Fatigue Swallows Up Vigilance

Herb Lee, MD

To the Editor

I am writing in response to the topic of fatigue and the practice of anesthesiology. It has been said that common sense cannot be taught in schools. Fatigue and performance are negatively correlated, as we all know from the admonishments to get a good night’s rest before exams. Don’t patients deserve even more consideration? Overworked doctors and medical errors have been a flashpoint for discussion ever since I was a resident 18 years ago. And we are still doing research to find out how many medical errors are committed while fatigued.

Why do we need more studies to prove this? Do you really think that the true incidence of death or permanent injury will be discovered this way without exposing individuals, administrators, and hospitals to liability? I’ve learned all I need to know about vigilance as a truck driver. Vigilance is necessary to prevent accidents. Fatigue swallows up vigilance. But there’s more. Fatigue depletes our cognitive power, diminishes our ability to retrieve critical information, and betrays our best intentions. We fail to see the obvious treatment and anesthetic options when fatigued. And even if we do, the energy to act on the knowledge of the best treatment plan is gone.

I find no reason for this continuing dialogue – fatigue and what to do about it other than an economic one: it costs more to hire additional people. Yet the economic costs of decreased productivity from injury due to medical errors is in the billions of dollars. Until our leadership recognizes that this is money we pay for as a society, which eventually impacts on our health care costs and our compensation, this cognitive dissonance will continue. As a matter of conscience, I as an individual will manage my fatigue in a way that occurs commonly, if covertly. I will not relieve my colleagues for breaks on certain occasions, nor will I accept responsibility to conduct an anesthetic for their ASA class IV patient just to facilitate the OR schedule. I will take my time to answer my pages. I will not move any faster to do endoscopy cases just because someone has just decided to add on 3 more cases to an already full schedule. Without the element of risk, we can all be the good Samaritans that we imagined ourselves to be when we applied to medical school. With risk, everything changes. Let us stand up and fight to protect our patients instead of finding yet another way to bend over and accommodate an overly demanding system, because the next bending over may just break our backs.

Herb Lee, MD
North Brunswick, NJ