Doctors making mistakes Exhausting your options for quality care Asleep at the scalpel If you've been a reader of mine for longer than a Twinkie's shelf-life, you've heard me railing about how behind heart disease and cancer, DOCTORS are the third-leading cause of death in the U.S. (Daily Dose, 4/15/03). Well, here's another related item to add to this "I've said-it-before" file... But what's really scary is that this item SHOULD be from the "obvious-to-anyone-with-half-a-brain" file. The fact that it isn't gives me reason for great pause — but sadly, not great surprise. So what's this "news flash," you're asking? Tired doctors make more mistakes! No, really? Yep, that's the finding of a Harvard University study (one that no doubt cost a million bucks or so to conduct) of interns at cardiac and medical ICUs at Boston's Brigham and Women's Hospital.
Regardless of how obviously true this would seem to be, the medical establishment is treating the research as some type of eye-opening breakthrough. Indeed, this is the first study of its type ever conducted, according to the AP article outlining the research. Whether this is because mainstream medicine really is completely clueless about the relationship between fatigue and doctor errors or because it's such an obvious correlation that nobody has ever bothered to officially quantify it before is irrelevant. What IS relevant, however, is this: It's a known fact that medical interns and residents commonly work shifts of ungodly length — as much as 24 hours without a break. And true to form, the study
found that "long-shift" subjects committed FIVE TIMES AS MANY DIAGNOSTIC ERRORS as their shorter-shift counterparts... They weren't just errors in diagnosis, either. In one instance, a long-shifter ordered 10 times the correct dose of a powerful blood-pressure drug. Another blunder caused a patient's lung to collapse when a sleepy intern botched inserting a tube into a nearby artery. In yet another instance (and the study only had 20 participants), a tranquilizer overdose caused one patient to suffer a dangerously low heartbeat and blood pressure.
This study's findings have spurred sweeping changes in the way doctors are allowed to work in Brigham and Women's Hospital. For instance, interns' shifts are now prohibited from exceeding 18 hours in a row (still an awful lot, if you ask me). But at least it's a trend in the right direction. But all this begs the question: WHY do interns and residents work such long shifts?
Hospitals would be quick to tell you that the reasons they work their interns like slaves (as many as 30 hours in a row, according to the study) is to train them rigorously "under fire" so they can
handle the pressure and strain of a massive crisis — like a terror attack. Obviously, though, it's really nothing more than a strategy for keeping costs down. After all, why should hospitals pay additional doctors when they can just double-up the shifts of the LEAST
EXPERIENCED staffers they've got (the article cites an average 80-hour work week for interns)? Oh, I don't know — maybe because your LIFE depends on it? What's also funny is this paradox: If keeping more doctors off hospital payrolls really saved money, how come the average cost of health-care premiums jumped more than 11% in the last year, according to the latest data from providers? Could it be because of the huge number of lawsuits these sleepwalking interns incur with their blunders? Again, it all comes down to dollars, not sense — and you're paying the price. One thing is for sure in my mind, though. Whatever the ideal balance of hospital payroll vs. lawsuit liability from the bean counters' point of view should be irrelevant. All that SHOULD
matter to hospitals, insurance companies, and individual doctors is rendering the best possible care to patients... That means not dozing off or zoning out while they're doing it.
Never sleeping on MY job as whistle-blower,
William Campbell Douglass II, MD | 
