Sleep thyself

Doctors are tough but need enough rest to work

People who haven’t slept in 24 hours shouldn’t drive. So can it possibly make sense for first-year doctors to be at work that long, taking care of patients?

The Accreditation Council for Graduate Medical Education has repealed its rule saying first-year residents must not be kept working more than 16 straight hours. That leaves them with the same cap that applies to more advanced trainee doctors: 24 hours, plus four more for handoffs. Another rule limits their average week to 80 hours.

Long shifts can contribute to patient health, the council argues, because they allow a patient to remain with the same doctor longer. But the council’s new rules also require both residents and faculty members to learn about fatigue and fighting it. The rules require policies to relieve, “without fear of negative consequences,” residents who can’t do their work, including because they’re too tired.

Ensuring physicians are at their mental best, despite longer shifts, will take a commitment by the medical community. The ACGME’s rules are a good start. But paper rules are not enough. They must be enforced.

This culture change in medicine can’t just be about first-year residents. Other doctors, including more advanced trainees, also work long shifts. Physicians at every level must be taught to combat fatigue and, when the situation warrants, allow themselves to be relieved.