If something goes wrong on a night shift, fatigue is no defence. Sara Dawson explores how managing your sleep will safeguard your practice and the lives of your patients
What do industrial incidents at Bhopal, Chernobyl and Three Mile Island have in common? They all happened at night.
Many studies of human efficiency and mental agility have shown significant dips between 10pm and 6am, and the risk of injury is 30% higher on a night shift compared to a morning one. Twenty to twenty five hours without sleep – as might be experienced by a doctor who has worked just one night and was without rest during the day leading into the shift – reduces psychomotor performance to the level of someone with a blood alcohol concentration of 0.10%.1 Night work requires doctors to remain awake and alert, when physiologically programmed to be asleep.
Sleep deprived interns and community service doctors work up to 200 hours of overtime per month owing to chronic medical staff shortages.2 Junior doctors often work extremely long hours – a normal day, through the night, and possibly a short next day. Working the night shift involves covering several hospital wards and managing acute admissions.
In the medicolegal world, a mistake by an overworked and tired doctor is still a mistake. Exhaustion is no defence for poor decision-making. Doctors who adequately prepare for a night shift minimise the risks for themselves and their patients, and reduce the likelihood of making errors.