Doctors posting photos of themselves using the hashtag #YoTambienMeDormi ("I also fell asleep"). (Christina Farr/KQED)
Countless studies have shown the benefits of getting enough sleep. Most neuroscientists will tell you high-quality sleep can boost your intellectual function, memory, alertness, mood, and more.
And yet, doctors and medical students continue to forgo a good night's rest. They regularly make important decisions about their patients' health on an unhealthy amount of sleep.
Despite some recent restrictions on the amount of hours that doctors can work, culture is still a problem. Sleep is rarely a topic at the medical conferences I attend. Doctors will talk your ear off about innovative medical products, challenges with medical records, or exciting new drug therapies. All that is great, don't get me wrong, but rarely do you hear them talking about the health benefits of sleep.
At the recent Exponential Medicine conference, I overheard a half-dozen conversations between doctors in the coffee line, boasting about how little sleep they needed. This prompted me to call them out on Twitter to gauge the reaction of other attendees.
The exception was John Mattison, the chief medical information officer at Kaiser Permanente. Mattison urged the audience to restore "ancient wisdoms," like exercising, maintaining a healthy diet, and getting adequate rest.
Where Does This Attitude Come From?
Popular culture has almost certainly contributed to the problem. As a longtime fan of medical dramas like House and Grey's Anatomy, I've wondered how the bleary-eyed doctors in these programs can trust themselves to make important life-and-death decisions. The show's protagonists seem to flit between surgery, flirtatious banter in the elevators and throwing back shots in the local bar, with little or no regard for sleep.
Moreover, medical schools are known for pushing their students to work late into the night, a form of hazing. Here's how one medical student described his experience in a recent post for the medical blog KevinMD:
Sleep deprivation is a unique experience. Imagine falling into a pool filled with caramel. You try desperately to swim out but slowly sink to the bottom, and there you are, looking up to see a brown-tinged world. Despite all of your best efforts to swim out, the caramel is just too thick.
This author would occasionally pinch his skin in an effort to stay alert, but the effect only lasted about 30 seconds. Would you trust a person that sleep-deprived to make snap decisions about your health? (For more on this, check out this viral meme where doctors tweet pics of themselves sleeping on the job.)
Some doctors say this attitude toward sleep has persisted in medical schools and residency programs, even today. There's still a fallacy that doctors are operating on a higher plane than the rest of us.
"It's both this desire to seem superhuman as well as this unhealthy self-sacrificing attitude," says Connie Chen, a graduate of UCSF's medical school and cofounder of a health coaching startup, Vida Health. "I think too often doctors try to solve problems by giving more of themselves, when really they should delegate more, and think of themselves as just one person in a team taking care of the patient."
One current resident at Stanford, who requested anonymity, says the work-hour restrictions haven't made much difference. It's common to fill out charts late into the night after a shift, this resident says, and those hours don't count. And "machismo" is a pervasive problem, along with the fear of being seen among colleagues as "not carrying your weight."
Moreover, there's little "institutional or cultural backing" pushing young doctors to get strict about their on-duty hours, so residents will routinely go for several weeks on less than three hours sleep a night.
"The true cost is the well-being of the physicians," the Stanford resident says, "the emotional and physical toll leads to intense burnout, and diminished patience and compassion."
How Can We Solve the Problem?
For starters, more medical schools need to teach their students about staying well, and not just treating the sick. Nutrition and sleep hygiene are a good place to start.
"Medical schools teach you about all the diseases; things you can test and treat," says Jordan Shlain, a Bay Area-based primary care doctor. Shlain says too few doctors talk to their patients about sleep, or take the time to ask them about the stressors in their lives that result in sleep troubles. And many doctors he knows don't seem to value sleep.
"I definitely saw this attitude, mostly among surgeons, that they were masters of the universe who didn't need sleep," he says. "It's an ego-driven thing."
Many of the doctors I spoke to say they've seen some improvements in the past two decades. Since the Libby Zion case in the 1980s, which threw into the spotlight the common practice of exhausted, inexperienced doctors treating patients, medical educators are thinking about how to teach doctors about sleep debt.
Lawrence Sherman, a medical educator and TED speaker, says young doctors are increasingly being introduced to this topic in their professional development, or "continuing medical education."
But to see the kind of change we need, I would implore organizers of medical conferences to introduce sessions and panels about sleep: Why doctors need it, how to talk to patients about it, and whether to use new technologies for sleep-tracking, like the Jawbone UP and the Misfit.
"The doctors who think being sleep-deprived is cool, they will run into problems later in life as patients," says Shlain.
Are you a doctor who doesn't get enough sleep? Or a patient who has had an experience with a sleep-deprived physician? Let us know at @KQEDScience on Twitter.
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