Limits on working hours may be relaxed after Brexit, warns employment expertBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4547 (Published 04 October 2017) Cite this as: BMJ 2017;359:j4547
All rapid responses
I welcome Anne Gulland’s article highlighting the issue of safe working hours for doctors. Many doctors are sleep deprived because of working long hours  and as many as 44% of doctors in some medical specialties report disrupted sleep . As well as long hours, other job stressors can contribute to sleep deprivation for doctors and interact with the number of hours worked to make the outcomes quite serious. For example, sleep deprived doctors are more likely to make riskier or impaired medical decisions and errors , , . The outcomes of sleep deprivation are also quite serious for doctors’ health e.g. it has cardiovascular and immune effects  and sleep deprivation also reduces safety e.g. 41% of doctors have fallen asleep while driving home after a night shift .
Policymakers considering whether to abolish the concept of safe working hours should therefore consider the impact on disrupted sleep for doctors. Sleep deprivation makes doctors feel more stressed and that, in turn, worsens their clinical performance such as by reducing surgical dexterity , mood and confidence – especially for junior doctors . As well as increasing stress, sleep deprivation can increase the risk of doctors having relationship difficulties, depression and committing suicide . There are initiatives into improving sleep for hospital staff working night shifts  and research into the effects of sleep deprivation on clinical performance , , , ,  but more research is needed to clarify the long-term effects of sleep deprivation on doctors’ health.
A limit on working hours per week is therefore important because it will protect doctors from sleep deprivation and its consequences.
 Eddy R. (2005). Sleep deprivation among physicians. BCMJ 2005; 47(4): 176-180.
 Medisauskaite, A. and Kamau, C. (2017). Prevalence of oncologists in distress: systematic review and meta-analysis. Psycho-Oncol 2017; Early view: Retrieved from http://doi.org/10.1002/pon.4382
 Weinger MB, Ancoli-Israel S. Sleep deprivation and clinical performance. JAMA 2002; 287(8):955-7.
 Aran A, Wasserteil N, Gross I, Mendlovic J, Pollak Y. Medical decisions of pediatric residents turn riskier after a 24-hour call with no sleep. Med Decis Making 2017; 37(1):127-33.
 Tobaldini E, Cogliati C, Fiorelli EM, Nunziata V, Wu MA, Prado M, Bevilacqua M, Trabattoni D, Porta A, Montano N. One night on-call: sleep deprivation affects cardiac autonomic control and inflammation in physicians. Eur J Intern Med 2013; 24(7):664-70.
 British Medical Assocation. More than a third of doctors fall asleep while driving. BMA News 2017; 26 January. Retrieved from https://www.bma.org.uk/news/2017/january/more-than-a-third-of-doctors-fa...
 Taffinder NJ, McManus IC, Gul Y, Russell RC, Darzi A. Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator. Lancet 1998; 352(9135):1191.
 Lewis KE, Blagrove M, Ebden P. Sleep deprivation and junior doctors’ performance and confidence. Postgrad Med J 2002;78(916):85-7.
 Farquhar, M. We must recognise the health effects associated with shift working. BMJ Opinion 2017; October 6. Retrieved from http://blogs.bmj.com/bmj/2017/10/06/michael-farquhar-we-must-recognise-t...
Competing interests: No competing interests.
Competing interests: No competing interests