Dead tired, or just plain dead?
By Dr John Zorbas, Deputy Chair, Council of Doctors in Training
Medicine has come a long way over the years. We’ve swapped barber shops and razors for sterile theatres and harmonic scalpels. We’ve changed our plague masks for hand hygiene. We’ve traded leeches for phlebotomy.
But there’s one thing we haven’t managed to change, and that is the body’s need for a good night’s rest.
Like an old Nintendo that had played just a touch too much Super Mario Bros., we still need to hit the reset switch and start again, clear and refreshed.
And, like an old Nintendo, there are no shortcuts. You can pull out the cartridge and blow on it in a vain attempt to get things going again, but there’s just no substitute for rest.
We work ourselves harder and harder to supposedly get more and more.
And if medicine does ever crack the puzzle that is fatigue, we’ll almost certainly destroy ourselves.
Our need for sleep is that last bastion of defence against taking these sub-par shortcuts. Our biology is clear on this: a mandatory period of unconsciousness is required every 24 hours.
The problem is that health is a 24-hour game. We don’t get to choose when our patients have their subarachnoid haemorrhages, their inflamed appendixes or their persistent nocturnal croup.
Illness happens around the clock, and we must work with this clock.
But pressures are increasing. This has led to doctors-in-training working increasingly unsociable and, oftentimes, plain dangerous shifts.
We’re not talking about missing out on the odd social event here and there. We’re talking about fatigue management, and this is no idle matter at all. Interstate truck drivers have strict schedules and relief patterns that are tracked via GPS to ensure compliance.
Pilots and their crews have rotations so strict that entire planes will be delayed to prevent fatigue from setting in, at the cost of hundreds of thousands to the airline.
The critics of fatigue management will often counter with the inadequacies of a 38-hour work week.
Let me be very clear on this: nobody is asking for hours to be restricted to 38 hours a week.
This isn’t like alcohol control, where a beer is illegal at 17 years and 364 days of age, but feel free to get plastered the next day. Fatigue is cumulative. It’s as much about the pattern of shifts as the duration of shifts, if not more so.
If fatigue management was as simple as an hour cut-off, we’d have it sorted already. Fatigue is more complicated than just your weekly hours.
The AMA has long been an advocate for safe working hours for doctors and, naturally, most of this work falls into the space of doctors-in-training rostered for shift work.
Since 1999, there has been a National Code of Practice in place to help both employees and employers best assess risk and manage fatigue in the workplace.
It is currently being reviewed by the Council of Doctors in Training, which is planning to a Safe Hours Audit later this year.
We have undertaken many such audits over the years to monitor working hours. Sadly, unsafe working hours are still all too common.
The literature is quite clear on fatigue. Fatigue kills, and it doesn’t matter whether you are a driver, a pilot or a doctor. If you’re a human, you’re subject to the never-ending diurnal requirement for restful sleep.
It has taken a gargantuan culture shift to show that working safer hours isn’t about laziness, it’s about safety and necessity.
Our next battle will be with health services who try to provide the same or increased services with less doctors and no technological advancement or true efficiencies.
If fatigue management is not a core component of working hours, you can guarantee that there’ll be a price to pay in blood, whether it be the doctor’s life or the patient’s life.
We are all human, and we’re are all tired at points in our lives. Fatigue management isn’t about being tired. It’s the difference between being tired, being dead tired and being dead.