Monday, November 21, 2011

Provigil and Physician Alertness

Physicians in certain specialties often stay up most or all of the night when they are on call, and then have to work the entire next day. This is very taxing mentally and physically. However, it is controversial whether this acute sleep deprivation affects how physicians perform at their job. Some say it puts patients at risk for errors, while others say it has little effect on experienced physicians.

Provigil (or Modafinil) is a stimulant medication approved for shift work disorder, narcolepsy, and excessive sleepiness associated with obstructive sleep apnea. It can help workers stay alert on their overnight shift. A study was done in London on 39 male physicians where they were given either 200mg of Provigil or a placebo after one night of sleep deprivation. They were given cognitive tests and asked to use a surgery simulator program to gauge their skills.

Results showed that those doctors that used Provigil did better on the cognitive testing, including working more efficiently, planning, working memory, had less impulsivity, and were better able to redirect their attention. However, no improvements were seen in the surgical simulator program. The study authors concluded that Provigil might help sleep deprived physicians to process information better, think more flexibly, and make decisions under pressure. However, it might not improve their performance on basic procedural tasks. I wonder if because these tasks have been done so often that they could do them well whether they are rested or not.

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