Changing the law, changing the culture: rethinking the "sleepy resident" problem

Ann Health Law. 2003;12(1):23-73, table of contents.


Ms. Whetsell examines the Bell Regulations, which limit New York's hospital residents' work hours and require increased supervision from senior doctors, in light of the currently pending federal bill that seeks to do the same. The article argues that the federal government should draw lessons from the New York experience before proceeding with similar guidelines. The article notes that many roadblocks have prevented successful implementation of the New York policy, including a long-standing tradition of "hazing" first-year residents with long, unsupervised hours; medical community resistance to the notion of residents' sleep deprivation and dislike of government interference; and a general fear within the medical community of increased medical malpractice liability and other indicia of "blame culture." The Article concludes that the most effective approach to patient safety related to residency sleep deprivation should work within hospital culture, not against it. The proposed alternative approach would encourage patient safety strategies that value teamwork and cross-discipline collaboration, and consequently result in greater satisfaction for residents, hospitals, and patients.

Publication types

  • Case Reports
  • Legal Case

MeSH terms

  • Fatal Outcome
  • Fatigue
  • Government Regulation
  • Guideline Adherence
  • Hospitals, Teaching / legislation & jurisprudence*
  • Hospitals, Teaching / organization & administration
  • Hospitals, Teaching / standards
  • Humans
  • Internship and Residency / legislation & jurisprudence*
  • Internship and Residency / organization & administration
  • Internship and Residency / standards
  • Malpractice / legislation & jurisprudence
  • Medical Errors* / legislation & jurisprudence
  • Medical Errors* / prevention & control
  • Medical Staff, Hospital / legislation & jurisprudence*
  • Medical Staff, Hospital / organization & administration
  • Medical Staff, Hospital / standards
  • Organizational Culture
  • Safety Management / legislation & jurisprudence
  • Sleep Deprivation*
  • United States
  • Work Schedule Tolerance*