Intended for healthcare professionals

Rapid response to:


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?

After an analysis of the effect of working hours and fatigue on performance in the workplace the authors conclude that EU working time regulations for doctors should not be loosened. They did not discuss work intensity or the difference between working alone and in a team.

A malign effect of the EWTR has been to reduce the number of doctors working out of hours. In the major surgical specialties where there used to be a team of three junior doctors working on-call, there is now often just one, working shifts. Clearly this allows little or no opportunity for the uninterrupted 15 minute breaks every few hours which Greig and Snow state overcome performance reductions due to fatigue. Has the effect of loneliness on tiredness ever been investigated? Long haul flights never have a single pilot.

When the EWTR is replaced, I hope the various employers and professional bodies will consider the possibility that working slightly longer hours as a member of a team will be be less tiring and more rewarding than working alone, not to mention improving continuity of patient care by reducing the number of patient handovers.

Competing interests: No competing interests

23 November 2017
John Black
Retired Surgeon and Past President Royal College of Surgeons