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The effects of fatigue on physician performance - an underestimated cause of physician impairment and increased patient risk

Abstract

Evidence is reviewed demonstrating the high level of drug and alcohol abuse and marital disharmony among physicians and the particularly high rate among anaesthetists. The relationship between these factors and the effects of fatigue is explored. The current evidence for reduction in physician performance and vigilance resulting from fatigue and sleep loss is reviewed. Supplementary indirect evidence is surveyed which suggests that increased experience may not compensate adequately for this reduced performance. Since hours of work can be controlled, it is essential that anaesthetists, their professional organizations and regulatory agencies ensure that pressure for efficiency does not result in fatigue and the consequent compromise of both patient and physician health and safety.

Résumé

On présente de ľévidence du niveau élevé ďabus de médicaments et ďacool, de problèmes familiaux parmi les médecins, et tout particulièrement parmi les anesthésistes. On examine la relation entre ces facteurs et les effets de la fatigue. Ľévidence actuelle de la perte de performance et de vigilance du médecin, causée par la fatigue et la perte de sommeil est révisée. On examine ďautre évidence indirete qui laisse entendre que ľexpérience de ľanesthésiste ne compense peut être pas pour cette perte de performance. Puisqu’il est possible de contrôler des heures de travail, il est essentiel que les anesthésistes, et leurs organisations professionnelles et régulatrices s’assurent que la production n’ entraîne pas une fatigue qui compromettrait la santé et la sécurité du patient et du médecin.

References

  1. 1

    Ross M. Suicide among physicians. Diseases of the Nervous System 1973; 34: 145–50.

  2. 2

    Rose KD, Rosow I. Physicians who kill themselves. Arch Gen Psychiatry 1973; 29: 800–5.

  3. 3

    Thomas CB. Suicide among us: can we learn to prevent it? Johns Hopkins Med J 1969; 129; 190–2.

  4. 4

    Bruce DL, Eide KA, Linde HW. Cause of death among anesthesiologists: a 20-year study. Anesthesiology 1968; 29: 565–9.

  5. 5

    Lew EA. Mortality experience among anesthesiologists 1954–1976. Anesthesiology 1979; 51: 195–9.

  6. 6

    Bissell L, Jones RW. The alcoholic physician: a survey. Am J Psychol 1976; 133: 1142–6.

  7. 7

    Freedman AM. Opiate Dependence, Comprehensive Textbook of Psychiatry/III. Kaplan HI, Freedman A, Sadock BJ (Eds.). Baltimore: Williams and Wilkins 1980; pp. 1594.

  8. 8

    Wallot H, Lambert J. Drug addiction among Quebec physicians. Can Med Assoc J 1982; 126: 927–30.

  9. 9

    Spiegelman WG, Saunders L, Mazze RI. Addiction and anesthesiology. Anesthesiology 1984; 60: 335–41.

  10. 10

    Farley WJ, Talbott GD. Anesthesiology and addiction (Editorial). Anesth Analg 1983; 62: 465–6.

  11. 11

    Goldman LI, McDonough MT, Rosemond GP. Stresses affecting surgical performance and learning. J Surg Res 1972; 12: 83–6.

  12. 12

    Friedman RC, Kornfeld DS, Bigger TJ (Jr). Psychological problems associated with sleep deprivation in interns. J Med Educ 1973; 48: 436–41.

  13. 13

    Uliana RL, Hubbell FA, Wyle FA, Gordon GH. Mood changes during the internship. J Med Educ 1984; 59: 118–23.

  14. 14

    Hawkins MR, Vichick DA, Silsby HD, Kruzich DJ, Butler R. Sleep and nutritional deprivation and performance of house officers. J Med Educ 1985; 60: 530–5.

  15. 15

    Poulton EC, Hunt GM, Carpenter A, Edwards RS. The performance of junior hospital doctors following reduced sleep and long hours of work. Ergonomics 1978; 21: 279–95.

  16. 16

    Leighton K, Livingston M. Fatigue in doctors. Lancet 1983; 1: 1280.

