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FEB 04/2015

How doctors can safeguard against fatigue

It is common for doctors, whether experienced or newly qualified, to work longer shifts than they should, sometimes without a proper break, time to rest or to eat. This obviously has a detrimental impact on the wellbeing of the doctor but also has a very real effect on the level of patient care.

A study conducted by Harvard Medical School found that intern doctors who do not get enough rest make four times as many errors as those who do not suffer from fatigue. The research also found that experiencing a mistake at this stage of their career can understandably put the professional under emotional strain.

Speaking about the study's findings, Charles Czeisler, Baldino Professor of Sleep Medicine, said it shows that "academic medicine is failing both doctors and patients by routinely requiring exhausted doctors to work marathon shifts", as the human brain "simply does not perform reliably for 24 consecutive hours without sleep".

Because of this, fatigue is a pressing problem for many in the medical profession - but how can it be addressed where there is still such high demand for doctors and nurses throughout the day and night?

Locum staff

Locum doctors and nurses can help address this issue by taking pressure off permanent staff. This is crucial at this time of year when there is a sudden influx of patients suffering from seasonal problems related to their breathing, falling or joints. By taking on agency staff, the hospital can ensure that patients get the high standard of care they deserve.

In addition, when handled properly, locum and agency staff are not an expensive, desperate solution and can be the ideal addition to strengthen a competent team in a time of need. Another benefit of locum doctors is that they can address a specific area of need with their specialist knowledge. Being able to choose from a pool of locum doctors can help you address the most pressing needs of your hospital, whether that be taking some of the pressure away from your permanent cardiologist or hiring a specialist geriatric consultant to deal with the high number of elderly patients coming for medical advice.

This will not only reduce the amount of waiting time for patients but will also reduce fatigue among staff and ensure everyone gets the best standard of care.

However, it's important that individual staff members take responsibility for their own fatigue and stress levels, even if their team may be understaffed.

Personal responsibility

If you are working as a doctor in a hospital, whether as a locum or on a permanent contract, you have an obligation to yourself and to your patients to ensure that you are fit to work. The standard of care you are able to deliver to your patients is directly related to how tired and stressed you are feeling. Fatigue can make you lose your concentration and this can seriously affect the decisions you make, which could potentially put a patient's health in danger.

However, with the demanding and stressful nature of a doctor's role, and the anti-social hours that come with the career, it's common for professionals to feel tired and pressured throughout a shift. This is especially true for doctors that have ascended to a high level, where their role constantly demands tough decisions and carries with it a huge amount of responsibility. For most consultants this is simply part of their role and dealing with this is what makes them a renowned figure in their field.

With both these facts in mind, it's important that medical professionals are able to make their own judgement about whether they are safe to practice, and when general tiredness or stress has become apparent enough to affect their decision-making process. This may be especially difficult for new or inexperienced staff as they will be eager to make a good and strong impression to their superiors, and outperform their peers. In this instance, they may not have the foresight to see when they are entering a potentially dangerous state of mind, and so this responsibility lies with the more experienced people they are working with.

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