“Physician, heal thyself” is a proverb from the Bible. It is often interpreted to mean that people should tend to their own frailties before trying to correct the defects of others.
Doctors frequently offer lifestyle advice to their patients. “Lose weight” and “exercise” are common admonitions. These are, of course, highly desirable. But one other important aspect of healthy living, a good night’s sleep, may get short shrift.
When people are sleep deprived, their judgment is impaired, their immune system may not function optimally and they may be at greater risk for obesity, diabetes and high blood pressure.
One would hope that physicians would encourage patients to get enough sleep. But the medical system is set up so that doctors-in-training themselves are chronically sleep deprived.
The Institute of Medicine would like to see that changed. This prestigious body, which advises the federal government on health policy, recently issued a report addressing lack of sleep for doctors in training. It called for significant changes in scheduling medical residents’ hours on duty.
Historically, residents put in unbelievable hours, often exceeding 100 in a week. That was supposed to be reduced to 80 hours a week in 2003, but residents still regularly work 30-hour shifts. The IOM now recommends that residents should get five hours to sleep after working 16 hours straight.
Why? Research has shown that residents leaving the hospital at the end of their 30-hour shifts are more likely to fall asleep at the wheel or be involved in traffic accidents. If they can’t drive home safely, can residents be expected to make life-and-death decisions on patient care properly? Many experts feel that fatigue probably contributes to the high rate of medical errors that harm patients in U.S. hospitals each year.
Doctors who have been through this barbaric system often defend it as a useful trial-by-fire experience. They argue that it offers an intense learning environment, like boot camp for Marines.
No other professional is expected to work 30 hours straight without sleeping. The FAA won’t let pilots plan to fly for more than 8 hours at a time. Federal regulators know exceeding that time frame wouldn’t be safe. Truck drivers are limited to driving 11 hours in a shift. Doctors’ work is at least as demanding as flying a plane or driving a truck.
Like it or not, health care providers often serve as role models for their patients. An obese physician has little credibility when he tells a patient to lose weight. A doctor who smokes can’t easily convince a patient to give up a nicotine addiction.
If physicians don’t value sleep, how can they encourage their patients to get enough for good health? We have prepared a Guide to Getting a Good Night’s Sleep that offers dos and don’ts, non-drug options and discusses the pros and cons of most sleeping pills.
For a different perspective on this issue, look for John Grohol's comment at e-patients.net
