Clinical Review State of the Art Review

Health consequences of shift work and insufficient sleep

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5210 (Published 01 November 2016) Cite this as: BMJ 2016;355:i5210

Re: Health consequences of shift work and insufficient sleep

Firstly, thank you for a fascinating piece of research. It is a truly monumental undertaking and deserving of the profession's approbation. It also needs to be considered in light of the hours worked by junior doctors and nursing staff who are working shifts that do not allow the body to acclimatize to rapidly changing hours and work loads.

In 1986/7 I caught the measles just prior to finals and was consequently a student for an extra 6 months. The change in my colleagues as they transitioned from Student to Junior Doctor was quite depressing and so I undertook a small project looking at the effects of stress and fatigue on Junior Doctors. A number of psychometric tests were run on the morning and afternoon of two consecutive days when junior doctors had worked on-take the night in between. Choice Reaction Time increased with increasing numbers of mistakes, Critical Flicker Fusion time decreased. Of most significance however was the deterioration in the Intelligence Quotient from an average of 120 on the morning of the first day to "below 80" on the afternoon of the second day. (The test was only accurate above an IQ score of 80.) Memory also deteriorated significantly between the morning of the first day and the afternoon of the second. To give all this some meaning, we repeated all the tests when the subjects were fully rested on a Sunday morning but had been given sufficient alcohol to raise their breath levels to above 40, the then legal limit for driving). I was able to conclude that Junior Doctors would be safer drunk than tired.

Unfortunately, when I asked my consultant if it were worth publishing I was asked, do you really want a career in medicine? The implication was that publishing such a study would mark me as a trouble maker and I bottled out. Some years later when through sheer fatigue I made a mistake that killed a patient, I wish I had acted very differently.

That is why I hope very sincerely, that senior colleagues will read this much more professional study and consider its implications for those whose role in life is to care for patients.

Competing interests: No competing interests

02 November 2016
Steven Hopkins
Management of Substance Misuse
Sutton Coldfield
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