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Does Working Longer Hours Endanger Patients?

March 25, 2017

The Accreditation Council for Graduate Medical Education (ACGME) will allow first-year resident physicians to see patients 24 hours per day, for up to 80 hours per week starting July 1, 2017. In 2011, ACGME limited the number of hours a first-year resident could see patients to 16 hours per day. ACGME restricted the patient time to 16 hours out of a concern that fatigued trainee physicians would be mistake prone. ACGME now claims that the restrictions it imposed in 2011 made no significant contribution to patient care.

Tired, fatigued, and inexperienced physicians can be a lethal combination. Consequently, ACGME will revise some of its restrictions to ease the burden on trainee physicians. Any work performed off-site will count toward the 80-hour maximum. Additionally, the first-year residents will be allowed to stay with cases longer to accommodate patients and families. The ACGME has increased the maximum work time allowed because the group's analysis has shown that working on 16-hours did not appreciably increase patient safety. Furthermore, the level of education the trainee received appears to be greater when working longer hours. Recent test results indicate that physicians receive better examination scores when exposed to longer work hours.

Many in the medical profession consider first-year residency to be a rite of passage. While this thinking may be outmoded, researchers claim that there is a tangible benefit trainee physicians receive while struggling to survive the first-year residency. The residents must endure a lifestyle change. They go from student to practicing physician and the period of adjustment benefits the student.

Danger still lurks for overworked, overstressed and exhausted doctors. One need not look any further than the famous case of Libby Zion. She was eight years old when she died after receiving medicine prescribed by an exhausted resident who was in the middle of a 36-hour work shift. That tragic incident gave rise to the implementation of the 24-hour work day and the 80 hour work week maximums.

Fatigue can wreak havoc on an individual's cognitive functioning. It can impair the doctor's ability to think clearly, make rational decisions, memory, and ability to communicate on an interpersonal level. Sleep deprivation, on the other hand, is different from fatigue but is associated with reduced levels of cognitive output. The effects of sleep deprivation can be observed in a person who has accumulated less than five hours of sleep in a 24 hour period.

The effects of sleep deprivation are:

• Declining cognitive functioning;
• Decreased efficiency;
• Decreased ability to think clearly;
• Anti-personal behavior; and
• Attempts at inappropriate humor.

There are certain times of the day that the tired body decreases functioning capacity. During the hours of 2 AM and 5 AM, the body's temperature is at its lowest and so are a person's mental abilities. A person's level of alertness plummets during this time. This deficit is attributable to a person's normal circadian rhythms. The body wants to sleep during the middle of the night. Sleep deprivation can be warded off by effort and increased alertness and increase dramatically when the project is about 90% completed. However, an extension of time required to complete the task causes an energy drain and fatigue to set in.

How Can A Georgia Medical Malpractice Attorney Help?

A knowledgeable and skilled Georgia medical malpractice attorney can conduct a thorough investigation into the claim of malpractice. One of the issues to be investigated is the level of performance demonstrated by the physician as determined by the physician's level of fatigue. Even if the newest training standards permit first-year residents to work longer, they must be aware of the consequences of fatigue and sleep deprivation as they relate to healthcare.

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Please Note:
Many of our blog articles discuss the law. All information provided about the law is very general in nature and should not be relied upon as legal advice. Every situation is different, and should be analyzed by a lawyer who can provide individualized advice based on the facts involved in your unique situation, and a consideration of all of the nuances of the statutes and case law that apply at the time.