Report: Young doctors still too tired for safety

[December 03, 2008]  WASHINGTON (AP) -- Doctors-in-training are still too exhausted, says a new report that calls on hospitals to let them have a nap. Regulations that capped the working hours of bleary-eyed young doctors came just five years ago, limiting them to about 80 hours a week.

Tuesday, the prestigious Institute of Medicine recommended easing the workload a bit more: Anyone working the maximum 30-hour shift should get an uninterrupted five-hour break for sleep after 16 hours.

At issue is how to balance patient safety with the education of roughly 100,000 medical residents, doctors fresh out of medical school who spend the next three to seven years in on-the-job training for their specialty. The long hours are in some ways a badge of the profession; doctors can't simply clock out if a patient is in danger.

But sleep deprivation fogs the brain, a problem that can lead to serious medical mistakes. So in 2003, the Accreditation Council for Graduate Medical Education issued the first caps. Before then, residents in some specialties could average 110 hours a week.

The government asked the IOM to study the current caps. Violations of current limits are common and residents seldom complain, the committee found. While quality of life has improved, there's still a lot of burnout.

And despite one study that found residents made more errors while working longer shifts, patient safety depends on so many factors that it's impossible to tell yet if the caps helped that problem, the report said.

So it also recommends:

• Experienced physicians should more closely supervise residents.

• Better overlap of schedules during shift changes to reduce chances for error as one doctor hands patients' care over to the next.

• Increase mandatory days off each month, and extend hours off between shifts depending on how long the resident worked, during day or night.

The accreditation council didn't immediately say if it would follow the recommendations.

[Associated Press]

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