A study published last week suggests tired hospital doctors might make decisions better if they took a drug that combats fatigue. So much for the science – what is less certain is the ethics of doctors turning to drugs to get through long shifts.
Doctors, like many others, already rely on stimulants like caffeine and nicotine to boost flagging performance, but Colin Sugden at Imperial College London and colleagues decided to test whether they could benefit from something stronger: modafinil, a drug originally designed to treat sleep disorders such as narcolepsy and sleep apnoea.
The exact way modafinil affects the brain is not known, but it is believed that it acts on specific parts of the hypothalamus responsible for keeping people awake.
After missing a night's sleep, 39 male doctors were put into one of two groups. Sugden's team gave one group a dose of modafinil while the other got a placebo. Both groups were then subjected to a number of cognitive tests, and asked to use a surgical training simulator to gauge their motor skills. Neither the participants nor the researchers they met knew which group received which treatment – a strategy to avoid inadvertent bias.
The doctors who had taken modafinil scored higher on the cognitive tests: they had better working memory, could plan more effectively and made less impulsive decisions – all useful qualities for a doctor. No improvements were seen in their surgical ability, however.
Docs on drugs
Some media reports of the work have suggested that it means doctors could perform better by taking modafinil. Sugden himself says that the research is too preliminary to make such a link.
"It is not clear how performance on tests of mental function relates to how someone performs as a doctor," he says. "Larger studies looking at the performance effects and safety of longer-term use of the drug would need to be performed before we could draw conclusions about whether or not sleep-deprived doctors might benefit from taking it."
If such studies find evidence that the drug could improve patient care, might doctors working long shifts be encouraged to take modafinil? Could they even face malpractice claims for failing to do so, as mooted online this week?
"This was an academic piece. We wanted to encourage a debate in order to identify the ethical considerations," says Sugden.
A European Union directive introduced in 2009 mean that junior doctors in the EU may not work more than 48 hours a week, and must have 11 hours of continuous rest out of 24. Previously, 60 to 100-hour weeks were been considered normal.
"[UK] National Health Service organisations should ensure staff are well rested to do their jobs properly – not replace good management with performance-enhancing drugs," a spokesperson for the UK government's Department of Health told New Scientist.
Surprisingly, though, it is not certain that patients suffer when doctors work long shifts. On the one hand, a 2007 study showed that doctors working overnight were three times more likely to make an error leading to a patient's death than those working on a normal schedule. On the other, a 2004 study of New York state hospitals that followed the introduction of legislation to reduce working hours found there was no change in the rate of deaths from due to congestive heart failure or pneumonia.
Journal reference: Annals of Surgery, DOI: 10.1097/sla.0b013e3182306c99
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