Is your doctor too tired? Hospital shifts and your health (CBC Marketplace)

this is marketplace so these are the electrodes wiring up doctors what's the longest you ever gonna wake close to 24 hours 24 hours straight marathon shipped we paid the ultimate price my precious dog it's just not safe your life in their hands is your doctor too tired they couldn't get my brain to write words on paper it is your marketplace good morning my name is James and I'm an orthopedic surgery resident it's currently 5:30 time to wake up go to work so I'm gonna start my timer hi this is Christopher La Voz it's 5:30 in the morning I haven't done this since I was a resident so I'm going to officially start my timer all right good morning dogs wait before me it's 5:30 right now look at the timer 26 hours we go every morning across Canada medical residents like dr. James Yin are getting ready to start their shift at the hospital a shift that's regularly scheduled for up to 26 hours we want to know how safe that is for us their patients so I'm going to start off just by measuring your scalp that's why we're in London Ontario wiring up at Western universities sleep left so these are the electrodes normally lab manager Laura rays studies people sleeping these are actually going to be measuring your brain activity but we're doing the opposite staying awake I'm gonna do one behind each year James our first year residents and cardiologist dr. Christopher Lavos are going to help us I'm gonna have you put your hand on top of this piece what will staying awake for 26 hours due to our brains so those are your electrodes can sleep-deprived doctors still make life-and-death decisions so there you go should they be allowed to to find out we head to Boston to meet world-renowned sleep expert dr. Charles Iceland most common way that physicians I sleep deprived is when they work a marathon shift which is longer than 24 hours how do shifts like that affect your care size less US National Survey discovers sleep-deprived residents are five times as likely to make a serious diagnostic mistake and have a risk three times higher for errors causing death you're actually turning significant numbers yeah it's one of the reasons why we're so concerned about these the so-called tradition of working these marathon shifts for the resident physicians is because they do increase the risk of serious medical errors and medical errors that cause harm to patients not just death but also illness and disability so today when you hear about hospitals that have medical residents on 20 or 24 26 hour shifts what do you think it's just not safe we paid the ultimate price for losing my my precious daughter Taylor is just over a year old when she needs emergency brain surgery but the hospital can't reach the attending surgeon by pager he said in a statement to the Board of registration that he turned his pager on vibrate when home fell asleep that I answer any of his pages former state trooper James McCormick it's her dad to me it was either two things was he the one that it was overworked no no perfect fit eek oh he was doing something that he shouldn't Taylor dies from a series of preventable medical errors how does that make you feel that fatigue may have played a role in all this I get depressed but I work through it you know I have to be there for my other kids and it takes a real toll on me personally in Canada it's hard to know how doctor fatigue and patient deaths are linked because no one is keeping track dr. Chris la voz spent six years as a resident before becoming a cardiologist and medical journalist what's the longest shift you've ever pulled as a resident the longest I'd ever been awake working at the hospital would have been close to 30 hours and that's not just awake 30 hours that's at work that's not work trying to make sure people don't die 30 hours oh good were you at making sure people don't die after 30 hours well I think pretty good cuz no one died so I take some some solace in that fact Chris doesn't work those long shifts anymore but James does what some the typical shift for you as a resident right now I'm surgical resident so rounding our inpatients in the morning then we have our daily assignments either working in a clinic or helping on do are then when your assignments over you kind of follow up with any of the lab tested you may have ordered what's the longest you ever been awake um think close to 24 hours 24 hours straight yeah are you still functioning at 24 hours are you still able to perform yeah I think so we yeah I mean you are I do feel a little bit more tired but for most part you're getting things done is he right let the brainwaves decide I just need to get you wired into our machine after 15 hours awake research scientist Stuart Fogle plugs my brain into the computer alright let's do this thing can you hear me okay yes I can when the cross on the screen changes to a countdown we need to press the spacebar fast just as tired residents have to make snap decisions under pressure Stuart and Laura watch my brainwaves as I try to react he's tired and there's still 10 hours to go and what definitely less quick reflexes are blunted a bit so we have to think about things a bit more and there is the obvious risk of making mistakes back when he was a resident Quebec oncologist dr. Allenby Steve Rose was regularly scheduled to work long shifts what did you think of 30 hours when you were a resident too much too much I had had one one instance where it was late at night I was asleep the nurse paged me asking for a specific drug to be prescribed and and the next morning I had forgotten that I prescribed this drug there was no negative patient outcome from that mistake but certainly it made me aware at the sleep lab its hour 18 of being awake pilots and bus drivers aren't allowed to work this long it isn't safe but many medical residents in Canada are still on duty do you ever remember being worried about being too tired yeah actually one time when I've been up almost 24 hours straight I was coming off the red was