I don’t want you to take care of me if you’ve been awake for 16 or more hours. It doesn’t matter how smart you are or how good you feel. There’s clear evidence that your cognitive and motor skills are beginning to deteriorate at that point. Yet medical education still refuses to admit this limitation to the delivery of modern health care.

Ironically, it’s the senior physicians, the attending physicians, who are more likely to perform well while fatigued. It probably has to do more with the better pattern recognition skills in experienced physicians rather than a lack of fatigue effect. Yet, it’s the attending physician who is home in bed while the least experienced physicians and medical students provide you with care in the middle of the night.

It’s been many years since the residents were limited in the number of hours that they are permitted to work- either consecutively or in aggregate per week. Yet no one can show a change in outcome associated with the limitation. Part of the reason is that residents in some programs are actively encouraged to “fake” the number of hours they record in their log books. In such a circumstance there would be no detectable result from a “reduction” in work hours since there is effectively no reduction.

The reductions proposed by the Institute of Medicine (“IoM”) are a welcome and necessary step for reducing patient harm. The IoM report also reiterates the need for those attending physicians to actually supervise residents. Again it’s an issue of safety.

So what should you do?
1) Ask who the “doctor” is. Is he/she a “real” doctor or just a resident?
2) Where is the attending? Will the attending learn about you and the planned care before the therapy starts?
3) Is the physician rested? Or, has he/she been working the permitted 30 (you read that right thirty) consecutive hours?

It’s your health. Take charge and take it seriously.