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Physicians, Heal Thyselves … With Caffeine?

January 2020 • Volume 130 • Number 1 www.anesthesia-analgesia.org 63 DOI: 10.1213/ANE.0000000000004365 The practice of anesthesiology is, at times, quite physically and mentally demanding. Anesthesiologists are faced with many challenges throughout their careers, including providing consistent safe anesthetic care to patients while finding the optimal work–life balance. As the practice landscape continues to change and evolve, achieving both of these goals may become more challenging. Pressures for increased productivity in a “do more with less” environment often lead to escalations in workload, stress, and loss of sleep, all of which contribute to physician fatigue. There is no doubt that physician fatigue—the inability or unwillingness to continue performance—leads to medical errors,1 and may lead to both physical and emotional hazards for health care providers. Unfortunately, it is easy to focus on our patients and ignore our own wellness. Luckily, safe care for patients and physician well-being are highly interconnected. A well-rested, emotionally balanced, and healthy physician can provide more consistent and safe patient care. In this issue of Anesthesia & Analgesia, Huffmyer et al2 examine the impact of drinking a caffeinated energy drink (160 mg of caffeine) on resident physician driving performance in a high-fidelity, virtual reality driving simulator after 6 consecutive shifts of night-float work. This study is an interesting progression of a previous study by these authors that examined resident driving performance using similar testing that compared a rested state versus an unrested one after 6 consecutive shifts of night-float work.3 The previous study results suggest that resident physicians have greater difficulty controlling speed and driving performance in the driving simulator after 6 consecutive night shifts, and were more likely to be involved in collisions. In the current study, the authors conclude that after 6 consecutive shifts of night-float duties, anesthesiology residents consuming a caffeinated energy drink had improved driving performance variables, including a reduction in collisions during a driving simulation. On the surface, this study appears to suggest a method for protecting residents who drive home after a series of night shifts, with likely accumulated sleep debt and fatigue. However, the study poses larger questions. Should physicians alter practice environments and their lifestyles to better manage the fatigue that continuously challenges their well-being? Or should they instead mitigate the negative effects of fatigue with supplemental aids that include caffeine or other stimulants/sleep aids? Although the latter may seem like a drastic solution to the problem of physician fatigue, the use of stimulants and sleeping aids has a long history in high-stress environments, including military aviation. Anesthesiologists face many challenges on the job, similar to those of military pilots. In both fields, long periods of duty requiring a high level of vigilance, unpredictable and long working hours, disruptions in circadian rhythm, and poor sleep quality all lead to fatigue.4 However, unlike active-duty pilots who are often deployed for time-limited periods, anesthesiologists work year-round. Furthermore, military pilots are often far from family in a focused environment, with many facets of life accommodated to aid in the success of their mission. On the contrary, the modern physician must often juggle the escalating demands of managing a family, home, and professional practice in a lifelong career. The military does suggest nonpharmacological strategies as a first-line measure to prevent fatigue; however, when extreme exhaustion occurs and could impact outcomes, pharmacological therapies have been used. One stimulant, amphetamine, was used during World War II by British and German forces.5,6 In other times of war, from Vietnam through Desert Storm, amphetamines and sedatives were approved Physicians, Heal Thyselves ... With Caffeine?