Turi McNamee says that shelling out $1.6 billion to let doctors sleep more is too expensive in our current straitened circumstances.  Au contraire, I think it's a bargain.

I am a gold medalist in the macho Sleepless Working Olympics.  I once worked a 60-hour shift without sleep.  (Yes, that's 2.5 days without any shuteye.)  One stormy February, I put in 468 hours, almost 120 hours a week for four weeks straight, sleeping an average of less than 4 hours a night.  I have enjoyed all the exciting side effects of prolonged sleep deprivation, like uncontrollable "microsleep" which once almost caused me to walk into the path of a cab, or the hallucinations that set in after 48 hours or so--not fun hallucinations, either, just long conversations with co-workers who turned out to have left the building hours or even days before.  I was essentially dreaming with my eyes open. 

So I know whereof I speak when I think about interns training on gruelling regimens.  And you know what I learned on all those sleepless nights?

Well, actually, not much.  It turns out that adequate sleep is crucial to memory formation.  But I did manage to process and retain one fact:  when you have not had enough sleep, you. are. stupid.

Your attention span shortens.  Your decision making process slows down to a crawl.  Your emotions fray--towards the end of that fateful February, I burst out crying when I learned that the delivery of a hot-swappable backup drive had been delayed.  In fairness, that drive was the only thing between me and going home to sleep.

That's probably the most pernicious problem:  on the margin, you start making decisions based on how quickly they get you back to bed.  If wretches have hung that jurors might dine, how many patients have gotten shoddy treatment that interns might sleep?  The answer is surely not, as we might hope, "none".

The value of a human life is generally placed at $5-7 million by regulatory agencies.  If letting doctors sleep more saves only 230 lives a year, it's worth it.  Moreover, since you can't learn well when you're tired, we might save many more, by training up doctors who actually remember what they learned as interns.

I understand that against this, you have to set the benefits of continuity of care.  But there's a funny thing:  if continuity of care were really that great, attendings would only have four days off a month, instead of the sybaritic five or more that McNamee is deploring.  Most doctors I know work really hard.  But they don't work a lot of 36 hour shifts, and they don't think that two weekends a month off is the height of decadence.