Two days ago a junior doctor in Australia left court. She is being charged for being involved in a fatal car crash. This young JMO had just finished her fifth overnight shift and was driving home (one hour commute).

She is currently being vilified in the press, saying that she should have known better than to drive after her shift. Fatigue being one of the big three killers on the road. This JMO veered into oncoming traffic, killing a woman and injuring two others.

She has pleaded guilty to negligent driving occasioning death, and negligent driving occasioning grievous bodily harm. Tiredness a factor in this terrible accient.

The court system say this doctor should not have driven, knowing that falling asleep at the wheel was a very real risk. Yet reading this story really gives me a sense of horror. It could have been me, it could have been anyone.

We’ve all had to do long night shifts – seven at a time, 12.5 hours per shift. Racking up about 88 hours a week of overnight work. It’s exhausting. Sometimes you barely sleep a few hours for the first few days.

It could be you

We’ve all probably driven home tired after an overnight shift. I know I have. When I lived over an hours drive from the hospital I would call my partner so that I could speak endlessly, if I was silent he would speak louder and make me respond. Scared I’d fall asleep at the wheel.

My senior colleague jokes about how whenever he stops the car on the way home from a night shift he puts the handbrake on. He ‘closes his eyes’ for a moment. Usually waking up to the sound of honking, he starts driving again.

My friend veered off the road into a ditch once, coming home from nights. Luckily he escaped unscathed and didn’t injure anyone else. The only victim his car.

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Fair work laws – overnight shifts

Fair work NSW recommend to limit the number of nights worked in succession for safety reasons. They suggest rotating rosters with shift changes every two or three days is preferable to seven-day rotating rosters. Fair work state that nightwork should be kept to a minimum. Three 8-hour or two 12-hour night shifts are the
recommended maximum number of consecutive shifts which should be worked.

Yet doctors work seven 12-hour night shifts in a row, regularly. Sometimes only have 48 hours off before starting a set of morning shifts.

Fair work write that especial care should be taken in work that involves mental strain, for safety reasons. I don’t know about you, but I consider work that affects the health and lives of people very mentally strenuous. We can’t afford to mess that up.

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Links between pilots and doctors

In medical school they often draw parallels between doctors and pilots. The world of medicine has learnt a lot from aviation. Policies, protocols, learning from mistakes. Yet medicine still has a lot to learn in my opinion, we need to look at the amount of hours a doctor works.

Pilots have strict limits on hours worked –   “a pilot shall not fly and an operator shall not roster him or her to fly in excess of 100 hours in 30 consecutive days”.

Doctors often work 100 hours a week. I know I have. In 30 days? Some clock up to 400 hours.

How is this safe?

Simple

For me it’s simple.

Would you rather a tired, hungry, dehydrated, overworked, burnt-out doctor? Or a well-rested, well-fed, hydrated, happy one?

I know which one I’d prefer.

Let’s stop viewing junior doctors as work horses, and value their wellbeing a bit more. It shouldn’t be a rite of passage, especially when lives of the public and the doctor are at risk.

This is evident in the case of this junior doctor who is now facing criminal charges. All because she was exhausted from her overnight shifts.

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Placing the blame on the individual

As I’ve seen time and time again, the system is placing blame on the individual. Instead of investigating why they’re routinely allowed to work excessive hours they’re asking why she decided to drive.

I know I’ve asked my dad to pick me up a few times before, I told him I was sorry but I couldn’t stay awake to drive home. I’m lucky in that I have a parent who would do that. Not everyone has this support system.

Some people are lucky in that they live next to the hospital, or with good public transport.

But what about those who live an hour away, don’t have people to help them, and no access to public transport?

It’s all well and good to say “you shouldn’t have driven”, but how do these doctors live then?

You’re expected to work those seven night shifts, if you don’t you’ll be seen as a bad worker and your colleagues would have to take on extra hours. Do you pay for an uber every day of the week? Do you just sleep at the hospital and never go home?

For me this week of ‘seven on’ is basically not living. You just sleep, eat and work. With 11.5 hours a day allocated to you getting home, eating, showering and sleeping. How do we better support medics who have no way of getting home but driving themselves?

There’s a lot to think about. Less hours and less overnight would help. Maybe a subsidy for nearby accomodation would work. Hospital funded transport?

Instead of blaming the individual, and giving them full responsibility to ‘figure it out’, we need a better and safer system.

We need to do better – doctors and the public deserve it.