1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue.
• a reduction in the efficiency of a muscle or organ after prolonged activity.
No, this post is not a part of my twenty six installment Psychiatry A to Z series.
You’ll have to wait for the next one in that group, which by the way will be looking at a “T” word. This one concerns a word that starts with the letter “F”, and it is a subject that has been weighing on my heart and mind for some time now. We are talking about fatigue here. Being dead tired. Zonked. Out of it. Exhausted. I wonder how you feel about it, especially those of you who read my blog and are either doctors or patients (or both in some cases) yourselves.
I am a psychiatrist working three different jobs, out of both love for what I do and a need for enough income to support my family the way I’d like to. (Psychiatrists are usually listed just above primary care physicians and pediatricians on the doctor pay scale. You don’t usually become a shrink, especially one who works in the public sector, to get rich. Yes, believe it.) One of these jobs is a telepsychiatry position that often requires that I work sixteen hour shifts, usually from eight in the morning to midnight. I find that I am most productive and sharp early in the shift, which would be expected I suppose, and that I must try harder to keep myself focused and sharp as the evening wears on. This is clinically significant in this study with an “n” of one, in that a lot of psychiatric patients show up in crisis in emergency rooms from about four in the afternoon until well into the night. I am not allowed to nap or sleep on the job, so for now a “strategic nap” is not possible. Coffee helps, but that’s another story for another day, isn’t it?
My family and friends have had several discussions over the last year or two on the changing “rules of engagement” for today’s interns and residents as compared with how we “old farts” trained (I am fifty three years old). Of course, we were all trained to work hard, work long hours, and not complain. It was part of the training and the job that was welcomed as we became doctors. I’m aware of the studies that look at degrading performance over time, but I’m also well aware personally of how grueling, long, tedious, difficult hours and situations build character, competence and ability under stress. I think it’s important to look at both sides of the issue and come up with the best solution that works in the service of the physicians of tomorrow as well as patient safety.
What do you think? Should doctors be like workers on factory assembly lines, doing just a few jobs repetitively and well but for shorter, limited amounts of time? Should they be allowed to take twenty minute power naps when working long shifts? Should they be allowed to choose to “work doubles’ and stay over for an extra shift if they want to do so for more experience or more income? If a doctor is driven to work long hours and busy schedules and chooses to do so, does this really pose a risk or danger to his patients?
Greg Smith is a psychiatrist who blogs at gregsmithmd.
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