Medical Care and Doctor Fatigue

Dr. Barron Lerner in the New York Times ("A life-changing case for doctors in training," March 3, 2009) misinterprets the history of Libby Zion and the Bell Commission, and draws the wrong lessons. The concern about medical resident fatigue dates not from the 1984 case but at least as far back as a 1971 study on the effects of sleep deprivation on electrocardiogram interpretation. Widely recognized concerns about physician fatigue led to a reduction from every other night call in the 1960s to every third then every fourth night in the 1970s and 80s. The tragedy of Ms. Zion’s death was the culmination, not the stimulus, of this trend.  
The important lessons of this death, not all of which have been addressed even today, are different concerns about how hospitals run:  Is it feasible for one physician to give adequate care simultaneously to patients "boarding" in multiple areas of the hospital, so placed because bed availability is sparse? How can physicians best care for hallucinating, intoxicated patients who resist care? How can one facilitate effective communication between supervising and supervised physicians? Are medical errors due to physician fatigue less or more severe than errors due to faulty handoffs? What system changes can one make to prevent these errors?

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