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NEJM: Sleepy Surgeons Should Get Patient Consent

《新英格蘭醫(yī)學(xué)雜志》：昏昏欲睡的醫(yī)生做手術(shù)需得到患者同意

Over the years regulations have developed to limit the hours of hospital interns and residents. Because someone putting in a 100-hour workweek might not be at their best when deciding which medication to prescribe or when inserting a Foley catheter.?But doctors who have finished their training don’t face any restrictions in their hours. Now The New England Journal of Medicine argues in an editorial that sleep-deprived physicians set to perform elective surgery should have to get the informed consent of the patient.

多年來規(guī)章制度已經(jīng)形成了限制醫(yī)院實習(xí)生及住院醫(yī)師的工作時間。因為有些醫(yī)生在一周工作100個小時的情況下，當(dāng)決定開出何種藥物或何時插入尿管時就可能并不處于自己的最佳狀態(tài)?？墒牵呀?jīng)結(jié)束培訓(xùn)的醫(yī)生在其工作時間里并未受到任何限制?，F(xiàn)在，《新英格蘭醫(yī)學(xué)雜志》在一篇重要評論中指出，睡眠不足的醫(yī)生在準(zhǔn)備執(zhí)行非緊急手術(shù)時應(yīng)當(dāng)?shù)玫讲∪说闹橥狻?/div>

Sleep deprivation can impair motor skills as much as alcohol intoxication can. The editorial cites a 2009 study in the Journal of the American Medical Association that found an increase in the risk for complications in patients who had elective surgery performed by surgeons who’d had the chance for less six hours of sleep during a previous on-call night.

缺乏睡眠會損害人的肌肉運動技能，其程度同酒精中毒一樣。這篇評論引用了《美國醫(yī)學(xué)會雜志》上2009年發(fā)表的一項研究，該研究發(fā)現(xiàn)接受非緊急手術(shù)的患者，若其主刀醫(yī)生之前值了夜班以致睡眠少于六小時，則該患者出現(xiàn)并發(fā)癥的風(fēng)險會增加。

The editorial's authors note that such consent represents a new responsibility for patients in making decisions about their care. It could damage the patient-doctor relationship. But, they say, "This shift may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas."

該評論的作者指出，這種知情同意代表著病人在對其疾病做出決定時要承擔(dān)新的責(zé)任。這或許會破壞醫(yī)患之間的關(guān)系。但他們認(rèn)為，“在制度體系能夠保證病患幾乎不會遇到這種困境之前，這種轉(zhuǎn)變或許是必要的?！?/div>

—Steve Mirsky

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