Are doc­tors too tired to care prop­erly?

The Irish Times - Tuesday - Health - - Front Page - Muiris Hous­ton

I woke up with a start. My car was at­tached to a set of rail­ings across the road from the main en­trance to the hospi­tal. The fact the rail­ings be­longed to the main hostelry in the area prob­a­bly didn’t help the im­age por­trayed to on­look­ers.

It was about 6.30pm on a Monday. I had been on call as an intern for the weekend and had worked from 8am on the Satur­day right through to 6pm on the Monday. A straight 58-hour work stint – but one with a difference.

Back in the day, a ju­nior doc­tor could ex­pect three to four hours’ sleep dur­ing a night on call. It was just about enough to keep you func­tion­ing. Two of these in a row fol­lowed by a “nor­mal” day’s work on the Monday en­sured you were pretty ex­hausted by the time you got to head home.

But this weekend had been a weekend from hell. I got no sleep on the Satur­day night and a miserly one hour’s shut-eye on the Sun­day.

In ad­di­tion to look­ing af­ter some very sick pa­tients on the wards, I had been in­volved in the am­bu­lance trans­fer of a young woman with a head in­jury to one of only two hos­pi­tals in Ire­land to have had a CT scan­ner at the time. My pa­tient had a car­diac ar­rest while in tran­sit; thank­fully she re­sponded to re­sus­ci­ta­tion.

Some 12 hours’ sleep later I was back for an­other day’s work, still shocked that I had fallen asleep at the wheel within min­utes of leav­ing the hospi­tal car park.

Since then, the im­ple­men­ta­tion of an EU work­ing time di­rec­tive was sup­posed to put an end to the ex­treme fa­tigue I ex­pe­ri­enced that Monday evening. How­ever, new re­search has found that more than half of UK trainee hospi­tal doc­tors have had a col­li­sion or near-miss on their way home af­ter a night shift due to sleep de­pri­va­tion.

The find­ings of the re­search, pub­lished in the jour­nal Anaes­the­sia, show that al­most 60 per cent of trainee anaes­thetists had been in­volved in an ac­ci­dent while driv­ing, cy­cling or walk­ing home af­ter a night on call.

Those who drive de­scribed swerv­ing across mo­tor­ways, crash­ing into other ve­hi­cles and hit­ting kerbs and round­abouts af­ter fall­ing asleep at the wheel. Al­most all doc­tors de­scribed the in­ci­dents as their fault. More than eight out of 10 re­spon­dents said they had felt too tired to drive home af­ter a night shift.

Some 72 per cent said that work-re­lated fa­tigue had neg­a­tively af­fected their phys­i­cal health, with al­most as many stat­ing it had dam­aged their psy­cho­log­i­cal well­be­ing or per­sonal re­la­tion­ships.

These find­ings were echoed in the re­cent RCPI Na­tional Study of Well­be­ing of Hospi­tal Doc­tors in Ire­land. It found ju­nior doc­tors worked 60 hours a week, with just 20 per cent say­ing they had enough time for fam­ily and per­sonal life.

A co-au­thor of the anaes­thetists study, Dr Laura McClel­land, warned that ex­treme tired­ness among doc­tors could lead to them mak­ing mis­takes when they are work­ing at night. One of the rea­sons is that the in­ten­sity of med­i­cal prac­tice has

Al­most 60 per cent of trainee anaes­thetists said they had been in­volved in an ac­ci­dent while driv­ing, cy­cling or walk­ing home af­ter a night on call

changed. Al­most one in five of the anaes­thetists sur­veyed said they were un­able to grab even 30 min­utes’ rest dur­ing a night shift.

Back in my ju­nior doc­tor days, there was a ded­i­cated room for each doc­tor who was on call at night. But fig­ures now show that about one-third of on-call medics do not have the fa­cil­ity to have a nap. This loss of sleep­ing fa­cil­i­ties must be con­tribut­ing to the high fa­tigue lev­els found in the lat­est study. A room to sleep in af­ter a busy overnight shift and be­fore head­ing home is also clearly needed.

From a pa­tient’s per­spec­tive, the fact that over half of the trainee doc­tors said fa­tigue had im­paired their abil­ity to do their job is fright­en­ing. It rep­re­sents a qui­etly smoul­der­ing threat to pa­tient safety.

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