To the Editor

It has always perturbed me that for the 20 years I’ve been a practicing anesthesiologist not once have I seen guidelines for work hours for anesthesia providers. We all know too well the regulations imposed for airline pilots, truck drivers, nuclear plant workers, and even for residents-in-training for whom the new policy on work hours started in New York State. These guidelines are not baseless. There are innumerable studies by the military and articles in our own journals that dissect the effect of fatigue and long hours on the type of work that we do. That work that I am talking about is work that requires our utmost vigilance on a second-by-second basis. Working 12-14 hours a day or more and having to come back and start the whole process over again not only is detrimental to our health, but even worse for our patients. It is common sense that whatever hinders our work will eventually affect the patient.

Why the resistance to setting up guidelines for practicing anesthesiologists? Are there not guidelines for drug abuse among physicians? Are there not guidelines on how we should conduct ourselves in a manner which benefits the patient at all times? Then why the resistance to mentioning, specifically, the role fatigue plays on our performance? I just do not understand.

In my community, anesthesiologists are working long hours and keep going at the same pace without relief. I am not sure that many weeks of vacation is an answer. Vacation just gives temporary relief, not a change in “workstyle.” We talk so much about lifestyle, but we should focus on “workstyle.” This subject has come up in Anesthesiology,¹ Anesthesiology News, and in the Anesthesia Malpractice Prevention Newsletter. So this isn’t a subject that hasn’t been dealt with, and our specialty needs to set the tone and document some guidelines.

I know I am not the only one who feels strongly about this issue, as I have seen many letters to the editor in various journals. I just hope that some day our leadership, whom I respect so much, will wake up to the issue of fatigue.

Laurette M. Ellis, MD
Miami, FL

References

1. Howard SK, Rosekind MR, Katz JD, Berry AJ. Fatigue in anesthesia: implications and strategies for patient and provider safety. Anesthesiology 2002;97:1281-94.