Preparing physicians for the real world

Long hours of work in opposition to our circadian clock lead inevitably to a physiologic process that manifests as fatigue. Sleep deprivation and fatigue in turn lead to predictably negative effects on performance and mood, combining to produce situations where health care providers are at risk of harming patients.1

The issues of how and when we work cannot be addressed by a single schedule, and there is no magic bullet. The type of professional life described by John Acres is all too familiar, the output of a flawed system that needs to be changed.2 Limitation of work hours is only one of many changes that could improve the health care system.1^,3 No training system can alter basic human physiology, so making trainees work unreasonable schedules does little but perpetuate the problem.

Health care is a hazardous industry where we do risky things to patients.4 Practitioners owe it to their patients to be optimally alert and able to perform. No health care professional would find it acceptable to arrive at work impaired by ethanol, yet many of us similarly impaired by chronic loss of sleep continue to care for patients.5^,6^,7 Work schedules such as Acres describes must be challenged so that a new reality can be developed to improve both patient care and physicians' health.

Steven K. Howard VA Palo Alto Health Care System Stanford University School of Medicine Palo Alto, Calif.