[plastics]

The problem with sleep deprivation is that unless you have an objective way of measuring your (mental) performance you're usually not able to realize when it declines, because your're self monitoring capabilities decline as well.

A simple test, that worked very well for me, was testing my reading speed (I know it is only a weak indicator for mental acuity, but it is easy and fast to test).

Under perfect conditions (well rested, optimal nutrition, completely silent room, no visual distractions, after mediation and a good cup of green tea) I am able to read about 800 WPM (which is not to bad) of the kind of text I usually need to read with good retention. For me this declines rapidly to less than 200 WPM (which is quite bad for a "knowledge worker") with sleep deprivation and/or a noisy environment, even though I believe I am doing fine.

That being said, even though I would say that doctors are handicapped "mental performance" is handicapped by their working conditions, I fully agree that it is better for patient safety to not hand off a patient to a new doctor say every 8 or 12 hours due to the amount implicit knowledge that a doctor gathers during a >24h time period about his patients that can't be transferred in a handoff.

Software Developers, imagine what a screw up it would be if you'd have to hand off your code every 8h to another developer, who'd have to continue right were you left... add to this not having a version control system, spotty test coverage and highly ambiguous specifications

[billybob]

"due to the amount implicit knowledge that a doctor gathers during a >24h time period about his patients that can't be transferred in a handoff."

While this may be true, the process of the handoff could be vastly improved. My wife is a resident, and the quality of info she gets during a patient handoff varies drastically, from detailed notes in a computer, correlated to medical history, to scrawled notes on paper. Sometimes she has to start from square 1.

Maybe the reason handoffs are harmful is because they're done poorly. And maybe they're done poorly because the doctor who's handing off is freaking exhausted.