Survey finds one in four NHS doctors are tired to the point of becoming disabled | Doctors
One in four NHS doctors are so tired that their ability to treat patients has become impaired, according to the first survey to reveal the impact of sleep deprivation on doctors during the coronavirus pandemic.
According to the report from the Medical Defense Union (MDU), which provides legal support to approximately 200,000 doctors, nurses, dentists and other healthcare workers.
The survey of more than 500 doctors across the UK, conducted over the past month and seen by the Guardian, found almost 40 near-misses as a direct result of exhaustion. In at least seven cases, the patients actually suffered harm.
Despite encouraging signs that the Omicron wave may be wearing off, doctors admitted that the constant pressure of the last 22 months fighting the coronavirus on the front lines was weighing on their technical skills and even their ability to take what should be simple medical decisions. Doctors have admitted for the first time that sleep deprivation is causing real harm to NHS patients.
Nearly six in 10 physicians (59%) said their sleep patterns had deteriorated during the pandemic. More than a quarter (26%) of doctors admitted to being so tired that their ability to treat patients was “impaired”. Of these, one in six (18%) said a patient had been injured or a near miss had occurred as a result.
One described how his patient collapsed after being prescribed penicillin, which he had previously told the same doctor he was allergic to. The doctor blamed a “perfect storm” for “chronic fatigue” and “an unmanageable workload”. Another said widespread staff shortages meant “mistakes are more common at the end of the day”.
“Doctors and their healthcare colleagues are operating on a vacuum,” said Dr. Matthew Lee, chief executive of MDU. “Our members have gone through a period of immense pressure caused by the pandemic and it is affecting all aspects of their lives, including sleep patterns.”
Fatigue increases the risk of errors and damage to the health of patients and doctors, he said. “In our survey, side effects reported by physicians due to sleep deprivation included poor concentration (64%), difficulty with decision making (40%), mood swings (37%) and mental health issues (30%).”
The MDU survey of doctors last month had 532 respondents, including hospital doctors, general practitioners, consultants, specialists and doctors in training. Almost one in 10 physicians (9%) said they felt sleep deprived on a daily basis at work. Another 28% said they felt sleep deprived every week. More than one in six (17%) said sleep deprivation affected their technical abilities when caring for patients.
Dr Michael Farquhar, sleep medicine consultant at Evelina London Children’s Hospital, which is part of the Guy’s and St Thomas’ NHS foundation trust, said that while fatigue among NHS staff had been a concern since for some time, the pandemic had “exacerbated” the problem, to the point of becoming a “critical” one, impacting patient safety and staff well-being.
“Even before the pandemic hit, fatigue was a huge problem in an NHS which is notorious for being under-resourced for the past decade,” he said. “Managing the impact of Covid has exacerbated significant issues that already existed, with many healthcare professionals ‘operating on steam’.
“When doctors are sleep deprived, they can lose insight, which means they can persevere when they do the wrong thing. Clinicians are more likely to make mistakes in simple, repetitive tasks, such as counting medications, and our ability to process, store and analyze information also suffers, meaning it can take longer to assess a patient’s symptoms and reach a diagnosis.
“Fatigue has been a major problem in the NHS for a long time…and with staff now exhausted by two years of the pandemic, it is a critical issue for staff wellbeing and patient safety.”
A total of 92% of physicians surveyed worked more overtime than they were registered or contracted to do, with more than half (52%) averaging between five and 20 hours of overtime per week. Almost one in three (29%) said they don’t have a break during a working day.
“Physicians need to recognize when they need to take a break, but they also need to work in an environment that is adequately resourced to take one,” Lee said. “In our survey, three out of 10 physicians had no breaks during the workday despite many long shifts. Additionally, 21% had nowhere to go, such as a staff room or a quiet place, to take a break.
The MDU said the government and NHS organizations must do more to ensure adequate resources are in place to allow doctors to take regular breaks.
Lee added, “Taking regular breaks is vital for doctors and their patients. The pressures on frontline healthcare workers are likely to get worse for doctors in the weeks to come. At a time of considerable understaffing in the NHS, it is more important than ever that staff fit for duty are properly supported so that they can care for patients safely.
Last week, after a Royal College of Physicians (RCP) survey found that one in five doctors felt overwhelmed with day-to-day work, Danny Mortimer, chief executive of NHS employers and deputy chief executive of the Confederation of the NHS, said: “Staff shortages and an exhausted workforce pose the greatest challenge to the recovery of our NHS and the return of safe, high-quality health services for all.”
The Department of Health and Social Care has been approached for comment.