coming on we rounded together on the patient so I could tell him everything that happened to them I tend to try to write something and I couldn't get my brain to write words on paper it's like yo give me give me the charts I'll write it don't worry about it that sounds pretty tired it's just tired at that point yeah and that's the problem you don't realize it as you're doing it would you want to know if your doctor had been awake for say 24 hours it's an interesting question should we be telling them you mean as a routine are you tired or wired test what you know about sleep and your brain at cbc.ca / marketplace always i opening this is your marketplace so we're gonna reattach everything that you guys pulled off to doctors and I are staying awake for 26 hours the same marathon shift many Canadian medical residents regularly work I feel okay a little bit Raj that's point a bit more tired and there's six more hours to go there it works we're just playing operation but many residents could be performing real ones after being awake this many hours 21 hours what do you think the odds are making a mistake are they better now than they were 10 hours ago I think you would still make the same decisions but I think it's gonna be a lot harder for you to sort of tease out what the patient is saying to get out some of the finer details it's not just Chris more than 8 in 10 residents surveyed say fatigue and long hours compromise the quality of care they give patients dr. Allenby Stavros remembers the time as a resident he wrote a prescription during a long shift I remember having a confusion about the pounds and kilos and the pharmacist calling me and saying you know the math is wrong after he do it if the pharmacist hadn't caught us what would have happened to the patient this was an antibiotic so it wouldn't have put the life of the patient in danger it could have bothered his kidneys perhaps that it could mean a prolonged length of stay in the hospital the patient has to go through an extra procedure and extra tests because we're fixing a mistake we did earlier were you ever scared about doing something that would result in a patient dying definitely scared scared enough to take action he files a grievance on behalf of all medical residents in Quebec doctor sais ler is called to testify we showed that limiting the shifts in no more than 16 consecutive hours significantly reduced the risk of serious medical errors the arbitrator agrees and in 2012 Quebec becomes the first in Canada to limit the length of shifts residents can work a maximum of only 16 hours I was happy that this went through I was happy that this was looked at carefully we were happy to be able to do to base our practice on the science that's coming out and move ahead since then other provinces haven't moved at all ranging from 24 hour shifts in BC up to 26 in Ontario working 26 consecutive hours is unsafe both for the physician themselves as well as for the patient we know that when people are awake for 24 hours their neurobehavioral performance is as impaired as if they were legally drunk now no one would argue that a patient doesn't have a right to know if they're going in for an elective surgical procedure that their physician is drunk so excited you out of the park Terry Masucci works at a Toronto advertising agency good girl puppy she needs surgery to repair a torn ligament in her knee now how would you feel if the doctor who did your surgery had been awake for 24 hours I feel nervous I mean I feel unnerved it would be you know a bit terrifying are they feeling okay then are they gonna remember what they're doing and with advertising there's a lot of long hours and trust me I know when I've slept three hours how I feel the next day would you want to know if your doctor had been awake for say 24 hours it's an interesting question I mean obviously yes I think it benefits the patient to understand what they're getting into when they're being put to sleep time for some answers we're meeting the president of the Royal College of Physicians and Surgeons of Canada dr. Emerich hey David yeah good to meet you dr. Kevin Emery co-chaired a national panel looking at resident duty hours if someone comes in for whatever they have to come in for and the doctor has been in the hospital for whatever reason for 24 straight hours should we be telling them you mean as a routine right now I would I would say that likely no because I think that there isn't evidence that suggests that that is an important factor that influences the outcome for those patients even though there are surveys and studies which have suggested that come 24 hours anybody doctors included are are problematic I would say that again from my perspective and from the perspective the systematic reviews of the literature that have been done there is not an impact on on patient care on the quality and patient safety the evidence seems to be good enough for New Zealand their max is 16 in the EU they cap their hours at 14 our 25 at the Sleep Lab in many Canadian hospitals residents are still briefing incoming doctors on their patients for the past three hours now I've been feeling like I can't properly function like I probably shouldn't drive a car yeah and if I feel like I shouldn't drive a car I kind of wonder why you should be able to be in a no our or making decisions that affect someone's life I don't think at the like the 26 our physicians are looking to go to the O R but they are available if necessary then the ICU you have less time to sleep but the work is what's keeping you alert and active for most of the night so okay you keep using these works alert and active yeah here's what I gotta say hey I forgot no I don't know that's what has something about sleep yeah you keep using words like alert and active and I'm looking at your face I know how long you've been awake the words alert and active do not come to mind I understand your concern and you're right I am not at my I'm not at my best now and yet I think that if you took most people who have had adequate