In the category of “duh, do they really need to spend money to study the obvious?” an April 2011 study in the Archives of Surgery reports that surgeons who are hung-over from excessive alcohol intake make a significantly higher number of medical errors as compared to those who do not drink to excess the night before. News flash: grass is green, the sky is blue, and people who can’t remember where they left their underwear last night but know it was somewhere after last call shouldn’t do surgery.
I hate to point out the part of this study that begs the politically incorrect question, but I got a little laugh out of the fact that it was led by Professors at the Royal College of Surgeons in Dublin, Ireland and Queens University in Belfast, Ireland. I know it is totally inappropriate to say it, but I wonder if they remembered to control for the fact that study participants might be Irish and thus might skew the results? Okay, I know…it’s wrong. Sorry, just couldn’t help myself.
In any event, the researchers began by taking eight surgeons and sixteen medical students out for drinks and dinner. All eight of the surgeons and eight of the medical students were encouraged to drink like they were trying to join Delta Tau Chi. Eight of the students weren’t allowed to drink any alcohol, but still went out for dinner with their pals (probably so there was someone to apologize for the group’s behavior toward fellow diners). The next day, the two-dozen study participants were asked to perform a laparoscopic surgical procedure. Fortunately for society, the laparoscopies were performed on virtual systems, not real patients. I can’t imagine any hospital’s Independent Review Board going for that one.
The results were as follows, as excerpted from a Reuters article about the study:
- At 9 AM the day after the drinking binge, hung-over students made about 19 errors on average during their procedures, while those who hadn’t been drinking made only eight. This difference hadn’t been seen the prior day between these groups, and the effect faded over the course of the day after.
- The surgeons also performed worse the day after their night out compared with before, with an increase in errors of about half as many more and seriously impaired ability to perform certain parts of the procedure. Remarkably, only one of the surgeons had detectable blood alcohol levels at the time these mistakes were made.
- The hung-over surgeons completed the surgery faster at 9 AM than they did before the party, but then became slower when tested at 1 PM. My guess is that they were rushing through the early morning procedures so they could resume their position praying to the porcelain god.
The study concludes by saying that someone out there in the universe should, “define recommendations regarding alcohol consumption the night before assuming clinical surgical responsibilities.” Apparently no one has done this yet.
Despite what may seem an obvious oversight, the focus of the American Medical Association (the entity that essentially governs these matters), has been on what they deem to be “impaired physicians,” who are defined as those who have an “inability to practice medicine with reasonable skill and safety to patients by reasons of physical or mental illness, including alcoholism or drug dependence.” While studies have suggested that there is a reasonably high number of physicians who have alcohol or drug abuse problems as compared to the rest of the population, other studies show that somewhere between one third and half of all physicians don’t believe it is even their problem to report a fellow physician who is impaired due to suspected or known alcohol or drug problems. To this I say, “what the hell?” Would those same physicians act the same way if they themselves were going to get operated on by someone who is still licking the olive juice off their sleeve?
However, my point is that the focus of the AMA code and supporting guidelines is basically retrospective in nature, focusing on physicians who have a full-blown addiction and/or ongoing tendency to repeatedly show up to work wearing a lampshade on their head. That is quite a different situation from one where an otherwise regular physician who doesn’t have a chronic alcohol problem has one too many at a baseball game and then drags himself in the next morning wearing dark sunglasses to fire up the laparoscopy machine. While logic would tell you that someone should report that guy too, there is no such obvious guideline that I can identify (if someone knows where it is, please tell me). You would hope that right after prescribing himself aspirin, the hung-over physician would cancel his surgery schedule. I wonder how many times that actually happens. I’m guessing just short of never.
This whole topic was eye-opening to me because I have spent a lot of time thinking and writing about avoidable medical errors but hadn’t even considered the kind that’s made because of a hang-over as one that I should add to my list of the top 10 terrifying reasons never to get hospitalized. And when you add to this problem the fact that surgeons in the study were still making hang-over induced errors despite the fact that their blood alcohol level had already returned to normal, it is hard to figure out how to screen out physicians at the operating room door. It would be one thing if you could use one of those devices you blow into and if you clear the blood alcohol level, your car will start. That’s not going to work on a hung-over doctor who, 12-hours after re-enacting Pee Wee Herman’s Tequila dance, won’t register on the scale.
Much successful promotion has been done in the United States to foster the concept of a designated driver among those determined to fight for their right to party. Seems to me that anyone who has to perform surgery the next day should be deemed a “designated doctor” and be ethically prohibited from drinking the night before wielding a knife on an unconscious fellow human. The Archives of Surgery study urges that, “Abstinence from alcohol the night before operating may be a sensible consideration for practicing surgeons.” I will start and end with “Duh.”