Research Activities, October 2013
Pros and cons of patient consent for sleep-deprived surgeons to operate
Patient Safety and Quality
Studies of the impact of sleep deprivation on the performance of physicians have had mixed results. Some show adverse effects on patient care while others do not. Recently, two noted physicians argued the pros and cons of whether sleep-deprived surgeons should be required to obtain informed consent from patients before elective surgery.
On the pro side, a neurologist who specializes in sleep disorders believes the evidence is clear and that the surgeon should disclose the risks and obtain consent. On the con side, a surgeon who is a leader of the American College of Surgeons believes informed consent is not the answer. Instead, surgeons should receive enough information on sleep deprivation to plan their work life so they can avoid such situations.
One doctor cites several studies that demonstrate the impact sleep deprivation has on performance. It impairs cognitive and emotional brain functioning, as well as clinical task performance and the mood of physicians. Repeated sleep interruptions experienced by physicians can lead to sleep deficiency and excessive daytime sleepiness.
The key question is if an ordinary patient would consider sleep deficiency a risk that should be disclosed to them? Would they want to know if their surgeon had been working for 24 hours or more straight before operating on them?
A poll found that 6 out of 7 Americans would consider the surgeon to be at risk to do harm; 70 percent would ask for another surgeon. That would suggest, according to the neurologist, that patients have the right to know if their surgeon has been working 24 hours or more and to decide whether to receive care from them.
According to the surgeon, mandating that a surgeon disclose sleep deprivation to a patient without a measurable effect on the outcome is not indicated. He believes it is inhumane to do so at a time when the patient is most vulnerable. Instead, surgeons should excuse themselves from doing the operation based on concern for patient safety. If they must disclose sleep deprivation, should they also disclose if they slept well before an operation or the many other personal factors that could interfere with focus and function?
According to the surgeon the solution should start with the surgeons. In addition to individual responsibility, surgeons should look out for one another and create rules on performing elective procedures after night calls. Finally, he notes that the bulk of the responsibility lies with the institution to make sure high-performing teams determine that everyone is "fit for duty."
For this doctor, informed consent is an easy way out. Instead, the surgeon and the system need to take responsibility for delivering high-quality surgical care. The study was supported in part by AHRQ (HS13333, HS15906, and HS14103).
See "Should sleep-deprived surgeons be prohibited from operating without patients' consent?" by Charles A. Czeisler, Ph.D., M.D., Carlos A. Pellegrini, M.D., and Robert M. Sade, M.D., in the Annals of Thoracic Surgery 95, pp. 757-766, 2013.