No sleepy make doctor bad

Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med. 2012 Jan.;19(1):85–91. PMID 22221346

Interesting little study, if only because it’s not really testing the right outcome.

As a few prominent tweeters/twits said, the results are hardly a surprise.

METHODS

• small observation study of 13 EPs before and after day and night shifts
• did neuropsych testing before and after along with cortisol and melatonin levels.

RESULTS

• NB they seemed to work 10 shifts a month – if I read table 1 right. Now I’m all for the part time working (it’s what I’m trying to do) it’s just that I don’t know if that’s representative of shift patterns for attendings in the US in general
• they were poor at the tests after both night and day shifts.

As mentioned at the top, this is hardly surprising – tired people make mistakes. The interesting question is whether they make mistakes when it really matters.

I know people stopped by police on the way back from shifts because they were driving all over the road.

I know a guy who has occasionally ‘woken up’ on a road not even near his house on his way home.

We definitely aren’t in good shape after long shifts, especially night shifts – but the key thing is it’s after the shift.

There is a key little ‘professional’ circuit in our heads that enable us to keep on top our game, when we know we have to be. The moment we walk out the ED, we’re no longer on our game. Our guard lowers.

It would be much more interesting (though I’ve no idea how to test it) to see how docs cognitively performed while still on shift, in a real-life situation.

Oh wait, that’s what we call M&M meetings…

UPDATE

Have a look at what Casey over a Broome Docs has written on this previously

And @skepticscalpel has done the same on this paper