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Comment and Controversy

OBs: The few. The tired. The impaired.

August 2005 · Vol. 17, No. 8

I was surprised when Dr. Robert L. Barbieri’s June editorial about the long working hours of ObGyns (“The few. The proud. The OBs.”) failed to mention the potential negative impact on patient safety. Dr. Barbieri apparently believes we should be proud to work such long hours. Instead, the editorial should have been called “The few. The tired. The impaired. The OBs.”

We are in the middle of a malpractice crisis, and patient safety also has taken center stage. The Institute of Medicine’s 1999 report,To Err Is Human: Building a Safer Health System,revealed that medical errors contribute to many hospital deaths and serious adverse events. They also contribute to our malpractice crisis. Yet the potential impact of sleep loss and fatigue on errors and malpractice suits, specifically among ObGyns, has received only sporadic attention.

Dr. Barbieri points out that ObGyns work about 61 hours per week, which tops all the specialties. Doesn’t anyone then draw a connection between the long hours of ObGyns and the fact that they are also on top when it comes to malpractice premiums? It’s a known fact that fatigue caused by sleep loss and circadian-rhythm disruption can degrade performance and reduce human ability in many respects. Numerous studies show that sleep deprivation increases errors and adversely affects patient care. Are ObGyns exempt?

We must stop pretending that long work hours are good for our patients. They are not. Until there is a limit to ObGyns’ lengthy hours, we will continue to get ourselves into trouble. And the lawyers will laugh all the way to the bank.

Amos Grunebaum, MD
Chief of Labor & Delivery, Weill Cornell Medical Center,
Weill Medical College of Cornell University,
New York City

Dr. Barbieri responds:

I appreciate Dr. Grunebaum’s thoughtful letter. I agree that our specialty needs to reflect on the possible relationship between extended work hours and medical errors. Studies from industrial settings suggest that work performance deteriorates with sleep deprivation.1 However, as of 2004, we lacked strong evidence that sleep deprivation is a major factor affecting patient safety in a hospital setting.

Recently, a study of PGY-1 residents at Brigham and Women’s Hospital found increased medical errors with extended work hours in an intensive care setting,2 most of them during night shifts.

At Brigham and Women’s Hospital, our attending staff has been reflecting on the relationship between extended work hours and clinical performance. One of our senior physicians, Dr. James Greenberg, has proposed the following guideline: “After 24 consecutive hours without sleep, no doctor may serve as an attending physician for patients until that doctor has had 6 hours of uninterrupted rest time.”

I wonder what Dr. Grunebaum and his colleagues would think of such a proposal.


1. Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996;19:318-326.

2. Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351:1829-1837.

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