I read with interest your editorial, “Making short shrift of long shifts: the regulation of resident work hours” [November]. As a practicing Ob/Gyn, I usually work anywhere from 24-hour shifts to 24-hour days all week long. I do not have the luxury of an organization to regulate the hours I am permitted to work each week. Instead, my patients’ needs dictate my schedule. When I work a call of 24 hours—awake all night with a sick patient, surgery, or deliveries—and then have to practice the next day, my thought processes are much slower than they would be had I the benefit of a full night’s sleep. I do not think clearly, and there is an increased chance of my making a mistake. Unfortunately, there is no easy answer to this problem. There simply are not enough practicing Ob/Gyns to give me the time off required for recuperation.
—MYER S. BORNSTEIN, MD, FACOG
Dr. Barbieri responds:
I appreciate Dr. Bornstein’s insightful comments. I agree with him: After being awake for 24 continuous hours caring for obstetrical patients, my thought processes are not as sharp as they were at the beginning of the shift. Currently, the federal government regulates work hours for airline pilots and drivers of large motor vehicles, such as 18-wheel trucks. It is possible that additional research on the effects of acute and chronic sleep deprivation on physician performance will stimulate regulatory agencies to limit continuous duty hours for physicians, which would forever change the field of obstetrics. However, it is unlikely that such a step will be taken without carefully weighing the impact on public health and access to care.