night instead of only 2. Three hours is hardly enough to make one feel fully rested, but slugabeds know that even a quarter of an hour of extra sleep can seem the most luxurious thing in the world.
The authors were unable to demonstrate any superiority of actual performance by the better-rested doctors, as measured by the crude outcome of patient deaths. This was not surprising because their sample size was too small; the experiment would have to be repeated on a larger scale to prove what seems intuitively obvious: that exhausted doctors – or perhaps I should say more exhausted doctors – are more inclined to make medical mistakes than less exhausted doctors.
Strangely enough, another study of a similar kind has shown that while protected sleep lessens the fatigue of young doctors, it increases their level of anxiety. The authors of that study hypothesized that the extra sleep merely compressed the amount of work they had to do, which remained the same, into fewer hours, thus increasing their anxiety. And when anxiety increases beyond a certain beneficial level, it tends to depress performance just like fatigue.
Perhaps young doctors are also so used to hearing how hard their elders and betters worked when they were their age that they feel slightly ashamed of their protected sleep periods, unluxurious as they might seem to the great majority of the population, as being indicative of a lack of commitment and stamina, what was known in my childhood as moral fiber. All I can say is that I would certainly not have wanted to be treated by me at the end of one of my forty-eight hour shifts.
First published in PJ Media.