Emma Plunkett: Consultant fatigue—from anecdote to evidence

Recent research into the prevalence and impact of fatigue on health workers should be a call to action, says Emma Plunkett

Recently, the results of a national survey of fatigue in consultants in anaesthesia and paediatric intensive care medicine were published in the journal Anaesthesia. Some of the newspaper headlines picked up on the large number of respondents who reported work-related fatigue; “Majority of consultant doctors suffer fatigue, ” said the Daily Telegraph, and, “More than 90% of senior anaesthetists and child intensive care doctors suffer work fatigue, survey suggests” in The Independent

For me, it wasn’t the proportion of consultants who reported experiencing work related fatigue that was surprising, although I’d like to know the secrets of the 9% who didn’t. It is work after all, and, whatever one’s occupation, I’m sure most people find work tiring to some degree, especially those who work night shifts or long days. But that’s not to say that I don’t think the results are strikingthere are many note-worthy points to mention. 

Firstly, I find the scale of the response remarkable. For almost 4,000 anaesthetists to take the time to fill in a survey in an environment which is flooded by requests for surveys, says volumes about the importance of the issue for those affected. These survey findings are, to my knowledge, the largest survey of consultants out of hours working patterns that has been conducted, certainly in anaesthesia and paediatric intensive care.  

Secondly, there is no denying the intensity of out-of-hours working for these acute specialties. The typical length of on-call periods, combined with the frequency of on-call, number of phone calls overnight and usual length of time it takes to go back to sleep suggests that, for some people at least, out of hours working is likely to be associated with significant disruption to sleep. What is even more worrying is that for some respondents, they have no option but to continue to work the next day, no matter how many interruptions or how poor their sleep has been. Of course the survey results are generalised and I’m sure there are places where consultants work infrequent on-calls and are rarely disturbed (lucky them!), but these results suggest they are the minority. 

Thirdly, I can’t help but be concerned by the scale of the impact of fatigue. Over half of those who reported fatigue said it had a moderate or significant negative impact on all aspects of their health and wellbeing as well as their ability to do the non-clinical aspects of their job. This, I think, should be a wake-up call for us all to think about what we can do to improve.  

And while the results of the survey may seem worrying, I think the conclusions are less so. After all, what the survey has done is describe the current state of playtranslating what was previously anecdotal into evidence. It is therefore a starting point for improvement and there is lots that can be done to improve. The survey results remind us of the importance of education of all healthcare staff (clinical and non-clinical) about the importance of good sleep habits.

Consultants cannot control the workload they experience when on-call (the message of this survey is not that consultants are called too much overnightthey should be called whenever needed) but everyone has some control over the quantity and quality of sleep at home. Not complete control of coursewe know that many are disturbed by dependents for examplebut a reminder about what makes good sleep hygiene might be helpful to improve sleep outside on-calls. Another improvement would be to increase the access to rest facilities for consultants—only one third of respondents reported having access. Dedicated rest rooms are unlikely to be available but there will be offices that are not used overnight which could be adapted to provide rest areas. It may take charity funding and some creative thought but there are solutions available. 

Finally, departments can develop fatigue risk management strategies. Other high risk industries have these and healthcare should be no different. Yes, there are unique issues and resources are tight, but we can no longer put our heads in the sand and pretend that doctors are immune to fatigue. Providing some guiding principles for fatigue risk management is one of the next steps for the Joint Fatigue Group.  

Working in the acute specialties in healthcare is immensely rewarding. It is exciting, challenging, and satisfying. It would be even better if we improved our management of fatigue. Hopefully these survey results will act as a wake-up call and prompt some positive change. 

Emma Plunkett is a Consultant Anaesthetist in Birmingham and chair of the Joint Association of Anaesthetists, Royal College of Anaesthetists and Faculty of Intensive Care Medicine Fatigue Working Group.
Competing interests: EB is chair of the Joint Fatigue Working Group