Sleep is a funny thing. We're taught that we should get seven or eight hours a night, but a lot of us get by just fine on less, and some of us actually sleep too much. A study out of the University of Buffalo last month reported that people who routinely sleep more than eight hours a day and are still tired are nearly three times as likely to die of stroke--probably as a result of an underlying disorder that keeps them from snoozing soundly.
Doctors have their own special sleep problems. Residents are famously sleep deprived. When I was training to become a neurosurgeon, it was not unusual to work 40 hours in a row without rest. Most of us took it in stride, confident we could still deliver the highest quality of medical care.
Maybe we shouldn't have been so sure of ourselves. An article in the Journal of the American Medical Association points out that in the morning after 24 hours of sleeplessness, a person's motor performance is comparable to that of someone who is legally intoxicated. Curiously, surgeons who believe that operating under the influence is grounds for dismissal often don't think twice about operating without enough sleep.
"I could tell you horror stories," says Jaya Agrawal, president of the American Medical Student Association, which runs a website where residents can post anonymous anecdotes. Some are terrifying. "I was operating after being up for over 36 hours," one writes. "I literally fell asleep standing up and nearly face planted into the wound."
"Practically every surgical resident I know has fallen asleep at the wheel driving home from work," writes another. "I know of three who have hit parked cars. Another hit a 'Jersey barrier' on the New Jersey Turnpike, going 65 m.p.h."
"Your own patients have become the enemy," writes a third, because they are "the one thing that stands between you and a few hours of sleep."
Agrawal's organization is supporting the Patient and Physician Safety and Protection Act of 2001, introduced last November by Representative John Conyers Jr. of Michigan. Its key provisions, modeled on New York State's regulations, include an 80-hour workweek and a 24-hour work-shift limit.
Most doctors, however, resist such interference. Dr. Charles Binkley, a senior surgery resident at the University of Michigan, agrees that something needs to be done but believes "doctors should be bound by their conscience, not by the government."
The U.S. controls the hours of pilots and truck drivers. But until such a system is in place for doctors, patients are on their own. If you're worried about the people treating you or a loved one, you should feel free to ask how many hours of sleep they have had and if more-rested staffers are available. Doctors, for their part, have to give up their pose of infallibility and get the rest they need.
Dr. Gupta is a neurosurgeon and CNN medical correspondent