Are train drivers, who work in an industry that acknowledges the effects of fatigue, safer workers than doctors?
Yes, according to British researchers, who say it's time for healthcare to take a lesson from industries that already understand the effects of fatigue and the link to worker mistakes.
University of Oxford researchers Paul Greig and Rosamund Snow write in BMJ that the medical industry should embrace approaches from transportation and other industries, which recognize that safety is critical. Fatigue is a major risk factor for mistakes and poor decision-making in the workplace, and individual workers are very poor at assessing their own fatigue risk.
“Good evidence shows that tired workers are more likely to make errors of judgment, react slowly, misinterpret data, omit key information and fail to question things that are unsafe,” the researchers write. Yet, doctors have historically worked long hours, and in some countries shift lengths are still lightly regulated.
The issue of long hours became a matter of debate in the U.S. earlier this year, as the Accreditation Council for Graduate Medical Education (ACGME) in March reversed a previous policy and, as of July 1, now allows first-year doctors to work 24-hour shifts in hospitals.
Despite opposition from some medical residents, the controversial change was among a set of revisions to the standards for all U.S. residency and fellowship programs by the organization that oversees doctors’ training. It lifts a requirement that limited first-year physicians to 16 consecutive hours of patient care.
Opponents said the change would jeopardize patient safety by putting new, sleep-deprived doctors in charge of patients, but the ACGME said returning first-year residents to the same schedule as other residents and fellows will allow for better team-based care and seamless continuity of care with fewer handoffs of patients between doctors.
Typically, healthcare workers think nothing of skipping breaks and working long hours. Those attitudes would be considered unprofessional and even illegal in other workplaces where safety is critical, the British researchers say.
There’s no evidence that healthcare workers are less able to withstand fatigue than those in other industries, which place much more importance on the cumulative effects of fatigue, consider working patterns and carefully manage worker breaks when assessing risk, the researchers say. They argue that clinicians should reduce their own risk profile and support colleagues who make changes to battle fatigue.