Tired Doctors. Ubani and Stevenson

There are two doctors who have been hung drawn and quartered by the media. Yes, the media lynch mob has been hunting down Ubani. The two are Daniel Ubani and Michael Stevenson. Both apologized for their actions. By comparison, as we all know Dr Jane Barton remains unrepentant.

Now, both doctors had a history of tiredness and stress. Stevenson had been overworking and Ubani had traveled a long distance. Ubani makes it clear in his letter of apology that tiredness had a lot to do with his actions. Kicking doctors who make mistakes when they are tired is all well and good but the doctors who need to be kicked are the manipulative, psychopathic, malevolent ones. Everyone in the world who is tired is prone to making mistakes.What more can a doctor in this situation do but apologize? The public spends their time moaning that doctors never apologize -we see the whines from here to Timbuktu. When someone like Ubani does apologize, they get bashed on the head again, and again and again then the lynch mob want more blood. How much blood does a doctor have? It doesn't encourage other doctors to apologize for their mistakes, does it? Essentially, the message from the media lynch mob is this - you admit fault, you apologise, you beg for forgiveness only to be shot repeatedly by them. Even when you are dead in your grave, they will still be there like vultures pecking at your carcass while the real malevolent murderer walks free.

That is a fact of life. It is also a fact of life that when a doctor is severely tired, they do not realise that they are limited in many ways. Michael Stevenson for instance had no insight into the impact of overworking. Ubani in retrospect understood why he had made the mistake. Tiredness impairs brain function. You go into a autopilot mode where you just carry on without thinking that mistakes may be made.

Are doctors expected to be human or just superhuman?

In 2009, there was research about tired doctors. Science Daily stated

"A study of clinical errors made by resident physicians in a teaching hospital reveals that the more tired they are the more mistakes they make. The study published in the International Journal of Behavioural and Healthcare Research puts figures to this seemingly obvious conclusion and shows that fewer errors are made if clinical practices are standardised. The research could help promote the case for improved working conditions for junior doctors in order to improve patient outcomes"

In 1999, the research was clear in the UK.

"The findings were presented at the British Psychological Society's annual conference in Leeds as junior doctors prepare to ballot on industrial action over what they consider to be unreasonable workloads.

The mistakes were split into four categories:

* Procedural 40%: Including one doctor who thought an emergency call to see a heart transplant patient was a dream and went back to sleep
* Misdiagnosis 29%: In one case a doctor missed an open wound - the mistake could have led to amputation
* Wrong prescribing 27%: Generally doctors would give a higher dose than they should
* Surgical errors 4%: Cutting too deep during surgery and severing a nerve in one case

One in four doctors had made between five and 10 mistakes while almost a third had made 11. Dead Tired Doctors attempts to raise the concern.

In 2004, further research showed the same thing in General Practitioners.

"Fatigue is causing them to make more and more prescription mistakes, according to a new report from the UK Department of Health".

In 2007, the same findings were put forward by the Journal of Occupational and Environmental Medicine.

"A study found that two-thirds of doctors had made an error at some point in their careers due to exhaustion and 42 per cent had done so in the preceding six months"

My own episode of tiredness was narrated in the local Evening Mail in 1999. This can be accessed here. During the time period I raised the issue that we were all being overworked, the medical establishment took this to mean that as a junior doctor you aren't " coping". The point was, I did cope and I did do a good job and I can honestly say, I made no drug errors or errors in management. I certainly know that Professor Rod Griffiths attempted to make a case of acopia, to conceal the fact that the standards of care were poor on Ward 87.

Consultants used to have the view " Well, I did it when I was young, why can't you manage it". This is why doctors are reluctant to admit they are tired and carry on bravely hoping that this won't lead to a disaster. There is a sense of fear about admitting to weakness. Peer pressure is an important aspect of why doctors never recognize their limitations.

This is what I said in 1999 [ Extract from the Evening Mail newspapers locally]

The young doctor recalls being stopped by police twice for falling asleep at the wheel.

"The hours were an absolute nightmare," she says. "Forty hours a week is a non -existent entity. Most of the time I was doing 72-80 hours a week and friends I have working in the NHS are still doing the same kind of shifts.

"You could work continuously for 48 hours on a weekend and then do the whole of Monday. They get round it by saying you get six hours protected sleep, but you never do because you get bleeped at all hours of the day and night. I never had an undisturbed sleep the whole time I was on call.

"You get to the stage when you make mistakes because you're nearly asleep.

"It also makes driving home really dangerous.

Exhausted

"On two occasions I was stopped by the police driving home and they made me get someone to come and pick me up. On another occasion I had to stop at a service station for a few hours."

After one particularly long weekend shift Dr Pal was so tired she was found fast asleep on the pavement by her car.

"I was absolutely exhausted, but when I got to my car it had been clamped," she says. "I just thought, I'll have a rest and I sat down on the pavement. The next thing I knew I was being woken up and it had started to get dark."

Junior Doctors hours finally changed.