The doctors sleeping under desks because they’re too tired to drive

Almost half the trainee doctors in NSW hospitals are so overworked and exhausted that they have made medical mistakes, raising grave concerns that the burnout affecting the state’s junior medicos is putting patients at risk.

The latest Hospital Health Check survey of 1766 junior doctors found 46 per cent reported making a fatigue-induced clinical error caused by the long hours they worked in NSW hospitals. Another 7 per cent said they would rather not disclose whether they had made such an error.

Junior doctors Jacqueline Ho and Sanjay Hettige.Credit: Janie Barrett

The survey, conducted by the Australian Medical Association (AMA) NSW, captured close to 20 per cent of the 10,000-odd trainee doctors working in NSW hospitals this year.

Dr Sanjay Hettige, co-chair of AMA NSW’s doctors-in-training committee, said the pandemic had exacerbated the chronic understaffing and massive workloads that had pushed trainee doctors to breaking point.

“We have been overworked and overworked, dealing with complex conditions, carrying these huge mental and physical loads,” Hettige said. “Our brains can only handle so much under fatigue. Of course, this is going to have ramifications for our patients.”

Clinical mistakes included medication errors and forgetting to relay crucial information during shift handovers, forgetting to check test results, missing steps when examining patients and overlooking a critical question when taking a patient’s history, Hettige said.

“If we don’t have basic protections and safe working hours, then patient safety will be compromised, and that is what we’re seeing,” he said.

Senior hospital physicians have repeatedly warned the state’s health workforce was burned out and broken by caring for increasing numbers of sicker patients needing more complex care and longer hospital admissions.

Ambulance patients faced record wait times, more than 76,000 people (one in 10 attendances) left emergency departments without finishing treatment, and a record 18,700 patients were waiting too long for elective surgery in NSW public hospitals between April and June — nine times more than before the Delta lockdown in 2021, the latest Bureau of Health Information Quarterly Report showed.

The Hospital Health Check Survey found the rate of trainee doctors working unrostered overtime had jumped, with 72 per cent reporting they clocked up more than five additional hours per fortnight, up from 60 per cent in 2021. Only one-third of trainees claim all their overtime.

Doctors are overworked and exhausted after two-and-a-half years of the pandemic. Credit: James Brickwood

Trainees work 80-hour fortnights, plus rostered overtime in the evenings, overnight and on weekends, which can be as long as 16 to 18 hours. They also routinely work unrostered overtime and cover on-call shifts, which often means they are either called into hospital or woken up several times a night to make crucial medical decisions over the phone, Hettige said.

“Then you’re expected to come in and do it all over again on minimal sleep,” he said.

The survey found more than half (56 per cent) worried that the excessive hours they worked were putting their own health and safety at risk.

Dr Jacqueline Ho, also a co-chair of the doctors-in-training committee, recalls feeling unsafe getting into her car after a long shift and finding a desk to sleep under instead.

“I know a number of colleagues who have had a car accident driving home after working long shifts, Ho said.

The Perrottet government committed to recruiting more than 10,000 doctors, nurses, paramedics, midwives, pathologists and allied healthcare workers over the next four years in an effort to ease the burden of chronic understaffing and surging demand on the state’s hospitals throughout the protracted pandemic.

Hettige said the state government needed to enshrine safe working hours and provisions in policy and employment contracts.

“We are working harder and longer, but under an award that is more than 30 years old. For a significant number of doctors in training, those contract conditions were written before they were even born,” he said.

NSW Health Minister Brad Hazzard said exhaustion and fatigue had affected healthcare workers globally over the course of the pandemic.

“I think it’s right to acknowledge young and senior doctors have been hit hard,” Hazzard said.

Hazzard said he had not received any reports of fatigue-induced mistakes made by doctors that had caused negative outcomes for patients “but in a large system that is a possibility”.

A spokesperson for NSW Health said the number of medication errors had fallen over the past two years.

“All patient safety issues are identified, immediate risks mitigated and actions taken to make systems improvements,” the spokesperson said in a statement.

“The last two-and-a-half years have been very challenging, and it is understandable that some staff may be feeling burnt out, anxious or distressed,” they said. “We encourage any health staff or frontline worker experiencing anxiety or feeling stressed to seek support as soon as possible.”

More results from the 2022 Hospital Health Check Survey

• More than one in three trainees reported being bullied at work, most commonly by their seniors.
• One in four had felt intimidated. The main aggressors were patients’ families.
• Female trainees were twice as likely to experience discrimination (31 per cent versus 16 per cent of male trainees).
• Women were less likely to claim unrostered overtime than their male colleagues, with surgical trainees accounting for the biggest gender disparity (38 per cent versus 57 per cent respectively).
• 54 per cent said that they did not feel valued by their hospital.
• 46 per cent said they would not recommend their hospital to another doctor-in-training.

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