ED attendances are increasing at a phenomenal rate worldwide. This, along with staff shortages has resulted in an ever-growing mob of exhausted and dissatisfied staff members. Exhaustion can result in worsening patient care and even lead to serious medical errors.
The European Working Time Directive (EWTD) have succeeded in capping average weekly hours, but 13-hour night shifts and a week of night shifts amounting to some 80-90 hours are not quite a thing of the past yet. To the great despair of their staff, many EDs have found ways around it…
The EWTD has also failed to cap the intensity of work and the proportion of antisocial hours worked. Is there anyone out there who actually gets all his or her mandatory breaks?
We are now a fully-fledged 24-hour service where in some instances nights are actually busier than day shifts.
We need to find a good balance between working sensible hours and continuing to achieve adequate training. The surgical specialties have long been denouncing the negative impact that reduced hours have had on their training.
How many of us have not ever felt slightly edgy when we have been tired or hungry or both and have allowed a colleague… or worse still a patient to sneak a glimpse of the inner Hyde character. This does nothing for patient compliance and satisfaction.
Being exhausted can, not only dampen motivation, but can also lead to poor attitudes to work and learning. Overworked doctors become lazy learners. It also breeds a “them and us” attitude. “If they give me nothing I will give them nothing in return- why should I do anything over and above the bare minimum expected of me?” In all work settings we know that a bad attitude can spread amongst staff like wild fire, which can escalate to full work place revolution, even amongst those you could have previously banked upon.
What about the dire effects on our health?
The aviation and driving industries have already recognised the dangers of exhausted staff on safety and performance and have imposed sensible mandatory breaks. https://blogs.bmj.com/emj/2012/05/16/crew-resource-management-in-the-ed/
In medicine however, we rarely practice what we preach, often eating convenience foods, finding little or no time for exercise and walking around in a haze of stress and sleep deprivation.
On a personal level, burnout can lead to depression and contribute to substance misuse and broken relationships at home, not to mention strained relationships at work.
The most common reason for rejecting a career in EM is a poor work-life balance. The answer to staff shortages is not to pile more work on the already over-worked. Worldwide staff shortages within ED are going to be a long-term problem unless we urgently seek to remedy these problems.
EM is a vibrant, challenging and growing specialty, but sadly its workforce will not be for much longer, so by balancing hours as well as training, please let’s make it an attractive career option again!
Sivanthi Sivanadarajah/Janos P Baombe