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Healthcare workers are trained to put the needs of their patients first before theirs. In the process, there are many aspects of their lives which go neglected. One area is definitely sleep. The recommended time duration for quality sleep for any adult is 7 hours a day but most doctors fall short of it. It has been debated for a long that short and poor-quality sleep can not only put a doctor's health at stake in the long run but can also increase the risk of making errors that can affect patient safety. Interestingly, the problem of sleep deprivation among healthcare workers doesn't have a straightforward solution.
As per experts, medical care these days is more complex than it used to be some decades ago. The complexity of the system creates barriers when it comes to limiting working hours in a hospital. More than external factors, the system itself is a part of the problem.
The concern for young doctors, who might be sleep-deprived, has led to many discussions around the optimal number of hours a practitioner must work but most of these suggestions don't work in a real-life situation. There has been a concern raised that if young doctors fail to receive vigorous training in the initial years or if their working hours are limited, it might lead to the birth of doctors who might struggle to work under real-time pressure. The reality of the medical system is an ever-increasing patient burden and more demanding care. Studies have also shown that healthcare workers like surgeons or procedure-performing physicians have their skill refinement directly proportional to the number of operations or invasive procedures they do on average. Hence, the solution to this problem might not be that simple.
Dr Parinita Bansal (from Agra) is an experienced gynaecologist/obstetrician cum cosmetologist. Having years of experience in healthcare, she feels that the problem of sleep deprivation is more twisted than it seems on the surface.
She said: "Getting continuous, undisrupted sleep is a problem, especially in the early years of practice. Sleep debt might differ from specialization to specialization. Doctors coming from emergency medicine, internal medicine, surgery, anaesthesiologists and others have a more erratic sleep schedule than those working in other areas of medicine. For us, it becomes a matter of adaptation. There is nothing right or wrong about it."
Talking about the long hours and rotating shifts in medicine, Dr Bansal feels that there are many other fields such as international markets where bankers and investors might have a similar kind of story to tell.
On being asked if there was some way to release some burden off the shoulders of the young doctors, she said that giving them a day off after extended duty or limiting working hours could provide some relief but according to her, this suggestion won't work in real life.
Dr Bansal explained: "Young doctors are more sleep deprived than those high in the hierarchy. There is a reason behind it. As you climb the ladder, you become seasoned at your work and might attend to only serious night calls that demand a certain level of maturity and experience from a practitioner. However, the lighter or less serious night calls are often much more in number and are usually tended by doctors who might still be in their training phases."
Explaining the complexity of the care demanded by a patient, Dr Bansal made use of an example to demonstrate the situation.
She said: "Let's say a surgeon performs surgery at night or a physician tends to an emergency case. Every procedure involves so much preparation. For any surgery, you might have to arrange blood, make calls to the anaesthesiologist and bring all the elements necessary for the procedure altogether. This might take away your night. After emergency care is given, there might be some unforeseen situations like sudden bleeding or other complications. You will have to tend to that as well. After all this, you can't shrug off and say your work is done. What about the follow-ups? Next-day morning might involve taking rounds and checking upon patients we tended to the day before. That morning 8 to noon 2 window is fixed for all. In medicine, the obligation doesn't end with your shift. Yes, we are sleep-deprived but unfortunately, there might be no other way out. Many healthcare workers might try to catch some sleep here and there but mostly sleep experienced under these situations is very fragile. The doctor might immediately come into action as soon as they get a call. It is a moral call and gradually it becomes part of our being. Ours is not a deadline work. It is a matter of life and death.
Dr Bansal informed that the healthcare system is seeing some promising changes. She said: "Doctors have started to work in teams. This allows them to share the burden together where one worker can fill in for another. An increasing flexibility can be observed. One can see a lot of exchange in duties among doctors. This can also give them the opportunity to cover some of their long-due sleep debt.
Dr Vikas Fauzdar, a practising surgeon at SMS hospital in Jaipur shared with the Health site that he is able to get on average five hours of sleep but that too with many breaks in between.
He said: "There are no fixed hours of sleep for us. I usually experience disrupted sleep and it occurs in bits and pieces. We sometimes try to catch sleep in the hospital but again it is very broken and not much continuous. With violence against doctors becoming common news every day, we young doctors are expected to be more careful with work. It definitely won't be possible if we remain chronically sleep-deprived. Somebody might falter somewhere. Lack of sleep does muddle with your attention and focus."
Dr Fauzdar informed that in a hospital like his which is a centralized unit, the patient burden is skyrocketing and this again has an impact on a doctor's quality and quantity of sleep.
Dr Sarath Narayan, a practising emergency physician at Sarvodaya hospital (Faridabad) said things along a similar line. He informed that while he is on a 48-hour shift, he is only able to nap for like three to six hours in sum. He calls these extended night shifts the dreaded "black night".
Emergency physicians are doctors who provide medical care to patients who might be in life-threatening conditions. In short, they deal with medical emergencies. Hence, their role makes them fall under the category of doctors who are often sleep-deprived due to overwhelming work window and high patient burden.
He said: "I have heard my friends speak about experiencing hallucinations or a delirium kind of state due to lack of adequate sleep. Lack of sleep will eventually show up in your body, whether physically or mentally."
Dr Narayan informed that doctors or healthcare workers coming from non-clinical settings are at a sleep advantage and have less sleep debt to cover.
Dr Shiv Kumar who works as a physician at ESIC Hospital (Bengaluru) said that sleep debt is not the same for all health workers. He explained that usually in the late hours, junior residents, interns and medical officers make the most of the workforce. Hence, sleep deprivation worsens as one goes down the hierarchy. He informed that it might also differ between a government and private hospital. The former has more accessibility and might see a higher patient burden than the latter.
Talking about sleep deprivation among doctors, he said: "It would call the situation double forked. In my career, I have seen sleep-deprived doctors who work extraordinarily under pressure and some who might mess up things here and there. It is a matter of and degree of adaptation. I have seen some practitioners deriving an adrenaline rush from these sleepless nights."
Explaining the long-term health impacts of sleep deprivation among doctors, Dr Kumar said: "Human body works the same for all. The effects of sleep deprivation remain the same for everybody, doctor, and patients alike. I have seen healthcare workers who follow unhealthy lifestyles. They aren't sleeping enough and might be skipping meals. Many are malnourished. Also, it is common to see young doctors with compromised immunity and who might develop conditions like TB and pneumonia. Also, suicide rates are fairly high among young doctors. Nobody is really talking about the impact of this lifestyle on their mental health. They are far more prone to mental health conditions like depression and eating disorders.
In an experiment described by Harvard journal, Dr Govindarajan and his team first examined the data for approximately 20,000 patients who had had surgery performed by a physician who had operated the night before, between the hours of midnight and 7 a.m. They then matched each patient with one of another 20,000 patients who had had the same surgery, performed by the same surgeon, when she or he had not operated the night before.
The study found that surgeons' sleep loss may not be as detrimental to patients' outcomes as one would think. It was found that compared with trainees, fully licensed physicians are likely more experienced and may not be as affected by sleep deprivation.
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