Matt Morgan and Peter Brindley: Why it’s time we all woke up to the importance of sleep

For too long, medicine has been a cult that deifies workaholism and mocks those who “fuss” about sleep, say Matt Morgan and Peter Brindley

Lauren Connelly was delighted when she landed her ideal job. After years of proving her mettle through hard study she stepped enthusiastically onto the medical ladder. She was now a doctor, and would hone her craft at a rural Scottish hospital. Fast forward a few weeks and Lauren was exhausted, both physically and mentally, after yet another 100 hour-week. Undaunted she readied herself for seven consecutive night shifts. This may have been her dream job, but the truth is that the rota rarely allowed for adequate sleep. Her death occurred on 17 September 2011 on Scotland’s busiest motorway, after falling asleep at the wheel. 

Following Lauren’s death, her dad, Brian [1], suffered his own insomnia, albeit for different reasons. Alongside grief, Brian Connelly was angry and in disbelief. After all, wethe supposedly sensible and all knowing medical professionhad blithely ignored decades of its own research. We know that lack of sleep kills. Data have consistently shown how it kills slowly and silently by increasing the likelihood of cancer, heart disease, immunosuppression, and weight gain. Poor sleep also kills suddenly and loudly through motor vehicle crashes and workplace trauma. If insomnia was a drug we would ban it immediately. If sleep was a drug we would prescribe it to all. Brian is right to speak up, is right to ask questions, and deserves our full support. The answer is seemingly simple: more and better sleep for all. The question remains: do we care enough to do the right thing? 

Speaking six years after his daughter’s death, you can still hear gritty determination mixed through his Scottish accent. He intends to wake up the government and the medical profession, and like all good parents, he just won’t quit. There is legislation to limit working hours, but Brian will tell you how it is commonly exploited and stretched. For example, we often tabulate average working hours. This sleight of hand allows 100 grueling hour weeks to be hidden within a rota, as long as that rota includes less hours over subsequent months. Brian is clearly smarter than the lot of us when he reminds us that: “Sleep cannot simply be banked and averaged over time.” We simply don’t believe that any doctor should be worked to death. 

For too long, medicine has been a cult that deifies workaholism and mocks those who “fuss” about sleep. Regardless of whether insomnia is limited to medicine or is, instead, a society wide issue, we can likely all agree that we need a cultural shift. This starts by senior folks speaking up and standing side by side with junior colleagues.

We should not, cannot, and need not stand by as doctors work hours that we would never condone for pilots or bus drivers. Lessons must be heeded. Fortunately, these are lessons that we have known for decades, and lessons that Lauren and her dad are shouting on our behalf. Patient safety matters, and so does practitioner safety. 

Brian is a professional working in the information technology industry. As such, both his advocacy and his day job could save more lives than any single doctor. This is because many of the greatest patient safety initiatives have been spearheaded not by highly qualified doctors, but rather by remarkable and tenacious people who had to respond to tragedy and refused to wait for us to do the right thing. Brian’s campaign mirrors another magnificent non-medical professional, the airline pilot Martin Bromiley, whose wife Elaine died unexpectedly after a minor operation. Inability to manage her airway should not have ended her life, but it did. Elaine died because while the doctors and nurses had all of the individual skills they had insufficient team skills. She died because of her team’s spiral of indecision, deferred responsibility, and its collective failure to act. She died because a team of experts is not the same thing as an expert team. This death was no one person’s fault, instead it was everybody’s fault. Accordingly, making things better is everyone’s responsibility. [2]

Like Brian, Martin Bromiley threw his energy into improving the system even while battling grief. They simply could not just stand by and let it happen again. Using decades old lessons learnt from the aviation industry, Bromiley’s Clinical Human Factors Group may well save more lives than you and I ever will. We suspect Brian’s campaign to reduce deaths from medical tiredness will be equally revolutionary and necessary and therapeutic. We medical practitioners have a lot of work to do. We need to wake up, and this starts by ensuring everyone is properly rested. We owe it to Lauren, Brian, Martin and Elaine…and many many others.

Matt and Peter would like to thank Brian Connelly for his bravery and time.

Matt Morgan is an honorary senior research fellow at Cardiff University, a consultant in intensive care medicine and head of research and development at University Hospital of Wales, and an editor of BMJ OnExamination.
Twitter: @dr_mattmorgan
Competing interests: None declared

Peter Brindley is a professor of critical care medicine, medical ethics, anesthesiology at the University of Alberta, Canada.
Twitter: @docpgb
Competing interests: None declared

References

[1]https://www.dailyrecord.co.uk/news/scottish-news/worked-to-death—exhausted-young-1084348

[2] https://qualitysafety.bmj.com/content/24/7/425