  17. 17

    Yogev S, Harris S. Women physicians during residency years: workload, work satisfaction and self concept. Soc Sci Med 1983; 17: 837–41.

  18. 18

    Vaillant GE, Sobowale NC, McArthur C. Some psychologic vulnerabilities of physicians. N Engl J Med 1972; 287: 372–5.

  19. 19

    Rose KD, Rosow I. Marital stability among physicians. Calif Med 1972; 116: 95–9.

  20. 20

    Spears BW. A time management system for preventing physician impairment. J Fam Pract 1981; 13: 75–80.

  21. 21

    Sakinofsky I. Suicide in doctors and wives of doctors. Can Fam Physician 1980; 26: 837–44.

  22. 22

    Wilkinson RT, Tyler PD, Varey CA. Duty hours of young hospital doctors: effects on the quality of work. J Occup Psychol 1975; 48: 219–29.

  23. 23

    Friedman RC, Bigger JT, Kornfeld DS. The intern and sleep loss. N Engl J Med 1971; 285: 201–3.

  24. 24

    Christensen EE, Dietz GW, Murry RC, Moore JG. The effect of fatigue on resident performance. Radiology 1977; 125: 103–5.

  25. 25

    Beatty J, Ahern SK, Katz R. Sleep deprivation and the vigilance of anesthesiologists during simulated surgery. Vigilance Theory, Operational Performance, and Physiological Correlates. Robert R. Mackie (Ed.). Plenum Press: New York and London. 1977, 511–27.

  26. 26

    Klose KJ, Wallace-Barnhill GL, Craythorne NWB. Performance test results for anesthesia residents over a five day week including on-call duty. Anesthesiology Sept 1985; 63: A485.

  27. 27

    Narang V, Laycock JRD. Psychomotor testing of on-call anaesthetists. Anaesthesia 1986; 41: 868–9.

  28. 28

    Baddeley AD. A 3-min reasoning task based on grammatical transformation. Psychonomic Science 1968; 10: 341–2.

  29. 29

    Welford AT, Brown RA, Gabb JE. Two experiments on fatigue as affecting skilled performance in civilian aircrew. Br J Psychol 1950; 40: 195–211.

  30. 30

    Poulton EC, Freeman PR. Unwanted asymmetrical transfer effects with balanced experimental designs. Psychol Bull 1966; 66: 1–8.

  31. 31

    Poulton EC. Unwanted range effects from using within- subject experimental designs. Psychol Bull 1973; 80: 113–21.

  32. 32

    Anastasi A. Psychological Testing. 5th ed. New York, New York: Macmillan, 1982: 290–1.

  33. 33

    Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958; 8: 271–6.

  34. 34

    Williams HL, Lubin A, Goodnow JJ. Impaired performance with acute sleep loss. Psychological Monographs 1959; 73: 1–26.

  35. 35

    Rosa RR, Alternative work schedules: effects on performance and ratings of fatigue and alertness. Dissertation Abstracts International 1985; 45: 1–133.

  36. 36

    Folkard S. Diurnal variation in logical reasoning. Br J Psychol 1975; 66: 1–8.

  37. 37

    Banks JH, Sternberg JJ.Farrell JP, Debow CH, Dalhamer WA. Effects of continuous military oprations on selected military tasks. Technical Research Report 1166. Springfield, Virginia: National Technical Information Service, Dec 1970: 1–27.

  38. 38

    Ainsworth LL, Bishop HP. The effects of a 48-hour period of sustained field activity on tank crew performance. Technical Report 71-16. Springfield, Virginia: National Technical Information Service, 1971: 1–103.

  39. 39

    Morgan BE (Jr),Brown BR, Coates GD, Alluisi EA. Sustained performance during 36 hours of continuous work and sleep loss. Technical Report ITR-75-31. Arlington, Virginia: U.S. Army Research Institute for the Behavioral and Social Sciences, 1975: 1–67.

  40. 40

    Olmedo EL, Kirk RE. Maintenance of vigilance by non- task related stimulation in the monitoring environment. Percept Mot Skills 1977; 44: 715–23.

