Anesthesia – like other high-reliability organizations – is fraught with risk, complexity and a razor thin tolerance for error. Among physicians, anesthesiologists are unique in our practice of calculating, prescribing and administering medications to patients in real-time, often without double-checks, and with great potential for harm. We deprive patients of their basic homeostatic functions, taking complete control of, and responsibility for, their lives. Thus, it is our responsibility to optimize our performance and avoid impairment.

The medical culture in the United States glorifies exhaustion as part of the complete self-effacement required to totally immerse oneself in medicine and become a physician. While trainee duty-hour changes have been implemented in response to factors such as the tragic death of Libby Zion and the Institute of Medicine’s report To Err Is Human, these still allow for a work-week...

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