The Phantom Menace of Sleep Deprived Doctors - E
Transcription
The Phantom Menace of Sleep Deprived Doctors - E
The Phantom Menace of Sleep Deprived1 Doctors A pediatric resident naps2 in an on-call room3 during an overnight shift4. The TV is often left on for white noise. By DARSHAK SANGHAVI Published: August 5, 2011 Last month something extraordinary happened at teaching hospitals around the country: Young interns worked for 16 hours straight5 — and then they went home to sleep. After decades of debate and over the opposition of nearly every major medical organization and 79 percent of residency-program directors, new rules went into effect that abolished 30-hour overnight shifts for first-year residents6. Sanity7, it seemed to people who had long been fighting for a change8, had finally won out9. Of course, the overworked10, sleep-deprived doctor valiantly11 saving lives is an archetype that is deeply rooted in12 the culture of physician training13, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, 1 Sleep deprived (doctors) privé de sommeil To nap-napped-napped faire un petit somme, sommeiller 3 An on-call room une chambre de garde (dans un hôpital, clinique) 4 An overnight shift un poste de nuit 5 To work for 16 hours straight travailler 16h d'affilée 6 First-year residents internes de 1ère année 7 Sanity santé mentale 8 To fight for a change se battre pour le changement 9 To win out – won out l'emporter, gagner 10 Overworked (the) (employés) surmenés 11 Valiantly vaillamment 12 To be deeply rooted in (sth) être profondément ancré dans 13 Physician training formation en médecine 2 1 influenced by their own residency experiences, often see hospital hazing14 as the most effective way to learn the practice of medicine. But over the last three decades, a counterpoint15 archetype has emerged: the sleep-deprived, judgment-impaired young doctor in training who commits a serious medical error. “Doctors think they’re a special class and not subject to normal limitations of physiology,” says Dr. Christopher Landrigan, an associate professor at Harvard Medical School and one of the most influential voices calling for work-hour reform. A large body of research on the hazards16 of fatigue ultimately led to the new rule on overnight shifts by the Accreditation Council for Graduate Medical Education, the independent nonprofit group that regulates medicalresidency programs. More than anything else, it was the death of 18-year-old Libby Zion 27 years ago17 that served as a catalyst for reform. Zion was jerking uncontrollably and had a fever of 103 degrees18 when she was admitted to New York Hospital on March 4, 1984. After she was admitted, Zion was given Tylenol and evaluated by a resident and an intern. They prescribed Demerol, a sedative. But her thrashing19 continued, and the intern on duty, who was just eight months out of medical school, injected another sedative, Haldol, and restrained her to the bed. Shortly after 6 a.m., the teenager’s fever shot up to 108 degrees20 and, despite21 efforts to cool22 her, she went into cardiac arrest. Seven hours after she was admitted, Libby Zion was declared dead. Libby’s father was Sidney Zion, a columnist for The Daily News. When Zion learned that his daughter’s doctor had by then been on duty for almost 24 hours and that young doctors were routinely awake for more than 36 hours, he sued23 the hospital and doctors and publicized the conditions he was convinced had led to her death. Stories about overtired interns appeared in major newspapers and on “60 Minutes.” Reforms followed, albeit24 slowly. In 1989, New York State cut25 the number of hours that doctors in training could work, setting a limit26 of 80 hours per week. And in 2003, the accreditation council imposed the 80-hour limit on all U.S. training programs, prohibited trainees from direct patient care after 24 hours of continuous duty and mandated at least one day off per week. 14 Hazing (US) bizutage Counterpoint contrastant 16 The hazards of les dangers de 17 27 years ago il y a 27 ans 18 103 degrees Fahrenheit 39,4 °C 19 Thrashing raclée, coup, dégelée, correction, rossée, peignée 20 108 degrees F 42,2 °C 21 Despite malgré 22 To cool someone refroidir qq'1 (sens propre) 23 To sue (someone, a hospital…) poursuivre qq'1 en justice, intenter un procès à 24 Albeit bien que 25 To cut – cut – cut (ICI) réduire 26 Setting a limit of fixant une limite de 15 2 To Landrigan, this was tremendous27, if incomplete, progress. He ran a yearlong study during which a team of interns at Brigham and Women’s Hospital worked alternate rotations, one on the traditional schedule — a 30-hour shift every third night — and the other on a staggered schedule28, during which the longest shift was only 16 hours. The results, published in 2004 in The New England Journal of Medicine, shocked the medical world. Interns working the traditional 30-hour shifts made 36 percent more serious medical errors, including ordering drug overdoses, missing a diagnosis of Lyme disease, trying to drain fluid from the wrong lung29 and administering drugs known to provoke an allergy. Thomas Nasca, the director of the accreditation council, cites this data as the single strongest argument for limiting doctors’ work hours. But this is where the neat30 story of the correlation between doctor fatigue and hospital error hits a wall. Landrigan’s research was compelling31, but his study was small and controlled. In normal, day-to-day32 practice in hospitals across the country, medical errors didn’t fall when work hours were reduced. A massive national study of 14 million veterans and Medicare patients, published in 2009, showed no major improvement in safety after the 2003 reforms. The researchers parsed33 the data to see whether even a subset of34 hospitals improved, but the disappointing35 results appeared in hospitals of all sizes and all levels of academic rigor. “The fact that the policy36 appeared to have no impact on safety is disappointing,” says David Bates, a professor at the Harvard School of Public Health and a national authority on medical errors. 27 To be tremendous énorme, considérable A staggered schedule un planning/des horaires échelonné(s), étalé(s) 29 Lung poumon 30 Neat bien tournée (histoire) 31 To be compelling être irréfutable, incontestable 32 Day-to-day (practice) quotidien, quotidienne 33 To parse (data) faire l'analyse grammaticale de, analyser, décomposer 34 A subset of un sous-ensemble de 35 Disappointing décevant 36 The policy la politique, les mesures 28 3