Working long hours can seriously affect health of doctors - and patients
Just as in other walks of life, social media is becoming a significant player in the lives of doctors.
At present both Twitter and Facebook are playing a central role in a growing campaign by junior hospital doctors to limit their working hours: #24hoursisenough is where you will find the latest tweets on the subject.
As I am writing this column, here is a message from one junior doctor: “There’s something seriously wrong when going home after 29 hours work feels like slacking off.” Another, rather poignantly and poetically says, “the dread of on-call and the sound of the bleep, cause palpitations through the day and haunt me in my sleep.”
The aim of the campaign is to restrict the number of consecutive hours worked by doctors in training to a maximum of 24.
Despite the European working time directive, it is still quite usual for a doctor to go into a hospital on a Saturday morning at 8am and to work right through to 7pm on the following Monday.
It is common for the non-consultant doctor to have just one or two hours of sleep for that entire 59-hour period.
Intuitively, such work patterns would seem anything but good for the doctor’s health, as well as posing a serious risk to patient safety. So what does research have to say on the subject?
The largest study ever to look at shift work of any type and cardiovascular risk, published in the British Medical Journal, found the risk of heart attack is increased by 23 per cent and the risk of having a stroke by 5 per cent in shift workers compared with regular daytime workers. And it found the worst shift of all for the heart is the night shift.
A Canadian study from last year found that, for many different cancers, men who worked at night had about double the risk of those who did not work a night shift.
The cancers included pancreatic, colorectal, bladder and prostate tumours.
Shift work has also been linked with anxiety and depression, and an increased risk of miscarriage and premature birth.
Moving to patient safety, research across a range of industries has shown an increased risk of accidents occurring on the night shift and with long working hours.
In the US, interns working a traditional schedule of 77-81 hours per week caused 36 per cent more serious medical errors than when working an average 65 hours per week.
Furthermore, interns had fewer than half the number of failures of attention at night when working a shorter week.
But is there any evidence that shortening the length of on-call shifts improves doctors’ performance and patient outcomes?
Research from Harvard University Medical School found that interns slept more and performed better when they were rostered in a way that gave them more time to sleep during their shifts.
And a separate study found that junior doctors made significantly more serious prescribing errors when they worked frequent shifts of more than 24 hours compared with when they worked shorter shifts.
Is it any wonder junior hospital doctors here are voting with their feet? Many are emigrating to New Zealand and Australia.
Irish doctors who avail of a job in the Australian health service can expect to work an average of 38 hours a week.
Significantly, nobody works more than a 15-hour shift at any stage with the majority of shifts nine hours in duration.
Finally I came across a study showing a 16 per cent risk of a car crash among junior doctors working extended shifts.
As an intern over 20 years ago, after an extended and sleepless weekend on call, I woke to find myself and my car attached to the railings across from the hospital exit. Plus ça change.
I wish to acknowledge the input of David Hannon, a final-year medical student at the University of Limerick, in the preparation of this column.