Doctors Urged to Admit Fatigue Before Performing Surgery
Since I have a number of friends who are starting their houseman (what a term…!) years, I often ask them if they are capable of making sound decisions during their notorious 36-hour rotations. Most human beings start displaying deficiencies in performing cognitive tasks when they are sleep-deprived, so I have to wonder if this practice of keeping doctors awake is a sensible one. We’re talking about life-saving or life-threatening decisions, for Chrissakes! Your cognitive processes better be working at optimum levels while you are slicing my spleen open with a scalpel.

From Neurocognitive Consequences of Sleep Deprivation by Jeffrey S. Durmer, et. al.:

Table 1 Summary of Broad Cognitive Performance Effects of Sleep Deprivation
- Involuntary microsleeps occur
- Attention-intensive performance is unstable with increased errors of omission and commission
- Cognitive slowing occurs in subject-paced tasks, while time pressure increases cognitive errors
- Response time slows
- Both short-term recall and working memory performances decline
- Reduced learning (acquisition) of cognitive tasks
- Performance requiring divergent thinking deteriorates
- Response suppression errors increase in tasks primarily subserved by prefrontal cortex
- Response perseveration on ineffective solutions is more likely
- Increased compensatory effort is required to remain behaviorally effective
- Tasks may be begun well, but performance deteriorates as task duration increases
- There is growing neglect of activities judged to be nonessential (loss of situational awareness)