To the Editor.
—Dr Leape1 is to be commended for his challenging look at the problem of error in medicine. However, his approach to understanding and preventing these errors, while thoughtful and provocative, all but neglects the conditions of sleepiness and fatigue as more obvious and potentially more fixable causes of mistakes.1Undiagnosed sleep disorders, effects of shift work, and chronic sleep loss are likely to cause sleepiness in many health care professionals.2 Numerous investigations have shown that sleepiness causes detrimental effects on psychomotor skills, memory, judgment, vigilance, concentration, attention, and learning, all of which could contribute to accidents and mistakes.2 Substantial evidence already exists to implicate sleepiness as one of the main pathways for errors in medicine and elsewhere, such as in motor vehicle crashes.3 Sleepiness and fatigue have been implicated3 as contributing factors associated with the well-known catastrophes (Challenger, Bhopal, Chernobyl) mentioned
Krakow B. Error in Medicine. JAMA. 1995;274(6):457-458. doi:10.1001/jama.1995.03530060031017