Sleep Deprivation and Performance of Residents

To the Editor.—  The study entitled "Sleep Deprivation and Resident Performance" by Deaconson et al¹ provides insight into the impact of sleep deprivation on performance during psychometric testing. I find it reassuring that sleep deprivation would not impair one's performance on cognitive and psychomotor tests. I do, however, take exception to the conclusion that, "by implication, performance in the provision of patient care" is not impaired. My objections are based on several concerns.First, the authors did not present any evidence other than conjecture that performance on these psychometric tests is relevant to caring for patients. Certainly, cognitive and psychomotor skills are required for patient care. However, caring for patients also requires compassion, empathy, and the ability to establish a patient/physician relationship and to exercise complex medical judgment. None of these skills were evaluated in this study by psychometric testing.Another issue not addressed by Deaconson et al is