How can doctors' shifts change to best serve patients?
Resident doctors often work marathon shifts despite risks associated with fatigue
CBC's Marketplace reports that many of Canada's 12,000 resident doctors may be working shifts that last longer than an entire day.
- Marathon 24- to 26-hour doctor shifts may be unsafe for patients: experts
- For more, watch the Marketplace report, Tired Doctors, Friday on CBC Television at 8 p.m. (8:30 p.m. NT) or online
Fatigue from such shifts may lead to mistakes. A 2012 report by the Resident Doctors of Canada found that more than 80 per cent of residents surveyed say fatigue compromises the quality of care they give patients.
But shortening shifts means that doctors have to hand off patients' cases more often, which also increases the risks of something going wrong.
A steering committee with the Royal College of Physicians and Surgeons of Canada looked at the problem three years ago and found that strategies such as managing the risk of fatigue are a better solution than limiting shift lengths.
How can doctors' shifts change to best serve patients?
Readers let us know in the latest CBC Forum — a daily, hosted discussion about topics of national interest. Here are some of their comments.
(Please note that usernames are not necessarily the names of commenters. Some comments have been altered to correct spelling and to conform to CBC style. Click on the username to see the complete comment in the blog format.)
"As an anesthesiologist, I work 24-hour shifts when on call and have been doing that for 18 years. We have two members of our group of 24 in our community hospital who are over 60 years of age and do 24 hours on call. There are not enough physicians to limit work hours to 12, 16 hrs at most. The health-care system would grind to a halt." — sleep Doc
"The thing about emergency medical care is that everything can change in a moment. It's easy to say, 'OK, work for 12 hours and then go home,' but there's no way to anticipate who will be coming into the hospital, what care is going to be needed or how long a patient might need care." — advocate for change
"It has a lot more to do with seeing if the resident (student) can operate under pressure and fatigue without making mistakes. Residents do have a level of supervision over them from doctors who have completed their training. I have absolutely no problem with grinding the prospective physicians in order to see if they can withstand the pressure." — jimmorton
"We need to stop clogging our emergency departments with complaints that can be dealt by family doctors. And of course family doctors need to have access to their clinics in after-hours and must be able to handle walk-in clients too. The whole system needs a shakeup so that everyone gets value for money spent." — im
"The other important aspect of this, beyond the extent of medical errors due to either sleep deprivation or increased patient handovers, is the effect on the residents' health. It's no secret that physicians have a very high rate of mental health issues and suicides. This has an overall negative impact on patient care and on our health care system as a whole." — mufasa
"By eliminating or at least substantially reducing mistakes at handover, we can easily justify shortening shifts. In our highly interconnected, digital society where all of the relevant patient data exists on a hard drive in the health-care system, there is no excuse for missing or erroneous information being transferred at handover." — R t
"Healthier health professionals will result in better care in the system. No human can maintain 24-hour marathons with any regularity and not suffer serious consequences. Even 12-hour shifts regularly are damaging to one's health. The 12-hour shift model needs to go too, in my opinion." — Hannah Smith
With files from CBC's Ghazala Malik