Asleep at the Wheel

Timothy B. McCall, M.D.

Recently an assistant cameraman on a Hollywood movie set was killed when he fell asleep at the wheel driving home after a 19 hour work day. His death has led to calls within the industry to limit films crews to 14 hours of work a day. Marketplace medical commentator Dr. Timothy McCall says the uproar sounds familiar.

The brouhaha over long working hours in Hollywood reminds me of a similar battle doctors waged in the 1980s. When I did my internship in 1984, we routinely worked 36 hours shifts and logged work weeks as high as 120 hours. There are only 168 hours in a week.

The same year the tragic death of a young woman at New York Hospital led State officials to implement regulations limiting doctors-in-training to 80 hours per week. Across the country, most specialties recommended similar caps.

I remember being so tired as I tried to write notes in patients’ chart at 4 a.m. that I would repeatedly nod off in mid sentence leaving foot-long pen trails littering the page. The only reason I didn’t have to worry about falling asleep while driving home was that I lived close enough to walk. Most of my colleagues weren’t so lucky.

In fact, a 1988 report in the Journal of the American Medical Association found that six out of seven surgery residents had fallen asleep at the wheel driving home from work; half of them have been involved in accidents. A surgical resident from my hospital testified before the Massachusetts legislature that he’d once dozed off during open heart surgery.

Today the spotlight on resident work hours has faded but the problem isn’t resolved. One survey found that 42 percent of internal medicine residents still work more than the allowable 80 hours weekly. The worst offenders are the surgery and OB-GYN programs where workweeks of 100-120 hours remain standard.

Ever wonder where some doctors learn their great bedside manner? Imagine working the current schedule of surgical interns at one major Boston hospital. Start in the ICU at 6:30 Monday morning, work all day, all night and get off late Tuesday morning. Wednesday be back at 6:30 am and stay up all night again. Repeat this for 2 straight months without a single day off.

I feel for film crews and wish them luck in their battle for humane working conditions. But there’s one big difference between Hollywood and medicine. When doctors are so tired that they fall asleep at the wheel, they may harm or even kill their patients in the hours before they drive home.

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