Intended for healthcare professionals

Observations Ethics Man

Waking up to the effects of fatigue in doctors

BMJ 2013; 347 doi: (Published 05 August 2013) Cite this as: BMJ 2013;347:f4906
  1. Daniel K Sokol, honorary senior lecturer in medical ethics and law at King’s College London and a barrister at 12 King’s Bench Walk, London
  1. daniel.sokol{at}

Fatigue is not a sign of weakness, nor something that can be suppressed by a cup of coffee in the mess or a splash of water on the face

On the evening of 12 February 2009, a Colgan Air aircraft carrying 45 passengers, two pilots, and two flight attendants stalled on approach to an airport in New York. The pilots failed to notice their low speed and did not respond to the stall warnings in time. The plane crashed, killing all on board. The pilots had travelled far to get to the departure airport and, in breach of company policy, had slept in the crew room the night before. The National Transportation Safety Board, in its accident report, concluded that pilot fatigue was a contributing factor to the crash.

Pilot fatigue is a recognised problem in the aviation industry, and there have been several symposiums on aviation fatigue. As a passenger, I am relieved that the industry is making efforts to identify the extent of the problem and to find solutions to reduce it. In medicine, the problem remains on the fringes. Some doctors will happily describe their struggle to stay awake …

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