It has been a long tradition in the medical field in the USA for doctors to work extremely long hours, especially residents (doctors still in training). This issue has been a focus of controversy for nearly forty years, after a patient named Libby Zion died under the care of a resident who had been on a 36 hour shift.

The case itself is controversial, but the parents sued the hospital because the attending physician had been working for nearly 36 hours straight.

Regardless of the debatable issues in the case itself, it put the public spotlight on doctors working under conditions of sleep deprivation. Since then, in the USA, the work hour rules have been limited. Residents should work no more than 80 hours per week nor 24 consecutive hours on duty.

While this is certainly an improvement, it is hardly a safe standard for patient care. And for senior doctors and specialists, there are no legal limits to working hours—none.

Compare the rules in the USA to those in the UK and European Union. Doctors there are not allowed to work more then 48 hours a week, nor more than a 13 hour shift.

Comparisons can also been made with other professions where the public safety is concerned. Airline Pilots and truck drivers have limits. Taxi drivers can’t work more than 12 hours straight, and air traffic controllers can’t work more than 10, and must have a full 9 hours of rest before the start of any shift.

The research on sleep deprivation is clear, people who don’t get enough rest have the thinking ability of a person who is above the legal limit of alcohol—impaired judgment and slow reaction times.

Says one surgeon, “I know of sleep deprived colleagues who made catastrophic mistakes on their patients. I know of residents who have fallen asleep standing up in the operating room.... And I know of doctors who have veered off the road after a night on-call and crashed their car into a tree. We need to stop denying the effects of sleep deprivation [and admit] that a sleep deprived doctor is dangerous.”

The problem is that traditional doctors worry about continuity of care, that is, they think there must be some loss of knowledge or skill if the patient is turned over to another doctor too quickly.

For critics, this is something of a God-complex by doctors who feel that the natural laws of sleep deprivation—that apply to all human beings—don’t apply to themselves. And also that they are superior to the other doctor to whom they must transfer the patient.

This, however, is an old paradigm. The new paradigm for patient care should be one of teamwork. Where skilled physicians assist each other, with adequate sleep, and sober consultation, on a patient’s care.