Sunday 22 October, 2006

Caffeine is not a substitute for sleep

Posted in Emergency Dept., Michael Tam, Rants, Wards, Workplace at 21:53 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Caffeine is the most widely used stimulant worldwide, and this is certainly true among Australian junior medical officers. Every morning, the wards are frequented by bleary-eyed junior doctors who do not become their cheery selves until the morning “cuppa”.

Juliano and Griffiths (2004) categorised and described a “caffeine-withdrawal syndrome” in a comprehensive review, and even concluded that “there is sufficient empiracal evidence to warrant inclusion of caffeine withdrawal as a disorder in the DSM [Diagnostic and Satistical Manual of Mental Disorders]” (1).

This study indentified the following ten rather famililar symptom categories:

  • headache
  • fatigue
  • decreased energy/activeness
  • decreased alertness
  • drowsiness
  • decreased contentedness
  • depressed mood
  • difficulty concentrating
  • irritability
  • and foggy/not clearheaded

Of more concern perhaps is what happens to those junior medical officers whose morning brew transforms them simply from grumpy to less-grumpy. Inevitably, the caffeine hit is relied upon multiple times a day. Onerous surgical rotations are a common offender.

About a decade ago, the Australian Medical Association (AMA) Federal Council “adopted a policy to promote a safer workplace for junior doctors and patients in public hospitals” (2) and launched the “AMA Safe Hours Project”. Although a “National Code of Practice” was released, few (if any) NSW hospitals follow its guidelines in implementation of rosters.

 

Caffeine, like with the above Dilbert cartoon, may improve your productivity but can make you prone to mistakes and even random episodes of craziness. Remember, sleep deprivation is used as a form of torture (4). Sleep is important.

 

After 17-19 hours without sleep, performance is equivalent to a blood alcohol level of 0.05% (3)

Even back in 1998, common sense practices for work shifts were published (5):

 

Good shift practices

  • Shorten night shifts, preferably to eight hours or less, and do not allow night work exceeding 12 hours;
  • do not allow any period of work exceeding 16 hours;
  • reduce consecutive night shifts to two or three;
  • roster time off duty after night shifts: 24 hours off for every two night shifts;
  • avoid on-call shifts which result in frequent calls at night followed by normal working days;
  • discourage voluntary night work by doctors working regular day shifts.

Fight for your entitlements. Form a strong JMO/RMO association and be industrially active!

Reference articles

(1) Juliano L., Griffiths R. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl). 2004 Oct;176(1):1-29. Epub 2004 Sep 21. [Link]

(2) Holmes G. Junior doctors’ working hours: an unhealthy tradition? [editorial]. MJA 1998; 168: 587-588. [Link]

(3) Williamson A., Feyer A. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med 2000;57:649-655 (October). [download PDF :: 182 Kb :: Link]

(4) Sleep deprivation. Wikipedia. Last updated: 20 October 2006. [Link]

(5) Olson L., Ambrogetti A. Working harder – working dangerously? MJA 1998; 168: 614-616. [Link]

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2 Comments »

  1. Michael Tam said,

    The Sydney Morning Herald recently published an article reporting that the majority of junior doctors in NSW still worked unsafe hours despite the campaign by the AMA in the past several years (1).

    The response from the Health Minister’s office:

    A spokeswoman for the state Health Minister, John Hatzistergos, said the number of resident and registrar doctors has risen by 18 per cent and specialists by 20 per cent since 2002. In the past year, 361 doctors had joined the NSW public health system, she said.

    “If doctors are working unsafe hours it should be reported to their employer.”

    The utter hypocrisy is numbing. Junior doctors are of course employed by the NSW Health System which is directly under the control of the Health Minister. Juniors doctors are not working unsafe hours for the fun of it, but rather are encouraged / coerced into these rosters. The Health Minister was put on notice for the failure by the NSW Hospital system and his department to substantially improve the working conditions of junior doctors and safety of the patients under their care. The response of his department is complete disinterest.

    As I have argued on numerous occasions, the only people who will stand up for junior doctors are junior doctors themselves. At the end of the day, even the AMA’s involvement is largely academic rather than for the interests of junior doctors. Form a strong JMO association and be involved in industrial issues.

    References

    (1) Metherell M. Doctors put sick at risk. The Sydney Morning Herald. 27 October 2006. [Link]

  2. Rhianna Miles said,

    And yet Queensland Health recommends junior doctors drink 5-6 cups of coffee per day in an attempt to ward of fatigue in their Fatigue Management Guideline published in 2009. http://www.couriermail.com.au/news/tired-doctors-urged-to-beat-fatigue-with-caffeine/story-e6freon6-1225770359223

    I am particularly impressed with the following quote:
    “Compared with other psychoactive drugs, for example, modafinil (a prescription-only narcolepsy treatment), caffeine is supported in its use as it is more readily available and less expensive,” the document says.


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