Physician groups bristle at proposed "sleep regulations"

Sleep deprivation can addle someone just as much as a bottle of whiskey and therefore justifies regulations to protect patients from yawning surgeons, asserts a recent editorial in the New England Journal of Medicine.

For one thing, surgeons who have been awake for 22 of the past 24 hours could be required by law to disclose their condition to patients scheduled for elective surgery, who could then decide whether to turn to a fresher white coat or reschedule, write the authors.

Not so fast, replies organized medicine, including the American College of Cardiology (ACC). Yes, fatigue can fuzz thinking and degrade technical skills. However, mandating disclosure of sleep deprivation would usurp a physician's professional judgment as to whether he or she is fit to operate and could give litigious patients one more reason to file a malpractice suit, physicians argue.

"It opens a whole can of worms," ACC senior vice president for advocacy, Dr Jim Fasules, said in an interview.

The debate over a regulatory solution for the problem of sleep fatigue is not as theoretical as a recommendation in an editorial. The consumer-advocacy group Public Citizen and two organizations representing medical students and residents have asked the US Occupational Safety and Health Administration (OSHA) to limit work shifts for all residents to 16 hours. Since residency training helps mold the culture of medicine, OSHA restrictions on hours could reverberate throughout the profession, and not entirely for the good, some physicians contend. For one thing, they fear the growth of a shift mentality that subordinates patient care to physician comfort.