Sleep Deprivation in the Practice of Medicine: Is it Necessary?

When you go to the hospital for treatment, you expect or hope for the best care that modem medicine can offer. The accelerating achievements of medical technology in the past several years contribute to that expectation. However, the realities of hospital and medical care are often far from the ideal. One factor that may contribute to less than ideal treatment in or out of the hospital is sleep deprivation, especially amorig interns. However, it wasn’t until the late 1960s that this topic was discussed openly in medical journals. Recently, there has been a burgeoning controversy among doctors about what contributes to physician and intern im@ment. Indeed, in the past five years alone we found over 600 relevant published papers. Adherents of both sides of this topic have aired their views in the New England Journal of Medicine. ~~ ISI@”s data identified a 1987 research front—’ ‘Impairment and stress in interns, residents, and physicians” (#87-2&i1)—that includes papers on the issue of sleep deprivation. (The core articles for this front are listed in Table 1.) While small in terms of the usual size of research fronts we disCUSS—57published (citing) and 9 core (cited) works in 1987–its very existence reflects the growing awareness of the problem if not acturd systematic research. Of the nine core papers only the three by J.D. McCue, University of North Carolina School of Medicine, Cha@ Hill; R.C. Friedman, CO hunbia University College of Physicians and Surgeons, New York; and R.J. Valko, Washington University School of Medicine, St. Louis, Missouri, are specifically concerned with sleep deprivation. The bibliography in Table 2 includes these 3 papers and 29 others. A recent review paper by John B.R. Parker, Department of Anesthesia, Saskatoon City Hospital, Saskatchewan, Canada, lists the results of studies on interns “acutely and chronically deprived of sleep”: difficulty in thinking and learning, memory lapses, negative personality changes, sexual dysfunction, and even suicide. From this evidence Parker asserts that