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Shift work and doctors' health

BMJ 2004; 329 doi: (Published 01 November 2004) Cite this as: BMJ 2004;329:0411412
  1. John Hobson, editor1
  1. 1Occupational Medicine, London NW1 4LB

Thanks to new European legislation on working hours, more doctors will have to work unpopular shift systems. John Hobson spells out how shift work can affect your health and performance, and what you can do to protect yourself

Shift work is a recognised risk factor for ill health and can affect safety and social wellbeing. Although it has become a fact of modern life, shift work is certainly nothing new in medicine, which has always provided care around the clock. The implementation of European legislation is new, however, and since 1 August 2004 all doctors, including those in training, should be working within the guidelines, which stipulate a maximum 58 hour working week for doctors. The European Working Time Directive provides guidelines on breaks and continuous working and requires employers to assess the health of shift workers. The directive is causing problems throughout Europe, and most countries will be left with a shortfall of doctors if they apply the rules fully.

Traditional medical shifts

In the meantime, most doctors at some stage in their careers will experience an extended period of non-standard working hours because of their on-call duties. This is unlikely to be the classic rotational shift pattern worked by those in industry, nursing, or the emergency services. In medicine, historically, doctors have worked a normal day and then remained on call through the subsequent night or weekend. This has more far reaching effects than working a rotational shift pattern--not only is there disruption of the normal circadian rhythm, but fatigue or daytime sleepiness as a result of prolonged working periods can have significant effects on general efficiency.

Health hazards of night work

Even if doctors adopt classic rotational shift patterns, they and their employers need to be aware that these shifts can have an effect on health.12 Night work causes a mismatch between the …

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