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September 1, 2007

Trucks, Planes, and Scalpels: Is There an Evidence-Based Approach to Surgeons' Working Hours?

Arch Surg. 2007;142(9):817-820. doi:10.1001/archsurg.142.9.817

There is at present an increasing body of evidence, in the form of both clinical studies and individual cases, suggesting that a tired physician is a dangerous one. A number of clinical studies have demonstrated that both technical and cognitive ability decline as a result of sleep deprivation and cumulative fatigue.1-7 Isolated cases in which long hours were thought to compromise patient safety have accelerated the implementation of such change at a local level. The unexpected death of an 18-year-old girl in a New York State emergency department in 1986 resulted in a landmark ruling against the hospital because she had been treated by an emergency department resident and a medical intern who had been on duty for more than 18 hours. The response to this ruling, along with lobbying from key political groups, resulted in a modification of New York State working hour regulations for physicians, limiting emergency department residents to work a maximum of 12 consecutive hours a day. Interestingly, since then, the effect of these regulations on physicians working in this state have been subjectively evaluated and shown to reduce fatigue and allow more time for reading, family interaction, and personal pursuits with little effect on examination scores and quality of patient care.8

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