I have been working in the NHS for nearly 30 years as a doctor, and one of the biggest challenges has been trying to combat the sheer exhaustion that comes from working relentless hours and from making difficult decisions, often multiple and in quick succession, that affect patients.
When I first qualified, I was on call on a 1-in-3 rota. This meant that I had to work from Saturday morning until Monday evening without a break every three weeks, with additional on calls during the week.
Sleep was snatched as and when you could grab it. The canteen was barely open and missing meals was common. I can remember once falling asleep whilst taking a history from a patient in A&E, only to wake up as they tried to creep off the trolley. When I protested that they were unwell, the comment came back "I'm going home, you clearly need the bed more than me." We agreed it was safe for them to leave if they agreed to return if they got worse.
On another occasion, at the end of a number of long shifts a colleague found me holding three bottles of blood saying, "I've seen a patient, put in a catheter and taken some blood, but I can't remember a single word he said to me and have no idea why he is here."' Fortunately the colleague took over the patient's care from there and I went home and slept.
As a junior training in surgery, I remember regularly being so tired that I had to pull over on my drive home for a nap before completing the journey. Many of my friends have similar stories, and it's a miracle none of us has ever been involved in a road accident.
After a particularly busy weekend on call when I had had no sleep for 48 hours, a patient arrived in the early hours of the morning needing a procedure to relieve swelling, which I could not perform. The registrar and consultant were in theatre performing emergency surgery. I couldn't think straight, and felt sick with tiredness, but the patient needed help.
All my brain could manage was that I had to reduce the swelling, which might help them avoid surgery. I told the patient to lie on the bed, and then tipped the bed head down to provide gravity to aid the process, before getting some much-needed rest in the doctor's mess on the sofa. The patient recovered and my actions were enough to avoid an operation, but it worried me constantly that I would inadvertently make a mistake because of the relentless nature of the job.
This happened a number of years ago. I now work as a consultant radiologist in a district general hospital. Patients can become seriously unwell at any time of the day or night and need doctors who are well rested and alert.
I have suffered a severe case of burnout and was off work for over a year, and consequently no longer do on calls. Radiology and some other specialties, including microbiology, frequently don't have junior doctors on call in a district general hospital, and instead we provide a consultant-led on call service.
It is now so busy that it is normal to have to report 50+ emergency scans in 12 hours, with constant interruptions. This is mentally very exacting. Every patient deserves the best care possible, and in radiology we are key to making a diagnosis so that the patients get the right treatment. The scans contain hundreds of images that have to be manipulated by powerful computers in order to aid interpretation. At the end of 12 hours staring at a computer continuously, your mind is tired and you don't look at the scan with quite the same acumen as you did at the start of the day. We try to compensate for this by taking longer to do a report and reviewing tricky scans the next day, but it is hard and there are many distractions and interruptions that break concentration.
Personal experience has taught me the value of building in several natural breaks to my day, and that self-care is vital.
What can be done to combat this? Personal experience has taught me the value of building in several natural breaks to my day, and that self-care is vital. I try and go for a walk most days. We take it in turns to buy coffee for colleagues to allow a bit of social interaction. I don't check emails at home and don't work on days off. I also don't take on more projects at work than I can reasonably manage, and I have learned to say no nicely.
I meditate, listen to music while reporting, take time to talk to juniors and consultant colleagues who need to discuss cases, and make time for medical students - they are a fabulous source of IT tricks. I leave work on time as much as possible and make sure I hand over tasks where appropriate.
It's important to make time for doing things that you enjoy outside of work. If need be, put this in your diary and commit to it. For me, this is time spent with my family and friends or in the garden.
There are things employers can do to help, such as providing proper food 24/7, rest facilities (including places where you can get a short power nap), properly planned rotas with adequate staffing levels and planned recovery time or a day off after a weekend on call.
It helps if rotas are given out well in advance and if there is communication and acknowledgement of work difficulties (particularly important during the pandemic). An open culture of being able to review clinical incidents or near misses and actually learn from mistakes and make positive changes is vital.
Tiredness is not something that will go away anytime soon in the NHS. But there are measures we can take to look after ourselves better and therefore our patients.
The opinions expressed in this interview are those of the author. They do not necessarily reflect the opinions or views of the MDU.