No one disagrees that sleep deprivation hurts physicians' performance. The question is what to do about it. Two very different approaches to one specific issue, what to do about an elective surgery when the surgeon scheduled to operate is short on sleep, are featured in the current New England Journal of Medicine. A Perspective piece argues that the consequences of sleep deprivation are so dire - the authors cite a previous study showing an 83% increase in complications in patients whose daytime elective surgeries are performed by surgeons with less than a 6-hour sleep opportunity between procedures the previous night - that self-regulation is not sufficient. Instead, "we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived," they write. No way, say three representatives of the American College of Surgeons, whose letter to the editor responding to the piece appears in the same issue of the NEJM. The solution is to train surgeons "to understand how fatigue degrades their mental and physical capabilities"