Wake-up call

Imagine that you are lying on an operating table at 8am. Which of the following surgeons would you choose to do your operation: Surgeon A who has consumed four shots of vodka for breakfast, Surgeon B who has narcolepsy, or Surgeon C who has been up all night working a 24-hour shift? The answer is that it doesn't much matter because all three will have similar psychomotor, cognitive and attentional impairment.

The Hospital Authority has proposed new measures to address iniquitous medical workloads and duty hours, one of which is to pay special allowances to compensate doctors for extra overnight shifts. Compelling scientific evidence on the impact of sleep deprivation on the clinical performance of doctors should caution against this proposition.

The practice of medicine demands onerous working hours. Historically founded on duty of care and apprenticeship, the custom morphed into a rite of passage, replete with misplaced bravado. Their professionalism lamentably exploited by employers, doctors are now routinely required to work lengths of time (cumulative and shift) that would never be tolerated in other fatigue-sensitive occupations like road transport or aviation. The uncomfortable truth is that extended duty hours, while tacitly tolerated by government, are dangerous for patients and detrimental to doctors.

People become sleep-deprived in two ways. Chronic loss occurs when continually excessive working hours prevent adequate rest and a sleep deficit accrues. Acute lack of sleep follows continuous wakefulness for 24 hours. Both produce a predictable decline in human performance, which is characteristically underestimated by those affected. Sleep debt can only be repaid by restorative sleep, not by the payment of special cash allowances.