training in cardiology and put them in a situation where they had to apply their training in their knowledge yeah they would apply their knowledge and training in a in a I'm trying to find the right word here and in a good fashion I should be able to come up with a better word than good at this point yeah but we're tired that's right four three two he's falling back asleep bow and a sneak-peek marketplace like you've never seen before people think go back to where you came from I'm like where Halifax Here I am a white guy discrimination doesn't come by my way a lot what are you feeling inside do you feel offended no I feel jealous don't blink you might miss your market place I've been awake for 26 hours with two doctors the Sleep Lab takes a look at what my brain is doing as I try to react quickly to the final test just like the routine but critical decisions medical residents have to make on the job he seems to be fighting to keep his eyes open where he's blinking quite a bit and probably having trouble focusing on the target his brainwaves they look drowsy actually more similar to when your eyes are closed so how do our resident James yawn do your action time - the task was quite quite normal in that in that range and I would say you performed admirably well for being awake for now 26 hours you're not a robot right we did confirm that yeah yeah make sure that you're a human being at all yeah yeah there's still may be signs of fatigue and drowsiness so it might appear you're okay on the surface but in fact there may be still signs that there's trouble how about our cardiologist and he's falling back asleep ow Chris la voz needs the rest but after a short nap he gets up to talk about his results I had to focus everything I had to just do that one task yeah I'd say that's pretty consistent with what we saw you feeling tired I'm feeling tired I have to admit I too was struggling a bit so what do his brainwaves reveal lots of blinking lots of drowsiness in your EEG periods where your eyes are closing in fact during the task almost a second it took you to respond when normally we should see respond in about 350 milliseconds too tired to safely drive when you look at results like that yeah if you were in a situation in a hospital where you were still working hmm would you know enough to take yourself out of the game I think at that point when I was doing the test I really felt that I just wasn't able to focus on the task anymore and and that's sort of the important part you have to always have that self-awareness of when you need help and when you need to call somebody in that would be a good call because in fact less than a minute total from when the task ended you're fast asleep making that call isn't an issue in Quebec where the maximum shift is 16 hours terry metochi lives in Ontario what do you think about that cuz we're not in Quebec it's crazy I mean you question why Ontario and rest of Canada isn't that way you know who's implementing the hours Canadian health care is free we should all be getting the same service same level of expertise from our physicians from our surgeons so let's ask the President of Canada's Royal College of Physicians and Surgeons dr. Kevin Emery there are a few things that we know do you think for instance at 24 hours someone is still functional as a physician we definitely do know that fatigue and sleep deprivation definitely does affect performance and the longer that you're up without sleep the more that performance is affected so if we know that why don't we have a maximum in terms of what a resident can work that narrow lens on just focusing on the maximum number of duty hours we don't believe is the right way to go but I think we know that come 24 hours someone is effectively legally drunk at that point by fatigue why are these residents still potentially expected to perform their duties we did recommend that we should be moving away from those longest hours that greater than 24 hours without restorative sleep that we need to move away from that but we believe that there needs to be some flexibility sleep expert dr. Charles size ler why is it that some in the medical profession are so resistant the idea of shortening shifts well a lot of it is about money there's a huge economic incentive to work those resident physicians who they're not paying the salary for as hard as possible so that they don't actually have to hire a physician and pay them the average salary for a resident 65,000 dollars the average for a physician 335 thousand is there an incentive to leave residents working longer hours because it saves money this is not something where residents are doing this work simply because it would be less expensive to have a resident do it and have other members of the team do it would you be comfortable bringing your parents in front of a resident who'd been awake for 23 hours I was showing clear signs of fatigue I have absolutely no hesitation whatsoever and bring a family member or a friend to be looked after I'm incredibly proud of the quality of care that our residents and our staff provide in the current system so absolutely I have no reservations at all dr. Emory's confident how about Terry metochi when you go for surgery tomorrow morning tomorrow morning 8 a.m. ok now that we've talked you all about sleep I know is that something you to ask yeah it's a tough one at that point if I asks do I jump off the bed you know I don't know that's a good question I have to I think we'll see when we get there let us know I will in the meantime our doctor Chris gets some much-needed sleep

Channel: CBC News

Views: 135,353

Rating: 4.8892732 out of 5

Keywords: CBC News, CBCNews, CBC broadcasting media, public broadcasting, news, Canadian News, Canadian Broadcasting Corportation (TV network), CBC News Network, marketplace, cbc marketplace, marketplace cbc, doctors, medicine, doctor, hospital, malpractice, sleep, insomnia, tired, sleepy, medical, mistakes, errors, nurses, test

Id: o2InLTV_hwE

Length: 21min 36sec (1296 seconds)

Published: Fri Feb 19 2016