Being a doctor typically involves high-intensity, time-pressured working patterns. These can lead to sleep deprivation and an increased risk of fatigue. The adverse effects of sleep-related fatigue are significant, impacting on a doctors’ health, wellbeing, and performance, and thus their safety and that of their patients.
While a range of factors can cause fatigue (including some medical conditions such as anaemia and diabetes, infections, anxiety and depression, medications, and lifestyle behaviours), a lack of good quality sleep is particularly relevant for doctors.
The National Sleep Foundation recommends 7–9 hours of sleep per night for an adult. Medical literature has shown that even a single night of missed sleep measurably affects cognitive performance. When adults do not sleep at least 5 hours per night, language and numeric skills, retention of information, short-term memory, and concentration all decrease on standardized testing. Speed of performance may be affected more than accuracy. Sleep deprivation may affect mood to a greater degree than it affects cognitive or motor performance, and, thus, may have a significant effect on a physician’s ability to communicate effectively.
Definition of fatigue and sleep deprivation
Fatigue is a subjective feeling of tiredness, weariness, or lack of energy, usually associated with lower performance (physical or mental). It is distinct from, and can cause, drowsiness/sleepiness, which relates to feeling the need or propensity to sleep, and difficulty in maintaining a wakeful state. Fatigue can be categorised as being transient (resulting from extended time awake/severe sleep restriction), cumulative (consecutive days of extended time awake/mild sleep restriction) or because of circadian disruption (being awake and working overnight).
Sleep deprivation is an acute or chronic lack of sufficient sleep resulting from disruption to the natural sleep-wake cycle. It can be caused by specific work environments (eg shift working), by environmental stimuli (eg external noises), or by sleep disorders. Recurrent sleep deprivation over time can lead to the accumulation of sleep debt (ie when an individual does not experience sufficient restorative daily sleep).
What factors put doctors at risk of fatigue and sleep deprivation?
- Long working hours as standard
- Routinely required to work beyond working hours
- Intensity and complexity of work, requiring for sustained attention over long periods of time in mentally demanding situations.
- An increasing number of patient consultations with more complex and multiple conditions
- Sleep disturbance while on call and unplanned interruptions of sleep.
- Shift working that impacts the natural sleep cycle, like night shifts or early morning shifts, or short recovery times between shifts (less than 11 hours).
What did our UK panel members have to say about fatigue at work?
This follow-up survey was developed to look at how fatigue affects doctors whilst they’re at work and making clinical decisions, as opposed to when they’ve left their workplace. We also looked at how fatigue is perceived, and what support is available for fatigued doctors.
You can see a summary of the results collected below:
What has been proposed to battle fatigue in the medical workplace
- Introduce mechanisms for doctors to influence the culture of their healthcare organisations
- Set minimum standards for working conditions related to rest and sleep, access to nutritious food and drink, and the tools needed to deliver care.
- Develop and maintain work scheduled and rotas based on realistic forecasting, supporting shift swapping, enabling breaks, and taking into account fatigue.
- Tackle the fundamental problems of excessive work demands in medicine
- Provide effective support and supervision to doctors.
- Promote training, learning and development.
- “Fatigue and sleep deprivation – the impact of different working patterns on doctors”, by the British Medical Association, January 2018.
- “Caring for doctors. Caring for patients”, by Professor Michael West and Dame Denise Coia, November 2019.
- “The impact of fatigue in the healthcare setting”, M. Garrubba & C. Joseph, March 2020.
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