Intended for healthcare professionals

Letters Effects of fatigue in doctors

European Working Time Directive may contribute to fatigue

BMJ 2013; 347 doi: (Published 04 September 2013) Cite this as: BMJ 2013;347:f5360
  1. Christopher J A Cowie, chair, British Neurosurgical Trainees’ Association1
  1. 1Royal Victoria Infirmary, Newcastle on Tyne NE1 4LP, UK
  1. christopher.cowie{at}

Sokol highlights the serious problems caused by exhaustion in doctors and indicates that one of the reasons why medical staff are overtired is non-compliance with the European Working Time Directive (EWTD).1 The two issues are inextricably linked, but compliance with the EWTD may also contribute to fatigue.

Redesigning rotas to comply with the EWTD means fewer staff in hospital at any one time, which leads to remaining staff being overstretched. Furthermore, while the total hours in hospital for each doctor have been reduced, the amount of work that needs to be done remains the same, increasing working intensity. Shift rotas adopted to comply with the EWTD are more tiring than an on-call system.2 Until action is taken to moderate the impact of the EWTD, the regulations will continue to compound the problem of fatigue.

Surgeons’ concerns about the reduction in operative training time as a result of the EWTD are well publicised.3 4 Sokol’s article briefly lambasts the surgical community, implying that surgeons are out of touch with the rest of the medical workforce, senior surgeons in particular failing to understand the challenges presented by modern medicine. Precisely the opposite is true. Senior surgeons best see the disastrous impact of the EWTD on the quality of surgical training, and their concern for patients in the future causes them to “pull faces of disgust.”

British people have every right to be concerned about whether their surgeon is fatigued, but they should be equally concerned about whether their surgeon has had the best training possible. A balance must be struck between the two issues.


Cite this as: BMJ 2013;347:f5360