Work hour limitation has been a topic for discussion for quite a long time including in medicine. Doctors who work long and continuous shifts are fatigued, sleep deprived and exhausted.
Fatigue causes memory and attention problems, difficulties in communicating; it also impairs judgment and understanding. Sleep deprivation is even more dangerous than working under the influence of alcohol. Being awake for at least 18 hours has been shown to be the same as someone having a blood alcohol content of 0.05%. And, being awake for at least 24 hours is equal to having a blood alcohol content of 0.10%. So, driving while drowsy is equivalent to driving after drinking too much of alcohol.
Hence, a pilot or a truck driver or a doctor who is fatigued and sleep deprived is more at risk of making errors, some potentially fatal.
But there are checks in place as far as pilots are concerned. They are required to undergo evaluation before a flight to assess their fitness to fly and also to look for alcohol or drug abuse. Their flying hours are restricted and they have a copilot as a backup. All these measures are in place to eliminate pilot fatigue.
Would we like ourselves to be compared with pilots or artisans? Are we simply mechanics trying to repair the human body or are we skilled ‘restorers’ regarding medicine as an art but armed with special knowledge and expertise?
In the Medscapes National Physician Burnout and Depression Report for 2018, general surgeons were among the highest rankers with a burnout rate of 43%. Orthopedics and plastic surgery were lower in the list with a burnout rate of 34% vs 23%, respectively. The top rankers in this list were critical care and neurology (48%) and family medicine (47%).
Primum non cere “first do no harm” is the fundamental principle guiding the ethics of practice of medicine. The principles of non maleficence (do no harm) and beneficence (do good) are derived from this.
So why are doctors and residents allowed to overwork? There is a need to debate on this.
Should the world medical bodies look into this and come out with relevant guidelines?