Safe working hours for doctors – Whose duty of care?
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Dr Nicola Cunningham, B.Med, MForensMed, FFCFM (RCPA), FACEM, is an Emergency Physician at St Vincent’s Hospital Melbourne, Senior Forensic Physician at Forensic Services, Victorian Institute of Forensic Medicine, and Adjunct Senior Lecturer in the Health Law and Ageing Research Unit of the Department of Forensic Medicine, Monash University.
Many doctors work unsafe hours with extended shifts, overtime and on-call rosters. In the pursuit of safer systems of work and improvements to standards of patient care, the issue of excessive working hours has long been the ‘elephant in the room’. The risks of onerous rosters are far reaching, with the potential to affect not only the health of doctors but their patients as well. Tragic and preventable cases of fatigue-related deaths do occur. Despite increasing recognition of the extent of the problem, the healthcare industry has been slow to find solutions.
This article outlines the regulatory framework that governs healthcare organisations, and provides cultural and historical context to working-hour arrangements for doctors. A risk-based perspective of the challenges to implementation of safe working hours, and a number of initiatives are presented. Enforcement of workplace health and safety (WHS) laws in a hospital setting can be an effective change strategy to combat entrenched culture, and the current tolerance of unsafe working hour practices by individuals and organisations.
Keywords: rosters, doctors, patients, fatigue, WHS laws.