It’s 8 p.m., and I stumble into my apartment and fall into bed. Somehow, I avoided nodding off in the car driving home. I just finished a 36-hour shift, something I thought was an inhumane task. Somehow, I survived on two hours of sleep, incessant phone calls, pages, and a granola bar. This morning I saw a cat in my apartment, except I don’t have a cat. I fumbled through patient care all day and had to listen to family members complain about their uncomfortable and periodically nurse-interrupted sleep. I forgo food tonight as I collapse into bed and fall asleep almost immediately. There are only ten short hours before I have to be back in the hospital to start another 36 hours. Medicine makes me sick. Not like in the emotional or moral sense, although it does that too. But practicing medicine actually makes me sick. In college, I quickly realized that if I don’t get enough sleep for a week or so, I will get sick. Every semester after finals week, I got my biannual cold from the sleep deprivation that is finals week for a premed. So, I would often spend Christmas or the first few weeks of summer coughing, sneezing, sniffling, and sipping tea wondering who got me sick, until I realized, after two embarrassing years, that it was the sleep deprivation that got me sick. Once I figured this out, it was a simple fix. Be more disciplined in my studying, prioritize sleep, and I won’t get sick. Surprise, surprise, it worked. Sleep is an incredibly important function for humans. It is the time that the body is able to assimilate memory and recover from the day. We can live longer without food than we can sleep. Sleep deprivation is widely known to cause a negative impact on mood, cognitive performance, and motor function. Executive attention, working memory, and divergent higher cognitive function — all functions that physicians with lives in their hands should have at peak working order — are particularly vulnerable to sleep loss. The American Academy of Sleep Medicine and the Sleep Research Study released a statement in 2012 stating that sleep deprivation contributes to a number of molecular, immune, and neural changes that play various roles in disease development. The changes in these biologic processes in response to chronic sleep deprivation contribute to the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. The problem is that our residencies, fellowships, and hospitals mandate long work hours because it has been the tradition in the American medical system. We do this not because it has been proven to be the best training system or that it provides the best care for patients, but simply because it is what was done previously. As other industries continue to advance with workforces that are more refreshed and are able to work effectively while they are at work, medicine continues to choose long, inefficient work hours. A recent study of over 2,000 surgeons asked respondents if they would have done anything differently during their career. More than half of the respondents would have done something different with their career. The most common thing this group would change about their career was to spend more time with family and taking better care of themselves. Unfortunately, despite our desire for the most up-to-date medical data, we as a medical community are incredibly slow to implement change. We have built these systems that put the bodies and brains of trainees and attendings on the line with increasingly high rates of burnout, addiction, depression, and suicide. We mistakenly believe that these systems are our only options because it’s all we know. Then, instead of fixing administrative burdens, streamlining EMRs, and reducing the non-patient care tasks that physicians must do on a daily basis, hospitals create yet another task to complete, a 30-minute online teaching module that every physician must watch on “wellness.” In the face of large amounts of scientific data, we need a large restructuring of the way we practice medicine. Reduced shift hours, night float systems, and a stronger focus on preventive measures are the only way to reverse the illnesses of burnout, depression, and suicide that medicine has propagated. Vybhav Jetty is a cardiology fellow. Source
