Two types of killer oversights Paging Dr. (sleep) Walker I've written before at great length about the hazards facing patients when they go to the hospital. There are administrative errors, careless and poorly-trained personnel, sanitation issues, risks of infection with hospital super-bugs, green MDs who know only the pill and scalpel, and plain old human error to contend with. But of all these things, there's one that, in my opinion, there's simply no excuse for: Medical errors because of fatigue. The hectic schedules of medical interns - who usually end up manning the Emergency Departments - are the stuff of legend. You've heard the stories: 24-hour shifts without a break, 100-hour+ work weeks. Back in late 2004 (Daily Dose, 11/22/2004), I wrote to you about the Harvard study that found doctors who worked long shifts made 5 times as many diagnostic errors as their shorter-shift counterparts. Another recent study really rams this point home. According to a recent Reuters online health article, a University of Michigan study shows that the long shifts of some resident doctors-in-training impairs them so greatly that they might as well be DRUNK. Published in a recent issue of the Journal of the American Medical Association, residents who put in work weeks of 90 hours or more performed worse on a test of coordination than doctors who worked a light 44 hours, then liquored it up until their blood alcohol level reached a nicely-buzzed .05. Of course, the federal government is all over this problem - they've enacted rules that restrict residents from working more than 80 hours a week. Although this may seem like a solution to the problem, contrast this to another job that carries with it the responsibility for large numbers of lives: Pilots. According to the Bureau of Labor Statistics, commercial airline pilots are prohibited from flying more than 100 hours per month - and most average around 75 hours of airtime. That's less than 20 hours a week, or around a quarter of what most ED residents work (whether they're fatigue-drunk or not). I wonder why they haven't enacted similar guidelines for MDs? Although hospitals might balk at the notion at multiplying their Emergency Department employment rolls by 3 or 4 times over, I'd bet dollars to death certificates that an immediate and measurable decrease in surgical errors and other iatrogenic (doctor-caused) fatalities would be the result. I wish that were reason enough to try it. And speaking of government doing too little to protect you from medicine's mishaps… ****************************************************
Once again, the FDA sounds "charge" after the battle According to an AP report from a few weeks ago, the heroic, always-ahead-of-the-curve Food and Drug Administration has issued a formal warning that cautions doctors to avoid using the typical MD's chicken-scratch when prescribing 3 drugs with similar names. The drugs, called Topol (for hypertension), Topamax (for epilepsy and migraines), and Tegretol (for nerve disorders), are made by three different manufacturers, and they could cause serious side effects if taken by patients for whom one of the others is prescribed. Among these are hallucinations and seizures. At least one suicide attempt is thought to have been linked to the mix-up. Of course, the only real solution to this problem would be to eliminate some drugs from the market. If the fact that there are so many drugs out there they can't name them distinctively enough doesn't tell the feds there are too many of them, I don't know what would. What's really ironic is that the whole thing is the FDA's fault to begin with… They have official oversight of new drug names during the approval process. Exercising MY "oversight" power, William Campbell Douglass II, MD | 
