Asleep at the wheel: The threat posed by exhausted doctors

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 that the railings belonged to the main hostelry in the area probably didn’t help the image portrayed to onlookers.

It was about 6.30 on a Monday evening. 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.

Some 12 hours sleep later I was back for another day's work, still shocked that I had fallen asleep at the wheel

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 a CT scanner at the time. My patient had a cardiac arrest while in transit; thankfully she responded to resuscitation.

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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 an accident 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.

72 per cent said that work-related fatigue had negatively affected their physical health

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. Over eight in 10 respondents said that 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.

Extreme tiredness among doctors could lead to them making mistakes

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.

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 the intensity of medical practice has 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 a 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 after a busy overnight shift but before heading home is clearly needed also.

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.

Mhouston@irishtimes.com    

@muirishousto