Consciousness Raising Exercise #39

Recent studies have exposed how the extreme levels of stress placed on medical students during the long hours they must work while in training to become physicians have made sleep deprivation an occupational hazard. Most of us have experienced what it feels like to fall asleep while watching television or reading a book. However, the threat of increased somnolence at work can cause a major problem with medical documentation.

Unfortunately, many doctors and medical students are great procrastinators when it comes to dictating reports and correspondence. By the time they actually sit down to dictate, some can barely keep their eyes open. I personally have listened to doctors start snoring while in the middle of a report, followed by a grunt and a confused dictator mumbling, “Huh? Where was I?”

During such moments, focus and memory are hardly in peak form. As a result, it is all too easy to make a mistake that will subsequently metastasize throughout a patient’s medical record.

Falling asleep at your desk is such a minor and embarrassing event that most people just laugh it off. However, when you see someone with an active case of narcolepsy, you get a very different view of the dangers involved.

A friend of mine who is normally quite healthy, athletic, and fit suffers from a peculiar form of narcolepsy in which his nervous system seems to suddenly need rebooting. Thankfully, he now has a devoted service dog who keeps a close eye for symptoms of a crash. But he will happily recite the story of how he once fell asleep at the wheel and was lucky enough to wake up in time to avoid a motor vehicle accident.

It all sounds quite theatrical and fantastic until you see it happen right in front of your eyes. Once, while we were on an Alaskan cruise, I witnessed such an event. We had just started looking at our menus when Richard’s head collided with his dinner setting. His three cruise companions looked up from their menus to see him slumped over the table, out cold. For a minute we weren’t sure what to do, as we were all aware of his attacks but had never really witnessed one. Just as we were about to call for medical help, Richard sat bolt upright and asked “Okay, what are we going to eat?”

Anyone who has earned a driver’s license should have learned to pull over to the side of the road when he is too tired to drive safely. In 150 words or more, explain why dictating medical reports when you are exhausted raises a risk management issue with regard to quality of patient care.