The Tired Doctor

Lately I have been feeling as though I’m continously catching myself after almost falling over. Either as soon as I recover from a duty I have a next one- or I simply never recover. I asked my friends and colleagues how they felt, and if the exhaustion I feel is unique to me. It isn’t. In fact, it isn’t unique to my rotation, my hospital or even my country.

Doctors often work over 12 hours with little to no sleep. Because everyday is different and you cannot predict what will happen in medicine- especially during an emergency duty… you never know how much sleep you can get during that call. That means, physicians are working 12, 24, 30+ hours not knowing if or when they’ll get to sleep.

Sleep is important, as it helps us reset and repair. When we go without sleep, our ability to ‘think straight’ is affected. Lack of sleep affects the very things doctors need to be functional and effective. It makes our cognition slower, affects our memory negatively and affects our ability to focus. There is cost when it comes to losing sleep.

Doctors may think that we can rewire the amount of sleep we need to function on, but the reality is we can’t. our Circadian Rhythm is pretty resistant to change… and we simply end up accumulating sleep dept, going through mental fatigue and eventually burn out.

While reading, I found many stories from many doctors about the ill effects of sleep deprivation. These stories endangered both themselves and patients. Stories of misdiagnoses, incorrect medications, falling asleep while driving and having accidents at work.

Studies have shown just how much lack of sleep can affect a doctor’s performance and wellbeing… and not just in a hospital setting. More mistakes are made the longer a physician works and eventually decision fatigue sets in. The longer this persists for, the more mental and psychological impact there is on the physician.

The cause and effect are widely studied and understood- yet there has been little to no change, especially in Jamaica. Every doctor has a story, both about themselves and their colleagues, about how sleep deprivation has affected them. Jamaican Juniour doctors in hospital settings are scheduled for, maybe, a minimum of 72 hours per week, most, often work much more. It is impossible to know how a call will go, so sometimes you can get a few hours of sleep and other times you will get none. Even if you do sleep on call, that sleep quality does not compare to the uninterrupted sleep you would get if you weren’t on call. Leaving most doctors tired the next day regardless of how much sleep they did or didn’t get.

Improvements need to be made on all levels, so that doctors can be taken care of. Regular breaks should be instituted, improvement in staff numbers to lessen the amount of hours a doctor has to work. Implementation of a shift system, similar to Accident and Emergency so that doctors aren’t working more than 8 hours at a time. Implementation of the above comes with its own unique set of challenges, as it forces a light on why the system was created like what it is in the first place.

With changes geared towards improve physician wellbeing and patient outcome, legislation plays a major role. Conversations surrounding, system improvement and efficiency, proper and fair renumeration and the implementation of wellness programmes need to be had. For juniour doctors, who are also learning as they work, decreased work hours may be seen as less exposure to clinical cases. I don’t think this is a strong enough argument to keep things how they are- we must become creative in providing balance. We must forget the notion that because it is being done there is no other way to get it done. And that because others have successfully done it before us, that we too must do the same.

There is benefit in putting physician wellbeing first, decreasing the load they carry and the number of hours they work. Improvement in work conditions and renumeration all result in better patient outcomes AND physicians’ lives.

Samantha C. Johnson