Sleep Deprivation and Performance of Residents

To the Editor. —  I read the recent article of Deaconson et al¹ with great interest, followed by astonishment. The notion that performance on psychometric tests, spurred by financial incentives, is directly related to the quality of patient care is absurd. I wondered why this study, with conclusions so politically sensitive and contrary to the prevailing beliefs, appeared without editorial comment.The words that define this study's problem are, "We conclude that the repetitive episodes of sleep deprivation... do not impair the performance of residents on psychometric tests and, by implication, performance in the provision of patient care." By implication? This is a leap of illogic unsupported in the data or discussion, and the image it conjures up of the physician as a pegboard-punching automaton is misleading and offensive. The key word here is care, which went unmeasured and undiscussed. What sleep deprivation so insidiously and dangerously undermines is