Views & Reviews Personal View

Safety and the flying doctor

BMJ 2008; 336 doi: (Published 24 January 2008) Cite this as: BMJ 2008;336:218
  1. Francesco P Cappuccio, Cephalon chair of cardiovascular medicine and epidemiology, Clinical Sciences Research Institute, Warwick Medical School ,
  2. Steven W Lockley, assistant professor of medicine, Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  1. f.p.cappuccio{at}

    Interest, curiosity, or dismay—which feeling predominates when we learn from BBC Newsnight that our NHS employs doctors who commute from Poland to cover the out of hours duties that local GPs are unable to work because they are too tired at night? Is it interest in an innovative solution for modern pan-European healthcare provision, curiosity in discovering huge variations in the standard of living across the medical profession in an open Europe, or dismay that the government’s emphasis, that healthcare practice should be based on the best scientific evidence, is little more than lip service?

    Working continuously for a long time, particularly at night, increases the risk of making errors and causing injury, which is why many professions limit the number of hours of continuous duty. These risks also apply to the medical profession: tired doctors make mistakes that harm patients (N Engl J Med 2004;351:1838-48) and themselves (N Engl J Med 2005;352:125-34) because of fatigue, attentional failures, and ensuing reduced performance (N Engl J Med 2004;351:1829-37). Seventeen hours without sleep reduces performance to the level of someone with a blood alcohol concentration …

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