The list of the sleep-deprived includes everyone from freshmen hoping to defy the legend of the compass to Wharton students preparing for that first crucial interview with Goldman Sachs. But, according to Lisa Bellini, gracing the top of the exhausted list are medical residents.
"Residents are sleep-deprived -- there's no doubt about it," said Bellini, vice chair for education and inpatient services at the Hospital of the University of Pennsylvania.
At Tuesday's Eighth Annual Thomas Langfitt Jr. Memorial Symposium, medical students, residents and doctors joined together to discuss the topic of "Resident work hours: does patient safety mandate government intervention?"
Four esteemed panelists spoke to the audience, each giving a short speech in order to heighten audience awareness of the increasing need to provide patient safety and resident satisfaction while simultaneously allowing enough time for residents to sleep and rest.
The discussion began with David Grande, a third-year resident at HUP. Grande said he is in favor of government intervention. After 24 hours of being awake, Grande said that residents might as well be drunk -- they have a cognitive awareness equal to a .01 percent blood alcohol level. He went on to say that it is not the fault of the resident for poor performance, but rather, the "fault of the system."
And on some level, Congress seems to agree with him. As of last June, Congress passed a bill that limited the residents' work week to no more than 80 hours.
However, Grande said this bill is only a first step in fixing sleep deprivation problems.
David Dinges, a professor of psychology and psychiatry, provided some scientific insight into the study of chronic and acute fatigue.
Dinges said that society must "own the problem internally so that it fits within our economic boundaries."
He explained that the public must realize that the health care industry is a 24/7 operation -- residents who work for hours on end suffer cortex damage resulting in faulty cognitive decision- making.
"We must control behavior involving work, rest and sleep schedules," he concluded.
Following Dinges, Jordan Cohen, president and chief executive of the Association of American Medical Colleges, flat-out opposed government intervention in the problem.
If the government "is invited into the arena, we are giving up our professional obligation," Cohen said.
Instead, he said, the problem should be handled within the medical industry in order to strike a balance between continuity in care and the risk of patient safety.
The debate concluded with an address by Bellini, who offered a solution of her own -- a mandatory nap program to help ease the fatigue of residents' hectic schedules.
But the sleepless nights, Bellini said, are only part of the problem.
"Sleep deprivation should be used as a scapegoat for a lot of what goes wrong with American medicine today," she said.
As Cohen noted, no clear evidence exists that patients have been harmed by tired residents. However, he said that with the chronic fatigue that often plagues the medical community, the potential for damage remains significant and more research is necessary.
