Surgery is typically a delicate procedure that requires care and a sharp eye to perform. Surgeons work long hours, and individual surgeries can last for several hours. After the second or third surgery of the day, it is not at all surprising that surgeons might feel extremely fatigued. Is this a problem? Fatigue can have the same effect on mental capacity as impairment from alcohol, and this could compromise a surgeon's ability to perform effectively.
In a study that I found, it was shown that the level of fatigue in surgeons is directly correlated to decreased ability in surgery. Physicians and medical staff were shown to be fatigued for 50% of the day, and could be extremely fatigued for as much as 25% of the day. Surgeons that showed extreme fatigue were as much as 22% more prone to error during surgery than one who is fresh (McCormick et al. 2012).
It could prove to be a responsible move to allow for surgeons and surgical staff to have rest time after a long surgery in order to become more focused for the next surgery. I had the opportunity to watch a neurosurgeon in the summer of 2015 perform two surgeries. Each one was over four hours long, and there was only about an hour of downtime between them, then there was a 5 hour surgery after that. During this downtime, the surgeon, P.A.'s, and the nurses were busy completing paperwork and preparing for the next surgery. There was barely any time for them to eat or physically prepare. It might not be possible to provide dedicated rest time due to the high demand of surgery, but it could prove useful by allowing surgical teams to recuperate and provide better service to patients.
McCormick, F., Kadzielski, J., Landrigan, C. P., Evans, B., Herndon, J. H., & Rubash, H. E. (2012). Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Archives of Surgery, 147(5), 430-435.
I completely agree that sleep deprivation can take it's toll on someone and surgeons, as amazing a they are, are not exempt from the side effects. I think that this becomes an ethical issue and something that the individual needs to take personal responsibility for. Unfortunately, humans are bad at judging their own fatigue level. Carlos Pellegrini, MD explains that surgeons should be trained to identify symptoms of sleep deprivation and take necessary action. As a medical professional, they should be providing the best care possible even if that means sitting a surgery out to catch up on sleep.
ReplyDeleteI think that there is plenty of evidence suggesting that there should be more downtime in between longer surgical procedures. Unfortunately, the demands of the hospital will probably keep preventing that and therefore it becomes the responsibility of the individual to make the judgement call. Surgeries can be rescheduled. Lives cannot.
http://www.nejm.org/doi/full/10.1056/NEJMc1012517?viewType=Print