The lack of sleep that becomes inherent in most health professional’s jobs is the largest drain of fuel for me. In my last post, I mentioned that one needs fuel to keep their fire burning. ”Rest,” ”sleep,” “recharging the battery“ are ways of saying that we need this down time to replenish our fuel supply. The fatigue fact air has been the elephant in the room for physicians and other healthcare providers. For a long time, centuries maybe, it’s been kind of a merit badge to say how long you’ve been working. I used to think that it was a great accomplishment to stay up all night doing my jobs. As I’ve aged, I discovered that this is crap talk. You just don’t think as well the next day. You forget stuff that is important to doing the job. You drive and don’t know how you get where you’re going. You fall asleep at the sop light. It sounds funny, but all of these things have happened to me.
A year or so ago, I was reading a journal article about the fatigued physician, as part of my annual OB/GYN Board re-certification. I was alarmed by a few things that were mentioned. Did you know that staying awake for 24 consecutive hours puts your brain in a state of disruption that is equal to being legally drunk? So a physician that worked in the office all day, then spent all night after that on the labor and delivery floor delivering babies or in the ED taking care of miscarriages or tubal pregnancies, then goes to the operating room for his/her regularly scheduled hysterectomies is actually doing those hysterectomies as if drunk. This sounds like a tragedy waiting to happen. The article also said that is takes three eight-hour sleeps to get back too normal. Did you realize that the vast majority of doctors never get eight hours of sleep a night, for years on end? As a doctor, this information scares the hell out of me.
Another article stated that some where between 50,000 and 100,000 deaths a year are due to the healthcare provider being tired. My mouth dropped open at that bit of data. It went on to state that the usual work shift of a resident physician in the first year of their residency is 36 hours. A physician at Harvard decided to decrease the work shift to two sixteen-hour work shifts and found that medically related errors decreased by 36%. That is amazing. This study lead to the Residency accreditation governing body to mandate that resident work hours be changed. I remember when these changes took effect, about fifteen years ago. Suddenly, these residents were not around for the surgeries that they needed to learn or the deliveries that they needed to do. For the attending staff, this meant more work for them. We all thought that the residencies would need to be lengthened in order for the training doctors to get their experience. In the ensuing years, the residencies stayed the same length. But now the residents were more rested and could remember their studies better. They were more engaged with their patients. The big problem was that when they graduated from their residency, they went to smaller practices and had to work more hours. They were unprepared for the “real” world day to day practice of medicine. The bottom line is that physicians need rest and needs to be supported by administrations in all hospitals across the nation.
The same problem of poor job performance in relation to fatigue is seen in other professions. Most notably, we’ve seen it in the transportation industry. The statistics say that it is safer to fly than drive a car. One reason for this is that airline pilots and crews are mandated to only work a certain number of hours in a row, twelve. After that, they are required to rest for twenty-four hours. On long flights, they actually have more than one set of crew on the plane. While one set is working, the other is resting is a special compartment is the tail of the plane. Why would this be a happening? The rested crew makes far fewer mistakes. If you make a mistake in a jumbo jet, hundred of people die. Research has also shown that this data is transferable across all of the transportation industry (trains, ships, buses). But for some reason, it has’t made it to mainstream medicine.
Beyond job performance, there are numerous detriments to ones health as one is deprived of sleep. Sleep loss leads to increased blood pressure and heart disease. It leads to increased irritability and social maladjustment. It leads to increased appetite and decreased metabolism, which subsequently leads to weight gain and obesity. If you are tired and irritable and hungry, you do not want to interact with other people and really don’t want to do your job. So, it stands to reason that work place productivity would decline as worker fatigue increased. Employers may not see this problem until something bad happens. It’s a shame in this modern world that someone has to breakdown in order for some positive change to occur in the culture of administration to be more proactive when it comes to worker health. A plane has to crash. A patient has to die. A doctor has to commit suicide. All are preventable if awareness is increased. I hope that this blog sheds some light on this subject. We’ll be looking more at the work environment in future posts.
TheRoastedNutt 