Yawning doctors: Harmful to your health?

A study in this month's Pediatrics examines communication lapses during shift changes that can have serious consequences for the health and safety of patients. Researchers at the University of Chicago observed first-year residents spending 10 to 15 minutes at the end of their shift informing members of the next shift about their patients. Frighteningly, the information that the outgoing residents identified as being most important was not successfully relayed 60% of the time. This included key points such as why certain patients where taking specific medications. Despite these shortcomings, both incoming and outgoing residents characterized their communications as effective.

Below the surface of these findings lurks a worrisome political subtext. The issue of limiting the length of shifts that residents are required to work weighs heavily on this research. In the US, 30-hour shifts are the norm, even though New Zealand has limited them to a maximum of 16 hours, and the EU to 13. Sleepy doc's are more likely to harm patients and themselves, and suffer from impaired judgment. Apparently the white coat doesn't make doctors any more impervious to old-fashioned fatigue than you or me. But despite ongoing reforms, America's medical education culture is unwilling to reduce work hours for residents. Often justified as necessary due to a physician shortage that we may or may not be experiencing, this new paper raises the possibility that shorter shifts may in fact create new harms.

"When resident hours are shortened, you have more hand-offs," says co-author Vineet Arora, MD. "You could have concerns about either a tired physician who knows the patient or a well-rested physician that may not know the patient. The tradeoff is between fatigue and familiarity."

But a third option is not mentioned: Taking steps to improve care coordination. I find it worrisome that the statement of trade-off is made with such finality. We already know that care coordination is one of the biggest problems in American health care today. And the efforts of pioneers including my former professor Dr. Paul Batalden prove that quality improvement efforts can lead to drastic reductions in medical errors and improvements in outcomes.

Dr. Batalden asserts that quality improvement is everyone's job, and constant development and training of the workforce is a necessary part of health care. Not only does this refine skills and identify opportunities for improvement, it empowers professionals with the ethic that they can and must improve what they do. That's why I find the assertion that "fatigue and familiarity" are the only two options during health care shift changes to be reprehensible. Not only is it not true, it's disempowering. We already have to worry about whether we'll be able to afford to pay for our stay, or whether we'll catch infections while in the hospital. Should we also have to worry about how sleepy the doctor is? And might doc's who are fresher on their feet also be able to communicate better at shift changes?

Photo Credit: The author.