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Fatigue and risk: are train drivers safer than doctors?

BMJ 2017; 359 doi: (Published 13 November 2017) Cite this as: BMJ 2017;359:j5107

Rapid Response:

Re: Fatigue and risk: are train drivers safer than doctors? An alternative measure in General Practice

I have worked as a GP for 29 years and have now moved into a salaried post in MSK. This has allowed me reflect on the obvious fatigue I felt in my last years as a GP.

I would propose that the appropriate measure of workload in General Practice is the "Number of patient contacts" (NPC) in the day. This includes a face-to-face, telephone consultation or home visit.

An NPC of 35 is, in my view, the safe and tolerable limit for a GP. Beyond 35 I would be aware that I was beginning to feel below par. Beyond 45, I was aware that I was at significantly higher risk of making an error. Beyond 50, I was aware that my brain was shutting down and any unfortunate patient who saw me after that was almost certainly not getting the best of me. Thankfully, I escaped unscathed in terms of serious errors, litigation and complaints.

I would suggest that the RCGP and the GMC look at this potential measure of daily stress and fatigue in the context of General Practice. Each consultation requires a significant social element, some clear thinking space, a shared decision and the communication of the thought and decision. When this pattern is repeated too many times in a day, the risks of error are greatly increased.

In order to maintain safety in the profession, jobs in General Practice should be rated and doctors employed on the basis of hours of work and an additional measure of daily number of patient contacts.

Competing interests: No competing interests

23 November 2017
Gregory Warner
General Practitioner