BREAKING POINT
Misdiagnoses, accidental overdoses, symptoms missed – exhausted medics fear for patients and warn of system at
WORN-OUT doctors are missing symptoms, misdiagnosing and even accidentally overdosing patients due to burnout and exhaustion.
A frontline registrar and junior doctors who spoke to the Irish Mail on Sunday this weekend admitted they have made serious errors caring for patients due to crippling tiredness.
And while none of the incidents resulted in direct harm, doctors warn that overworked frontline medics and a chronic shortage of hospital staff will have serious consequences unless the problem is addressed.
The concerned clinicians spoke out as a report from the Irish Medical
Organisation (IMO) last week warned that tough working conditions are affecting patient care.
A ballot for strike action has been sent to members and will be returned early next month. Sources this weekend indicated there is widespread support among junior doctors for strike action, which would heap more pressure on the hospital system.
Providing an insight into conditions, one junior doctor who has worked at several hospitals across the country said dealing with patients in overcrowded hospitals is ‘like balancing plates. People do not realise how threadbare the system is’.
The registrar, who did not want to be named, warned ‘the capacity for mistakes is there in abundance’ and said he himself had made a serious error due to tiredness.
He told the MoS: ‘When I was a very new doctor on one set of nights I was so bleary-eyed I misread instructions for antibiotic dosing for a very complex patient that was under a specialist team and accidentally overdosed them.
‘No harm came to the patient. It was brought up with me personally as the hospital does with prescribing errors. I am not afraid to say I nearly cried – all because I thought I’d hurt someone when I thought I was helping.’
The doctor admitted it was not the only nearmiss he experienced due to exhaustion. On another occasion, he had to work back-toback night shifts from Thursday until Sunday, and then day shifts on Monday and Tuesday. He said: ‘On Tuesday I was seeing patients that were referred from A&E almost as soon as I came in to work until 9pm that night. By 2pm I was so fatigued that I sat in the doctor’s office and, no exaggeration, I have never felt as ill in my life. I’m not one for hyperbole but in all honesty, at that point, I would’ve been fine just not existing.’
As the day wore on, he admitted six more patients but, by evening, he ‘remembered none’ of them.
‘Thankfully I had their notes and all was above board management-wise, but how dangerous is it that the doctor admitting these patients hadn’t any memory of them, just was running on autopilot?’
He said on a day-to-day basis, acutely unwell patients often have to be ‘left unattended’ as there is only one registrar and a few interns working on a shift.
‘As the registrar on the wards, you are running between them, directing the interns what to do and making decisions, then scurrying off to the next emergency. Sometimes you have to leave one patient unattended entirely because there’s nobody free until you get there.’
The doctor said this can lead to shortcuts and potentially more serious errors.
He told the MoS: ‘A critical symptom missed, a deteriorating patient left longer than they should be before being seen. We work really, really hard to try and stop that happening, but it is a system that, quite frankly, is designed for mistakes to happen and potentially critical ones.
‘I can’t speak for my surgical colleagues but, honestly, how anyone can operate safely having not slept in 30 hours is beyond me.’
Another doctor, who has since left the HSE, said, ‘When it’s 4am and you can barely keep your eyes open, but you’re stood over a deteriorating patient, sometimes you just want them to shut up and that is the worst feeling in the world’.
Researcher Dr Niamh Humphries of the Royal College of Surgeons in Ireland said one doctor she spoke to for her work was unable to have short conversations with patients because they were being ‘bleeped’ by their emergency alarm eight times in less than five minutes.
Dr Humphries told the MoS: ‘Doctors I have spoken to said they don’t have enough time to spend with patients. They are constantly overstretched and constantly pulled in different directions. They are the face of the health system. They are constantly apologising to patients for what the health system can’t provide.
‘They do not have enough time to give everyone. Even though they’re working really long hours there is still too much to do.’
Dr Humphries warned the tough working conditions will exacerbate
‘I misread instructions for antibiotic dosing’
‘Sometimes you have to leave one unattended’
‘Doctors opting to emigrate is a real sign of trouble’
the problem of Irish doctors leaving for better conditions abroad.
‘Doctors are happier to exit the system than to raise any issues they see. If they are opting for emigration rather than staying in the system then that’s a real sign of trouble.’
The number of adverse incidents in hospitals rose to more than 105,000 last year, with claims rising by over 30% over the past five years, according to the State Claims Agency.
A spokesman for the IMO said its research ‘confirms the worrying rise in the number of doctors experiencing burnout and stress’.
He told the MoS: ‘A significant contributory factor in this worrying trend is the unsustainable long hours which doctors are now forced to work and which we believe pose safety risks for doctors and patients. Longer working hours is an issue for all doctors but we are particularly concerned at the hours worked by NCHDs which are routinely in excess of legal and safe limits.’
A spokesman for the Department of Health said: ‘It is acknowledged that progress made in reducing the working week and the occurrence of excessive shifts was impacted by the pandemic. The Department and the HSE are committed to all medical staff working hours that support patient safety.’