While regulations have been put in place to restrict the work hours of doctors in training, no such regulations exist for fully trained physicians. A recent editorial in the New England Journal of Medicine argues that sleep-deprived physicians should not be permitted to proceed with an elective surgery without a patient’s informed, written consent.
According to the authors, "This approach would represent a fundamental shift in the responsibility patients are asked to assume in making decisions about their own care and might prove burdensome to patients and physicians and damaging to the patient-physician relationship." They further write that "this shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas."
The editorial authors identify a number of barriers that may make this informed consent and surgery rescheduling unpopular with patients and physicians. Patients may have made logistical provisions for their surgery and may be unhappy if they have to reorganize their schedule again. Clinicians may lose cases to colleagues and thus income. Departments and institutions may lose income if patients reschedule and seek treatment elsewhere.
And while the study authors acknowledge that there may be financial and administrative costs associated with any informed consent plan, they argue that the costs may be offset by improved surgical outcomes and reduced complications.
Should drowsy surgeons be obligated to inform patients of their sleep deprivation? Vote in Sleep Review‘s web poll.
