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Medical Interns and Sleep Deprivation

Most doctors recommend that we get between seven and eight hours of sleep a night. But what happens when those doctors don’t take their own advice? Often hospital doctors are forced to work long shifts. Some medical interns will work up to 85 hours a week, including two “extended shifts” that can last up to 30 consecutive hours.

The result of these extended hours is that doctors make a lot more mistakes than they normally would. They also make more serious mistakes than they normally would. A study conducted at the Harvard Medical School reveals that when these extended shifts were eliminated, the interns made 36% fewer serious medical errors. Those students who worked the extended shifts made 21% more serious medication errors and as many as five times as many serious diagnostic errors, says Charles Czeisler of Harvard.

Medical interns have traditionally been a severely sleep deprived group, prone to car crashes, health problems, and errors at work. This problem is so bad that in 2003, the Accreditation Council for Graduate Medical Education (ACGME) capped the number of hours that interns were allowed to work at 80-88 hours a week.

Two recent studies in the Journal of the American Medical Association have evaluated the effect that the ACGME standards have had on the medical internship. The first study asked interns how often the standards were adhered to by their hospitals. Of the 4,015 interns that responded, 83.6% reported that they were required to violate the standards at some point during their internship.

The second study looked at whether interns were at risk for injuring themselves as a result of sleep deprivation. This study compared the number of needlesticks and lacerations, known as percutaneous injuries, to the hours worked by the interns. The study predictably found that percutaneous injuries occurred more often during long shifts and night shifts. Of the 17,003 surveys collected, the study noted nearly 500 injuries due to “lapse in concentration” or “fatigue.”

The inability of doctors, especially emergency doctors, to get a good night’s rest is troubling. These doctors are required to perform up to 200 tasks a day, from diagnosing diseases to prescribing medicine to performing surgery. Hospitals put their patients at risk every day when they place interns on the hospital floor who are not fully rested.

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