Regulator warns over sleep-deprived junior doctors

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doctorsfocusIn a move that will resonate with SA junior doctors, the UK’s General Medical Council has warned that trainee doctors in the that country’s National Health Service are often so sleep-deprived that they are in danger of harming patients. SA junior doctors are currently campaigning for an end to excessive hours.

The Guardian reports that this is according to the General Medical Council’s biggest annual survey of trainee medics’ experiences, which found increasingly heavy workloads and widespread staff shortages mean the UK’s 54,000 junior doctors are being left to look after wards of patients without proper experience.

One in four doctors below the level of consultant say their schedule leaves them sleep-deprived and 43% describe their workloads as heavy or very heavy. Those with the most intense schedules are much more likely to encounter patient safety being put at risk, the survey found.

The report says in one unnamed hospital, a junior doctor was the sole medic left in charge of 300 patients overnight – a case the GMC’s CEO, Charlie Massey, said was extremely concerning. The risk of the doctor being unable to deal with two medical emergencies happening simultaneously meant such lack of cover should never happen, he said.

“Patients who are in hospital overnight are in a hospital for a good reason and if something should happen to one or more patients during that nightshift, and that trainee has been left alone, that creates real potential risk to patients,” Massey said. He said he was “astonished” to have learned that a single doctor had been left unsupervised and having to handle the care of so many patients.

The proportion of trainees describing themselves as sleep-deprived rose from 21% in 2012 to 24.4% this year. “This is an increasing and worrying trend and it’s very concerning when doctors say that it’s jeopardising their ability to make good judgments and to provide safe care,” Massey is quoted in the report as saying.

“Sleep deprivation matters because (tired) doctors may not remember all of the things that they should remember – for example, all the things to do to safely intubate an individual – because they are so knackered or may not remember all the patient’s history and may therefore make the wrong clinical judgment about them.”

Massey is so worried by the potential for patients being harmed by rising fatigue and workload pressure among hospital doctors that he has written to every NHS provider of care across the UK warning them to take steps to ensure the safety and quality of care
are protected.

A separate survey of junior doctors, undertaken by the Royal College of Physicians, found that 80% of trainee medics say their job sometimes or often causes them excessive stress. One in four of the 498 junior doctors surveyed by the RCP said their job seriously affected their mental health and 54% said it affected their physical health. Pressure on trainees had reached a “harmful and unsustainable level”, the college said.

Massey said the demands being placed on trainees were now so great that there was a risk of some being “used and exploited” by their hospitals because there were too few staff to cope with the work that needed to be done.

Massey also voiced unease that the quality of handovers from one set of doctors to another – which are integral to patients receiving good care – had emerged as a growing concern. Young doctors’ clinical education is also being interrupted by them being called out of training sessions to attend to problems involving patients, the GMC found.

NHS Employers said the new contract being imposed on junior doctors in England, which prompted the recent year-long industrial dispute between the British Medical Association and the government, would remove or mitigate many of the concerns behind their rising dissatisfaction.

The Guardian report
GMC survey
Royal College of Physicians survey

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