  41. 41

    Paget NS, Lambert TF, Sridhar K. Factors affecting an anaesthetist’s work: some findings on vigilance and performance. Anaesth Intensive Care 1981; 9: 359–65.

  42. 42

    Bruce DL, Back MJ, Arbìt J. Trace anesthetic effects on perceptual, cognitive, and motor skills. Anesthesiology 1974; 40: 453–58.

  43. 43

    Bruce DL, Bach MJ. Effects of trace anesthetic gases on behavioural performance of volunteers. Br J Anaesth 1976; 48: 871–76.

  44. 44

    Smith G, Shirty AW. Failure to demonstrate effect of trace concentrations of nitrous oxide and halothane on psychomotor performance. Br J Anaesth 1977; 49; 65–70.

  45. 45

    Smith G, Shirley AW. A review of the effects of trace concentrations of anaesthetics on performance. Br J Anaesth 1978; 50: 701–12.

  46. 46

    Frankhuizen JL, Vlek CAJ, Burm AGL, Rejger V. Failure to replicate negative effects of trace anaesthetics on mental performance. Br J Anaesth 1978; 50: 229–34.

  47. 47

    Kortilla K, Pfaffli P, Linnoila M, Blomgren E, Hanninen H, Hakkinen S. Operating room nurses’ psychomotor and driving skills after occupational exposure to halothane and nitrous oxide. Acta Anaesthesiol Scand 1978; 22: 33–9.

  48. 48

    Davenport WG. Vigilance and arousal: effects of different types of background stimulation. J Psych 1972; 82: 339–46.

  49. 49

    Wolfe RH, Weiner FF. Effects of four noise conditions on arithmetic performance. Percept Mot Skills 1972; 35: 928–30.

  50. 50

    Poulton EC. Arousing environmental stresses can improve performance, whatever people say. Aviat Space Environ Med 1976; 47: 1193–1204.

  51. 51

    Poulton EC. Environment and Human Efficiency. Springfield, Illinois: Thomas, 1970.

  52. 52

    Keep PJ. Stimulus deprivation in windowless rooms. Anaesthesia 1977; 32: 598–600.

  53. 53

    Keep P, James J, Inman I. Windows in the intensive therapy unit. Anaesthesia 1980; 35: 257–62.

  54. 54

    Lord Taylor. The natural history of windows: a cautionary tale. Br Med J 1979; 1: 870–5.

  55. 55

    Fuller RGC. Prolonged driving in convoy: the truck driver’s experience. Accid Anal & Prev 1984; 16: 371–82.

  56. 56

    Harris W. Fatigue, circadian rhythm and truck accidents.In: Vigilance: Theory, Operational Performance and Physiological Correlates. Mackie RR (Ed.). New York: Plenum Press, 1977.

  57. 57

    Broadbent DE. Variations in performance arising from continuous work. In conference on individual efficiency in industry. Cambridge, England: Med. Res. Council, 1955: 1–5.

  58. 58

    Wilkinson RT. Aftereffect of sleep deprivation. J Exp Psychol 1963; 66: 439–42.

  59. 59

    Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984; 60: 34–42.

  60. 60

    Reason J. The psychopathology of everyday slips. The Sciences Sept/Oct 1984; 45–9.

  61. 61

    Couch NP, Tilney NL, Rayner AA, Moore FD. The high cost of low-frequency events. N Engl J Med 1981; 304: 634–7.

  62. 62

    Naitoh P, Townsend RE. The role of sleep deprivation research in human factors. Hum Factors 1970; 12: 575–85.

  63. 63

    McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med 1982; 306: 458–63.

  64. 64

    Binner PR, Potter A, Halpern J. Workload levels, program costs, and program benefits: an output value analysis. Adm Mental Health Spring 1976; 3: 156–65.

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Correspondence to John B. R. Parker.

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Parker, J.B.R. The effects of fatigue on physician performance - an underestimated cause of physician impairment and increased patient risk. Can J Anaesth 34, 489–495 (1987). https://doi.org/10.1007/BF03014356

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Key words

  • PSYCHOLOGIC RESPONSES: sleep deprivation
  • fatigue
  • ANAESTHETISTS: performance
  • fatigue