By Shamar Blunt
A consultant physician at the Queen Elizabeth Hospital (QEH) says the practice of junior doctors working shifts in excess of 30 hours is “dangerous” and needs to stop in the interest of patient and public safety.
“It’s not acceptable,” Dr Kenneth Connell acknowledged in an interview with Barbados TODAY, a day after Government Senator Dr Crystal Haynes called for an end to 30-hour work days for these professionals.
He disclosed that an internal study done in the department of medicine showed that “11 out of 14 junior staff members felt significantly burnt out”. Although he did not indicate when this study was done, Dr Connell said the findings were “significant”.
“These are doctors in internal medicine who have been working long shifts, so 32 hours at least. Internal medicine admits roughly about 70 per cent of the admission burden to the hospital… but yet these doctors are working at their limits, having not slept,” the doctor said.
The Deputy Dean of the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus suggested that just as there are limits on the number of hours pilots are allowed in the air, having caps on the length of doctors’ shifts would be in the best interest of the public.
“Is it possible for pilots to be flying a plane for 30 hours without rest, or working 30 hours? I have been in airports where flights have been [delayed or] cancelled because, during the upcoming flight, the pilot would have crossed his number of hours without sleep.
“But yet, we have people making critical decisions, life or death situations, that have possibly not slept or we cannot guarantee that they were sleeping for ‘x’ period of hours. To me, in 2023, that is unacceptable,” he said.
During the debate on the Appropriation Bill, 2023 in the Upper House on Tuesday, Senator Haynes said the problem of doctors working extremely long shifts needed to be addressed urgently to safeguard the safety of both patients and healthcare providers.
“[Working excessive hours] is very normal for a lot of doctors, both at the intern level and at consultant level. You work all day on the wards, you spend the night in the ER [emergency room] dealing with emergencies that are coming through all night, and then you continue to work into the next day. That is something that is a threat not just [to] patient safety but [to] the personal safety of our healthcare providers,” the medical practitioner said.
She noted that there were studies which showed that working for more than 17 hours with little rest can lead to fatigue-related impairment in cognitive and physiological functioning, which is comparable to the person having a blood alcohol concentration level of 0.05 per cent – similar to levels seen in alcohol intoxication.
Responding to Senator Haynes’ concerns, Dr Connell acknowledged that junior doctors are often asked to work even longer than 30 hours while on call.
“I thought it was a conservative estimate of saying 30 hours, to be quite honest. I’ll use my speciality as an example. [They] start work at 8 a.m. – these are junior doctors if they are on call –, they work through until 8 the next morning. That is described as the on-call period and then when they finish that period, their day then starts. So from 8 a.m. until 4 p.m. [the following day], which by my calculation is 32 hours at least,” he explained.
“This doesn’t mean that they will leave at 4 p.m. because they may leave after, but they continue their work day as if it is a new work day.”
Dr Connell said while this is viewed as a “badge of honour” among healthcare providers, the practice is a dangerous one.
“It is almost what I would describe as an unacceptable badge of honour in medicine, that we work long hours and we did it and therefore, our juniors should do it. It’s not acceptable. Mistakes will happen,” he warned.
“In some parts of the hospital, like emergency rooms, there is a shift system so doctors do an eight-hour shift or six hours and then they leave and then another shift comes. Obviously, the ER is high intensity so they need that, but my argument is it is not in the public health interest to have a doctor that has been working continuously – so not just in hospital but sleep deprived – for 30 hours, and is making any clinical decisions. That doctor should not even be getting into their vehicle and driving home. That’s dangerous.”
The medical consultant stressed that for the situation to change, additional funds would have to be made available to hire additional doctors to improve the shift system.
“It is not going to be a cheap transition. The only thing that is preventing doctors from working shorter hours is [that] you will need to hire more doctors. There needs to be 24-hour coverage, so if one group of doctors are going to work [fewer] hours, then someone has to come in and take over from them.
“So this resistance to change is largely driven by a financial kind of argument where we cannot afford it. But the flip side of it is can you afford the public health risk? If the answer to that is no, then doctors have to be capped on the number of hours that they’re working,” he said.
During her contribution to the debate, Senator Haynes suggested that the University of the West Indies (UWI) “is producing enough doctors every year that we should be able to expand the complement of staff at the junior doctor level to do away with this system and to roll out a proper roster where we can limit the number of hours”.
Dr Connell told Barbados TODAY that even if more graduates were coming out of university, additional posts would have to be created for them to fill.
“They’re only going to get hired if there are posts for them. So, if you don’t have enough paid posts in the hospital then you can’t hire enough doctors to allow for a shift system to begin with,” he said.