Doctors' working hours: can the medical profession afford to let the courts decide what is reasonable?

@article{Nocera1998DoctorsWH,
  title={Doctors' working hours: can the medical profession afford to let the courts decide what is reasonable?},
  author={Antony Nocera and Diana Strange Khursandi},
  journal={Medical Journal of Australia},
  year={1998},
  volume={168}
}
The pattern of long work days followed by nights interrupted by calls is regarded as normal by the medical profession. These calls are, at best, simple telephone calls. At worst, they may entail returning to the hospital several times a night. Few other workers do this, and data on its long-term effects are entirely lacking. Being on-call impairs sleep even when there are no calls, II and as five or six hours' uninterrupted sleep is needed to avoid performance decrement'? perpetual or frequent… 

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References

SHOWING 1-10 OF 26 REFERENCES

The impact of long working hours on resident physicians.

  • T. Mccall
  • Medicine
    The New England journal of medicine
  • 1988
TLDR
Even without long hours, residency training would be stressful for house officers, who often find there is more work to do than time to do it.

Sued and nonsued physicians' self-reported reactions to malpractice litigation.

TLDR
Sued physicians reported significantly more symptoms than nonsued physicians, and were more likely to stop seeing certain types of patients, think of retiring early, and discourage their children from entering medicine.

Extended workshifts and excessive fatigue

  • R. Rosa
  • Business
    Journal of sleep research
  • 1995
TLDR
It is concluded that extended workshift schedules should be instituted cautiously and evaluated carefully, with appropriate attention given to staffing levels, workload, job rotation, environmental exposures, emergency contingencies, rest breaks, commuting time, and social or domestic responsibilities.

Neurobehavioral effects of the on-call experience in housestaff physicians.

Sixty-tree medical residents were tested on a battery of computer-based, self-administered neurobehavioral tests before and after a 36-hour in-hospital call plus postcall day to assess the central

Sleep deprivation and resident performance.

TLDR
The assumption that sleep deprivation associated with usual on-call schedules impairs cognitive and motor performance of residents such that clinical care of patients may be compromised is not supported by the authors' observations.

Effects of timing of shifts on sleepiness and sleep duration

TLDR
The results from the few studies available show that sleep duration is clearly determined by the change over time between the night and the morning shift—no more than 5 or 6 hours of sleep is obtained before the morningshift if the shift starts at 06.00 hours or earlier.

Speed and direction of shift rotation

  • P. Knauth
  • Business
    Journal of sleep research
  • 1995
TLDR
To minimize the disturbances of the circadian system and the accumulation of sleep deficits, rapidly and clockwise‐rotating shift systems would seem to be preferable.

Fatigue, alcohol and performance impairment

TLDR
The performance impairment caused by fatigue is compared with that due to alcohol intoxication, and it is shown that moderate levels of fatigue produce higher levels of impairment than the proscribed level of alcohol intoxication.

Long-term adjustment of circadian rhythms to a rotating shiftwork schedule.

  • K. Dahlgren
  • Psychology
    Scandinavian journal of work, environment & health
  • 1981
TLDR
Results showed that after 3 a of experience the awake temperature curves had a flattened shape in connection with both the beginning and end of the nightshift week and also during the free days, during sleep there was however a short-term adjustment of the temperature curves within the night shift week.