Monday, July 11, 2011

Sleep Deprivation, Blogging, and Anonymity

Last week a guest post on KevinMD by Felicity Billings, MD suggested that attending physicians should have restrictions on the hours they work. She recounted a story about a presumably tired cardiac surgeon (“Dr. Lewis”) who had been awake for more than 24 hours. An anesthesiology fellow, she wanted to tell his next patient how tired he was but did not. Fortunately, the case went well. She stated, “All the research has shown one thing: sleep-deprived doctors are bad doctors.” This elicited several comments including one from me pointing out that all research has shown no such thing. In fact recent papers have found that there is no difference in the outcomes of complex cardiac and thoracic cases done by sleep-deprived surgeons.

Today posted a story entitled “Anonymous posts: Liberating or unprofessional?” by Kevin B. O’Reilly. It’s an interesting look at the controversial subject of anonymous blogging and tweeting. I was interviewed for the piece and explained why I prefer to remain anonymous. 

So what do these two events have to do with each other?

I Googled Felicity Billings, MD and found out many things. She works at Brigham and Women's Hospital in Boston. She blogs at “One Case at a Time.” She has written many other posts with rather detailed patient information which she apparently feels she has de-identified adequately. In one instance and to her credit, she obtained permission from a patient and his sister to write about his case.

When I first started blogging, I expressed my concerns regarding such detailed posts involving patients. I pointed out that a smart plaintiff’s attorney could ask a physician if she blogs or tweets. If she says “yes,” I believe everything she has written would be discoverable. Just imagine for example that a patient who had the heart transplant surgery had a late complication and in the deposition phase of a malpractice suit, it came to light that the subject of her post, “Dr. Lewis,” had been awake for 24 hours before doing the surgery.

I choose to blog anonymously for the reasons stated in the article. I have avoided writing patient-specific blogs and tweets, because even if de-identified, they may come back to haunt me.


Anonymous said...

You know, it's really simple. Some people can function well without much sleep. Some people can function adequately without much sleep. Some people cannot function at all without much sleep.

This is another "no need to spend money on a study" kind of thing. I tire of all the chatter.

But, I will say that most have some idea how they roll once they complete an undergraduate degree. But then again, it's less a problem since just about every young student who wanted to go be in medicine (or whose parents wanted them to), or other degree of similar stature, is already taking some sort of ADHD drug, for legitimate purpose (of course)... :o)


Skeptical Scalpel said...

And some people function poorly even when they've had more than enough sleep.

Anonymous said...

Every professional has different ways of going about their profession and each finds success in their own way. By naming her in your blog post here, you serve no purpose other than to attack her directly. What's the point? Can't opinions be shared on line with no consequences? She didn't attack you personally in that blog which suggests surgeons should work fewer hours. Certainly pilots have serious work hours restrictions for obvious reasons. Why shouldn't doctors have the same thing or are we all just too macho and have to prove ourselves? Take a break and get some rest.

Skeptical Scalpel said...


I'm not sure how I could have cited the Billings post without naming her. She put her name on it herself. The statement that all research shows that sleep-deprived doctors are bad doctors is incorrect. I don't see it as an "attack." I have blogged about the surgeon-pilot comparison ( I don't think it is valid.


I didn't post your comment for obvious reasons. I find it interesting that you (and the others) chose to remain anonymous. But that is fine with me. Email me at and we'll talk.

Debra Stang said...

I wouldn't want a sleep-deprived surgeon working on me. Between cognitive impairments and poorly regulated mood, he/she would be in no condition to provide safe medical care. I've worked with residents who are sleep deprived, and let me tell you, it's not a pretty picture.

Debra Stang
Alliant Professional Networking Specialist

Skeptical Scalpel said...

@Debra Stang

Your anecdotal experience is interesting but if you click on the "recent studies" hyperlink in the post, you will see the data clearly do not agree with you.

Sleep deprivation said...

Sleep deprivation can lead to Constant yawning, Grogginess, Poor concentration, mood changes, etc. There are several causes for deprivation, such as illness, work, medications, poor sleep hygiene, personal choices, etc.

Unknown said...

First of all, health professionals are the ones who should know how to take care of their body. The fact that they are on-call and sometimes extend their working hours results to sleep deprivation. I wonder if doctors and surgeons are trying some natural sleep aids.

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