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NEJM: Sleepy Surgeons Should Get Patient Consent

An editorial in the The New England Journal of Medicine recommends that patients provide informed, written consent to undergo elective surgery by physicians who haven't had enough sleep. Steve Mirsky reports

Over the years regulations have developed to limit the hours of hospital interns and residents. Because someone putting in a 100-hour workweek might not be at their best when deciding which medication to prescribe or when inserting a Foley catheter. But doctors who have finished their training don’t face any restrictions in their hours. Now The New England Journal of Medicine argues in an editorial that sleep-deprived physicians set to perform elective surgery should have to get the informed consent of the patient. [Michael Nurok, Charles Czeisler, and Lisa Soleymani Lehmann, "Sleep Deprivation, Elective Surgical Procedures, and Informed Consent"]

Sleep deprivation can impair motor skills as much as alcohol intoxication can. The editorial cites a 2009 study in the Journal of the American Medical Association that found an increase in the risk for complications in patients who had elective surgery performed by surgeons who’d had the chance for less six hours of sleep during a previous on-call night.

The editorial’s authors note that such consent represents a new responsibility for patients in making decisions about their care. It could damage the patient-doctor relationship. But, they say, "This shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas."

—Steve Mirsky

[The above text is an exact transcript of this podcast.]

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