Issues of Fatigue in Medical Residents

How would you feel if you knew that the doctor inserting the stent in your heart was on the 24th hour of his shift? Understandably so, most likely worried. Thoughts going through your head would definitely include what would happen if this doctor fell asleep or inadvertently caused a severe injury as a result of drowsiness. Unfortunately, these are realities that all patients who are treated in teaching hospitals face. Medical residents often work unimaginably long shifts, sometimes exceeding 24 hours. Levels of fatigue by the end of these work periods have contributed to accidental injuries and deaths; it is no secret that humans make more errors when they are tired (Bates). Why not just limit shifts to a standard eight- or twelve-hour day? Continuity of care. This concept has caused physicians to widely believe that they are immune to the symptoms of fatigue. Only recently has the medical community begun to implement some work hour restrictions. While continuity of care is definitely important to patient safety and equally as important to teaching medical residents, the potential rewards do not justify the inevitable risks. Fatigue in medical residents is a serious issue and a cause of worry to patients worldwide.
Fatigue and sleepiness is a concern both in and out of the medical field. Humans who work at night often experience disruptions of circadian rhythms. Working for extended periods of time can cause degradation of memory, inattentiveness, and poor coordination. Recently, an oil tanker ran aground near Rhode Island while being piloted by a captain who had not slept within 36 hours. In Pedro, Wyo, an engineer and brakeman on a train fell asleep and plowed into another train (Moore-Ede). These conditions ...

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...epressant phenelzine. Later, the resident ordered meperidine, a drug that should not be taken in conjunction with phenelzine. Shortly after, Zion experienced respiratory failure and passed away. The incident led to an investigation, and the grand jury found that the resident had been working for more than 22 ours at the time the medication was ordered. The report cited “medically deficient care” and described the residency system as a whole as “counterproductive to providing quality medical care” (“Medical Resident Fatigue”). Regulations have gotten stricter since 1984, but residents still often work shifts in excess of 22 hours. Therefore, the work hour restrictions that the ACGME recently put into place still need to be studied and revised to provide residents with ample time to rest and recover during long shifts in order to properly ensure patient safety.