Fatigue Dangers Provoke Questions

M. Jack Frumin, M.D.

To the Editor

I would like to raise the matter of fatigue as a significant risk factor in anesthesia.

As is well known, airline pilots must be alert during their flights. And to that end, the FAA has had, for a long time, a strict program of work hours limitations to prevent tired pilots from piloting airplanes and thereby endangering passengers.

What may not be known is that the State of California (and perhaps other states as well) have analogous rules for truck drivers, and for the same reason that the hours that airline pilots work are limited.

The work of an anesthesiologist is at least as taxing and important as that of an airline pilot or a truck driver. Yet there is virtually no regulation, no standard for our activities namely, the number of consecutive work hours that an anesthesiologist can work before he is required to stop and get some rest.

There was a malpractice suit in California in which the judge directed a malpractice verdict against a surgeon who worked all day and kept on working so that he was up all night with emergencies. Then, when he went on to do his regularly scheduled 8:00 A.M. case he had a mishap. The Judge’s action was based on his common sense, not on law, not on regulations, not on prior judicial rulings. His position, simply put was that no person, doctor or otherwise, who works all day and continues to work all night can be expected to perform optimally the next morning as well.

Yet this is exactly the situation in anesthesia many, many times. Why is it permitted?

I hate to say it but I think it is chiefly a matter of greed, income, dollars whatever you wish to call it. The remedy in this matter would be far more drastic than any of the activities of the Foundation to date. Regulation by some agency or authority of the hours one works which has a direct significant effect on income will cause howls like you never heard before

However, in order to make the case, though, on a rational basis, I would suggest two courses of action. One enlist (pay for) the support of scientists who are experts in the field of “shift work”, which is exactly what we do. A second approach would emulate what the Highway Patrol does in California. Compare the incidents in anesthesia with the work history of say the previous 24 hours of that physician. This would require going into the insurance companies data bank and then doing detective work through other records all of which may not be possible because of rules of privacy.

I hope that this is a provocative letter. It is meant to be.

M. Jack Frumin, M.D. Atherton, CA