Intended for healthcare professionals

Rapid response to:


Error, stress, and teamwork in medicine and aviation: cross sectional surveys

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:745

Rapid Response:

Out of hours work and errors

Dear Sir,

The article by J Bryan et al in the 17th March edition (pp745-49)
made a link between mistakes and tiredness and observed that doctors are
poor at assessing the impact of these factors on their performance.

Airlines have been sighted as having the vision to introduce systems
designed to minimise risk. As well as adopting a culture where error
reporting is encouraged the airlines not only are aware of the impact of
stress and long hours on performance they have done something about it.

The Government by not applying the EU working hours directive in full to
medicine must carry a significant proportion of the responsibility for the
effect of long hours on performance. It is interesting that while calling
for tighter controls to foster improved levels of quality the government
and the profession feels that primary care out of hours work is best
performed by GP's in co-operatives. This inevitably means working through
the night as well as during the day. Both normal daytime services and out
of hours services must therefore inevitably carry increased risk. It seems
that society wants it's cake and it's halfpenny!

Dr Tim Ballard
GP, Wiltshire

Competing interests: No competing interests

21 March 2000
Tim Ballard
Great Bedwyn, Wiltshire