Junior doctors' working hours and the circadian rhythm of hormones.

摘要

Junior doctors' working hours have been debated ever since evidence emerged that continuous on-call commitments, with no or some disrupted sleep, can potentially affect the efficiency and safety of medical care delivery. The problem of overworked junior doctors is two-fold, affecting the health of the young doctors but also potentially their patients.A recent American study revealed that attention span and cognitive performance after a heavy call rotation are more significantly impaired than after alcohol ingestion with a blood alcohol level of 0.04-0.05 g% (per 100ml of blood). In the USA, working hours for junior doctors of over 100 hours a week were considered routine and even by some as a mandatory rite of passage. Others warned, however, that continuously overworked junior doctors may represent a problem spiralling out of control, exacerbated by the increasing demands of rapidly developing medical technology. In 2003, the Accreditation Council for Graduate Medical Education reduced working time for US interns and residents to no more than 80 hours per week and limited continuous on-call commitments to 30 hours, but this is still a considerable workload. In the UK, this problem was addressed by the introduction of the New Deal in 1991 which aimed to reduce working hours to 56 hours per week by 1996. Adherence to the new policy, however, was variable. The European Working Time Directive (EWTD), introduced in the UK in 2004, aims to restrict working hours to 48 hours per week and impose a limit of 13 hours of continuous on-call commitment by 2009. The potential consequences of this change on doctor's quality of life and the standard of patient care are discussed below.