The following is a stream-of-consciousness reflection prompted by this article discussing how addressing sleep deprivation is residents has not made a noticeable dent in mistakes made in teaching hospitals.

I worked in the food industry on and off for over five years. One thing I learned pretty quickly about food prepared by other people was that the less known about how it ended up on my plate the better. It’s not that cooks or servers are particularly unsanitary people, but they are human and they do cut corners from time to time. Most people, even those who have never worked in restaurants, have some idea that they are happier just plain not knowing a few things about food service. I will also add that I have never had an incident of improperly handled food making anyone sick. Perhaps it happened without my knowledge, but never enough to cause worry.

We like to imagine, as the plate is set before us, that the food traveled from its original form to the elegant (or not so elegant) plate before us untouched by human hands or dirty countertops. This is not possible. We know that, but we choose to ignore what we know in favor of peace of mind. For the most part we fare well with this approach.

Medicine operates like this as well, to a certain extent. We like to imagine that our physicians and nurses come to us well rested and invested in our cases. We don’t like to imagine that long hours and similar symptoms start to blur together over time. We don’t like to imagine that jokes are made at our expense or corners are cut for the sake of convenience. Television and movies encourage this fantasy; the doctors on Grey’s Anatomy and House make mistakes, but there are immediate consequences that they learn from each time.

The fact is that doctors get bored sometimes. Or they get cocky. Or overwhelmed. Or tired. Or forgetful. And much of the time this doesn’t actually hurt the patients. Sometimes it does and everyone gets into a tizzy about how to make sure that such a thing Never Happens Again. I don’t mean to imply that this is a bad response, we should always look to improve ourselves, but it can oversimplify the problem. How do we stop people from making mistakes? The best we can do is minimize those mistakes.

Recently hospitals have been making an effort to  reduce resident hours so that they won’t make as many mistakes from sleep deprivation. Which to me, as a future resident, seems like a fantastic idea. On the other hand, no reduction in hours is going to change the fact that residents are cheap labor and are going to be given the most unpleasant shifts as a result. Unpleasant shifts mean rotating shifts, which means having to rewire one’s entire circadian rhythm on a weekly basis. This is not easy, nor healthy and will result in sleep deprivation whether the individual works 140 hours or 80.

And even despite that, a good night’s sleep does not make physicians, especially those in training, any less susceptible to the drudgery inherent in any profession. They make  mistakes. So do we all.

When I worked in food service we would meet every week to discuss the problems we were having in the restaurant and brainstorm ways to deal with them. Every week there would be a new tweak in our policy. Every week we would hit a snag; some piece of business for which the new policy hadn’t accounted. It was like the adage about insanity: doing the same thing over and over again expecting a different result.

I support doing everything possible to reduce hospital mistakes. I think reducing resident hours was a good idea, and I think sleep deprivation is still a huge problem in hospitals. Nor do I mean to defend lazy or incompetent doctors. But how many mistakes did you make at work today? Lives are on the line, but at the end of the day the doctors are still human.

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