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When was the last time you used tiredness as an excuse? It was 7am, I was just starting to congratulate myself on the end of another set of night shifts when I got a call from the medical registrar to tell me a patient had been moved from majors to resus, she was unconscious and barely breathing.
Nobody seemed to know very much about this woman, so I asked for the foundation doctor who’d clerked her some hours ago. I’d have read the notes myself but I was hand-ventilating the patient.
To be honest, I also found myself highly irritated by the fact that nobody seemed able to give me a coherent history and so when the F1 arrived, I was probably less kind to him than I would have liked.
Don’t get me wrong, I wasn’t overtly mean but I think I forgot to tell him it was ok, that this wasn’t an inquisition, that I just needed an overview, quickly, to help me make some decisions.
It probably felt like an inquisition.
The patient was intubated and in the subsequent half an hour proved difficult to stabilise. Somewhere in the midst of this I was inconveniently confronted with how tired I was. I usually like to think three steps ahead, now every thought was wading slowly through treacle towards me.
Somebody still needed to speak to her family and somebody needed to find out what had happened to her in the first place.
Looking at this woman, who was on the verge of something final I was weighed down by the thought she deserved a brain as sharp as a razor. Mine felt about as lethal as a butter knife, but the clock said 7.55am, so I picked up the phone and called the unit. I knew the day-time consultant would already be in.
The consultant arrived into resus; fresh, friendly, smiling. I just looked at him and said ‘I’m so tired’.
In all my years in medicine, I have never used those words as an excuse.
Was this acceptable? I think a lot of the ‘we came from a school of hard-knocks’ type doctors might mutter that it’s not. That things were harder for them, that we don’t know how good we’ve got things. My own opinion is that both generations experienced a different life, comparison is unrealistic, unhelpful and unnecessary.
But here is the thing; I felt guilty. I felt guilty that I had not tied that patient up in a nicer package in time for handover. I felt guilty I hadn’t been nicer to the F1. I felt guilty I was tired.
I can hear the replies; I’d have felt worse if I’d harmed her. I’d have felt worse if my communication with her family wasn’t up to scratch. I’d have felt worse if I’d missed something important.
True, but I still feel guilty.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter
Thank you for telling us about this; it needs to be told and please
please dont feel guilty. But for me can you envisage the same scenario when you are a 57 year old consultant who has just had to do the same shift because of holes in juniors rotas?
Recognising that you are tired and that it will compromise patient care, and doing something about it is commendable, not shameful. Hold your head high
Don't feel guilty, every human being is different, those with a conscience are rare, you do good so stop beating yourself up!
Just as the duty of candour is changing the way we view communication around mistakes, steps need to be made with regards to the effects of tiredness on cognition. Tiredness causes mistakes and it's no longer acceptable to use 'this is how we always did this' as an excuse. Clear Royal College of Physician guidance is published on the matter, and especially around nightshift working, and yet you continue to hear stories of trusts clearly violating this. It's time for another change, it's only a matter of time before (yet another) junior doctor dies on the drive home after falling asleep.
I trained under the old sytem ...where the hours were longer, but they were also kinder. We stayed on the same wards for 6 months , we knew the staff and how everything worked. We were not expected to deal with emails, forgotten passwords to login to the tempermental technology which were told makes our life easier, with a sprinkling of possibilities of manslaughter charges all distracting us from our main duties to our patient. There were only 24 hours in the day.
F1 can be apologised to .........."I am so tired" was the truth , it was not an excuse. It also served as a warning to the consultant that you may not running on a full tank of gas and so arguably safer for the patient.
I also come from a different generation. Sure we worked 100+ hours a week (yes, we really did) but things were different. Everyone was part of a real and meaningful team - they belonged. Most junior doctors still lived in the mess and weekends on call were not lonely or demoralising, After a bad night operating, the kitchen would send bacon and eggs to theatre - no charge. The whole atmosphere was different - it may be hard to believe , but it was all a lot more fun. Perhaps most importantly, when things went wrong - and they DID - the usual reaction was to say that everyone did their best.
You are right - comparisons are meaningless.
Thank you for sharing this story. There needs to be more honesty and compassion towards the real issue of tiredness, especially at the end of a night shift. The way you have relayed the events is so human and we have all been in that scenario and felt the exact same way. You did absolutely nothing wrong.
Never think that way at all, I am senior middle grade, I developed chest pain and shortness of breath at work and I was admitted to CCU because of improper directorate management that implemented non complaint on call rota. I worked three trauma weeks with 2 strikes single handed in space of 6 weeks plus working my usual day time hours i.e multi tasking. I worked continuously for 14 days till I was burnt out. I had bradycardia and chest pain,then I collapsed at GP surgery 2 days after being discharged from CCU. I was given GTN spray for chest pain, my heart rate was 38/min,the GP panicked when I collapsed, he connected the defibrillator thinking I cardiac arrest. I am traumatised and scared for life of that experience. All of HR including CD and BMA are aware of this issue before it happened but nothing been done about it! Got back to work after 3 months, the pressure is building up on me again to work the same role.
You have to learn to say NO, health and family comes first then work, I think we are only numbers and expectations from work are unlimited.The service is stretched and resources are the same.
Congratulations on doing the right thing. It is not easy - misplaced guilt is all too common.
Been there, felt like that!
Well done. You did the right thing. You are only human. If you were driving a vehicle and felt tired you would pull over and rest unless somebody else could drive instead. So you "pulled over" and asked your consultant to "drive". Well done for not allowing tiredness to stop you make a good judgment. Well done as well for sharing this. If you're not fit to drive then should you be working? You are not the problem - a lack of staff, funding, resources, coupled with rightly high expectations is. It takes guts to admit you're not up to something. Well done - and sleep well!
This has been a problem for a long time but its seems to be getting steadily worse with rising workload, ability to intervene and rising expectations from public and government in the face of increasingly inadequate resources. The problem is how to get the message over to those with the political power to help reduce the workload by improving social care and make the resources measure up to the expectations. They seem to be deaf!
Why are we only know publicly talking about it, we have walked into this mess!
In the 60s junior Drs. were tired I still remember it well But we were supported by the team not just other junior Drs but the nurses esp the sisters who frequently provided coffee & toast during a shift porters who found X rays no computers! but most of all theTeam houseman SHO Registrar SeniorReg & consultant ( who knew if he ( she) was called all else had failed & knew every member of the team . Management has put young Drs in a dreadful isolated position having to find patients (not x rays) no team support little nursing support etc to work such long hours the management has a duty of care for all the staff we the retired still remember the tiredness but also the colleagues who helped us survive .