Asleep at the Scalpel

Still, it is common sense that one would prefer one’s surgeon to be fresh as a daisy rather than have a mind befuddled by exhaustion. The author, a specialist in sleep medicine, suggests that hospitals should forbid surgeons from operating who have not slept the night before, and that that they, the surgeons, should inform their patients about the state of their sleep when asking for their consent to an elective (non-emergency) procedure. This sounds like common sense.

As usual in such proposals, however, there is difficulty in knowing where to draw the line. According to research, chronic as well as acute sleep deprivation affects performance, both intellectual and manual. Chronic sleep deprivation is caused by things other than long hours at the hospital: for example, marital unhappiness. Should the surgeon have to reveal the state of his marriage to his patients? "Are you sure you are happily married, doctor?" As further research is done (subjects for theses are always need, after all), it is inevitable that more factors affecting performance will be found, bad traffic on the way to the hospital, for example, or difficulty finding a parking space. The list is potentially endless.

Thus a request for informed consent could end up sounding a bit like the Confessions of St Augustine or, worse still, of Rousseau. And here is one interesting little snippet: when the hours that junior doctors in Britain were allowed to work were restricted by law, the sickness rate among them promptly doubled. Is it better to have a tired doctor, or no doctor at all? Probably a bit of both.