Sleep deprivation is an issue that affects practising physicians and not only medical residents, and we need to establish standards for maximum work and minimum uninterrupted sleep to ensure patient safety, states an editorial in CMAJ (Canadian Medical Association Journal).

A recent study indicated that lack of sleep can result in higher rates of surgical complications if a surgeon had less than six hours of sleep the preceding night. Doctors practising post-call may not be at optimal levels as fatigue can effect mental acuity.

"The problem may only be getting worse," write CMAJ editors Drs. Noni MacDonald, Paul H├ębert, Ken Flegel and Matthew Stanbrook. "Medical care today is more complex than in decades past....Increasing complexity of care at the bedside or in the operating theatre places unprecedented cognitive and physical demands on doctors who oversee and deliver care in these environments."

However, there are barriers to limiting physicians' work hours, including increased costs and the need to increase the number of doctors and residents in the system. As well, ensuring that physicians comply with restrictions on work hours may be a challenge.

"We doctors ourselves are part of this problem," write the authors. "We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride."

They suggest that "licensing, accreditation, insurance and government institutions need to establish minimum best practice standards for maximum work and minimum uninterrupted sleep hours."

Kim Barnhardt
Canadian Medical Association Journal

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