Pity the doctors in some Australian hospitals. A recent audit found many who are obliged to work inhuman hours. And it’s not a problem confined to Australia. Similar findings surface in the headlines from time to time in many other countries. Wherever it happens, the long hours are bad medicine for the doctors and worse medicine for their patients.
More than 500 doctors across the country responded to an Australian Medical Association (AMA) “safe hours” survey, published in October in Melbourne’s The Age newspaper. The audit tracked the hours doctors worked in the week of May 8 to 14 in 2006. One doctor in a hospital in the state of Victoria worked 107 hours in one week. Another worked a 100-hour in an emergency department at a regional Victorian hospital, including one shift that lasted 34 hours. A regional Victoria trainee surgeon reported working more than 70 hours a week, with 17 hours in one day, and no days off over a three-week period. A senior Melbourne doctor worked two consecutive weeks of more than 70 hours each, including a 17-hour day.
An article in May 2005 on medical errors in The Ergonomics
Report™, a publication for professionals in ergonomics-related disciplines, noted that fatigue results in bad medicine. Night shift, overlong hours, the shortage of nurses and overwhelming patient loads add up to chronic fatigue, even exhaustion. Tired minds are often forced into instantaneous and life-and-death decisions.
In one of many studies in the May article to explain the impact of sleep deprivation on performance, Australian researchers supplied figures for hospital medical residents that set the problem in context. The effect of lost sleep (sleep debt) accumulates over time and does not dissipate, they say. In “Fatigue is no defence for negligence by a doctor in an action by a patient,” published in the Medical Journal of Australia in 1998, the researchers reported that cognitive psychomotor impairment after 17 hours of sustained wakefulness is equivalent to a blood alcohol concentration of 0.05 percent; after 24 hours of sustained wakefulness it is equivalent to 0.1 percent. These are blood alcohol figures that could land a driver in jail on DUI charges.
The AMA is considering using the results of the audit to push for mandatory restrictions on doctors’ work hours, a measure certain to benefit patients as well as the doctors.
Sources: The Age, Irish Times, The Ergonomics Report