will overwhelm the aspiration to fully complete the
consent process via voluntary disclosure.
Yet, how easily can a surgeon deal with the repercussions of this disclosure? What options are available
for the sleep-deprived surgeon scheduled to perform
your mother’s sigmoidectomy? There is no standard,
institutionalized process to deal with mandatory or
voluntary disclosure of sleep deprivation. To improve
outcomes, the surgical profession must recognize
that sleep deprivation harms patient care, is an issue
that affects informed consent, and requires systemic
changes to accommodate the effects of mandatory
disclosure.
Sleep deprivation affects surgeon performance as it
affects all people—by impairing motor performance
and cognitive performance. 2 Drivers who slept less than
six hours the previous night were 10 times more likely
to be involved in a vehicle crash. 3 The performance of
fighter pilots, who are trained extensively to execute
tasks reflexively, suffers from sleep deprivation. 4
Though difficult to admit for some, surgeons
also are human and suffer from performance deficits secondary to sleep deprivation. Sleep loss leads
to a reduction in resident physician performance, and
an increase in perioperative complications. 5, 6 Conflicting evidence from large retrospective reviews
show that the science is not settled, and randomized
trials are needed. 7, 8 Nevertheless, in light of recent
evidence that medical errors are the third-leading
cause of death in the U.S., surgeons can improve quality by reducing errors due to sleep deprivation. 9 The
stakes are too high to wait until further research
confirms these preliminary findings. Recognizing
that sleep deprivation affects performance and could
affect patient outcomes, even slightly, is the first step.
Informing the patient
After acknowledging that surgeon sleep depriva-
tion could endanger patients, our duty is then to
inform patients of this risk factor. The informed
consent procedure is a hallowed process, more intri-
cate than a simple contract. It is one aspect of a
fluid discussion where the surgeon describes the
patient’s disease or injury, the medical and surgi-
cal treatments considered, and the potential risks
and benefits for that particular patient.
Yet, are we truly informing the patient of all
the risks of surgery? Are all the ramifications that
affect this sacred opportunity to operate on another
person being discussed? A simple categorization
of the variables affecting postoperative outcomes
could be divided into “patient factors” and “health
care factors.” As part of the informed discussion,
the patient learns about the risks associated with
their comorbidities and the steps taken to reduce
those risks. Health care factors are varied and difficult to alter, and they are more challenging to
explain as part of an informed consent. Even the
definition of sleep deprivation is ethereal and differs from surgeon to surgeon or patient to patient.
However, the number of hours that a surgeon has
slept in a 24-hour period or the number of sleep
interruptions during the night are quantifiable. If
it can be calculated, and its effect on patient care
can be placed into the proper context, then it must
be disclosed.
The precise definitions, mechanisms, and recommendations of disclosure will not be delineated
here. Rather, the surgical community needs to conduct an honest and thoughtful critical analysis of
how to achieve the goal of informed consent as
it pertains to the provision of health care by surgeons. The debate should not center on whether the
surgeon should inform the patient, but instead on
how to integrate the disclosure into the surgeon’s
schedule. Surgical societies have a duty to draft
consensus statements supporting and outlining the
details of mandatory disclosure. If we don’t create
the process, then the terms will be foisted upon us
by a well-meaning but inexperienced populace supported by nonsurgical groups. 10
36 |
