The business of doctors keeping people alive is fundamentally tiring. Doctors running long shifts with insufficient support isn't just a television trope. Sleep deprivation is the norm in the industry, and that means fatigue is a reality. Unfortunately, it is also a reality that can lead to medical malpractice, including patient injuries and deaths.
Fatigue is a condition that goes beyond simple tiredness. It means physicians often nod off and lose high-level cognition in ways that endanger patients.
If you or a loved one has suffered an injury or worse, you should consult with an experienced team of medical malpractice lawyers. Learn about the role of fatigue in physician mistakes and how you can protect your rights.
Doctors pull long shifts and often end up sleep-deprived. For some reference, sleep deprivation of 15-20 hours can create the equivalent impairment of a blood-alcohol level of 0.05-0.1%. In other words, a sleep-impaired doctor may be operating in worse shape than a legally drunk driver.
The prefrontal cortex is the part of the brain that deals with judgments, decision-making, and impulse control. It is also the part of the brain that struggles first when a person has had insufficient rest.
Combine this with the workload a doctor has to hold mentally.
Now, throw in the basic skills that doctors have to repeatedly exercise in dealing with each case. Medicine requires a long working memory, good reaction times, and vigilance.
Sleep deprivation makes it challenging for a doctor to critically assess their own ideas. If they make a mistake, a sleep-deprived doctor is less likely than a rested one to correct it. Worse, doctors often go unchallenged by nearby doctors, nurses, and other professionals.
Overwork is baked into the working culture for doctors from the time of their residencies. In the old days, residents might have pulled 24-36-hour shifts. Even now, with limits in place, the cap sits at an 80-hour work week for residents. There are no limits on attending physicians, either.
Doctors are frequently on-call for overnight shifts and emergencies, too. Double shifts are incredibly common in emergency rooms, ICUs, and surgical suites. Understaffing at hospitals, especially small ones, only adds to the trouble.
Research has demonstrated that doctors' error rates significantly rise between hours 9 and 16 of a shift. Errors go through the roof after that.
The post-call period is especially worrisome. This is the time when doctors are transitioning off of overnight duties. They often perform handoffs to the next shift and discharge patients with little to no oversight.
Overwork during night shifts only compounds the problem. Doctors lose their circadian rhythm, which broadly and negatively affects performance. Worse, the culture of the medical world portrays power through sleepiness as heroic and critical to the job.
Medical work is about predictably going through details in a way that arrives at answers and treatments. Plenty of processes in medicine fail when sleep makes it harder.
Diagnostic work is among the most challenging. Sleep-deprived doctors are more likely to accept the first possible diagnosis rather than work through a problem. Likewise, poorly rested physicians are more prone to forgoing tests to confirm their diagnoses.
Dosing is another problem for fatigued doctors. Professionals may choose the wrong medication, ignore known interactions, or get the dose wrong if they don't have enough rest.
Procedural errors often occur, too. Fine-motor movement is critical in modern surgery, especially with the rise of laparoscopy. Today's procedures often run into double-digit hours, also.
Communication and documentation are just as important. Even if the doctor on the current shift is rested, the fatigued doctor from the last shift may have forgotten to tell them something important. Even failing to pass along a single piece of paperwork can be life-threatening if the omission leaves the next doctor less informed.
Monitoring is more likely to lapse when doctors are fatigued. A doctor may ignore an alarm, especially if there have been repeated alarms over a long shift. Tired doctors are more apt to ignore the deterioration of a patient, too.
A medical malpractice lawyer typically needs to address the core question of whether a doctor met a professional standard of care. This means attorneys have to document where things went wrong and then explain to an insurer or a jury how that constitutes malpractice.
Malpractice rules usually require a physician to stay in a condition where they can render competent care. Severe fatigue can produce a deviation from the standard of care.
Attorneys work hard to find the paperwork that documents how and why fatigue happened. Sign-in and sign-out logs include badge swipes and maybe even signatures. Schedules show how shifts work. More importantly, they sometimes open hospitals up to claims based on institutional neglect.
Incident reports and internal communications tend to tell who was making decisions at the time when something went wrong. Payroll records reflect much of the same information.
Lawyers also frequently rely on expert witnesses to discuss fatigue's impact on physician performance. Sleep medicine specialists can explain to insurance companies and courts what the consequences of low rest are. They can flag peer-reviewed research that often builds a case more. Experts can even connect the dots between the specific time and nature of an incident versus a physician's documented fatigue.
