"Dangerous levels of doctor fatigue"

About: Derby Hospital

(as the patient),

This year I have had a medical problem that has meant a quite a lot of visits to Derby Hospital.

I saw a different doctor each time. I was shocked to find that each of these doctors was working an exhausting roster. The first doctor I saw in A&E had not had a day off for 6 weeks. The next doctor had not had a day off for 5 weeks. The next doctor was only here for a short time but after just a few days had dark circles under the eyes, having been rostered on during the day and on-call at night. This seemed to be going on for the whole time that doctor was here. Another doctor said that they just did not get any time to recover from the demanding nature of the work at Derby. One doctor told me that the situation was dangerous.

I was told that one reason for this treatment of temporary doctors is money - it costs the hospital the same whether the doctor is on duty or not, so Hospital Management likes to get it’s moneys worth. I don’t understand why Derby’s longer term doctors are treated this way. Is this State Health Department policy?

I would expect that Hospital Management owed its most important staff -doctors of all levels - a duty of care. How can Derby hospital expect to attract new and long term doctors like this?

The effect on patient care is a concern as this study shows:

Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication.

(The National Center for Biotechnology Information, USA)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739867/

A lot of patients in Derby are Aboriginal and have complicated health problems and many do not have English as a first language so extra time and care is needed to communicate properly.

The result of my own treatment was, as told to me by one doctor, “not very good”. I will never know if it might have been better if every doctor had not been fatigued.

Meanwhile, maybe the old saying still applies: “when in pain, catch a plane”.

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Responses

Response from Rachele Humbert, Acting Operations Manager, Derby, WACHS

picture of Rachele Humbert

Dear Be Alarmed,

Thank you for taking the time to provide us with this feedback. I am shocked to hear about the level of fatigue you saw in the doctors who provided you with care. I would like to speak to you directly if I could with regards to the situation you have mentioned so that I can get further details from you. I can then investigate the situation with our Regional Medical Director and provide you with specific feedback.

You can contact me on 08 9193 3337 or by email rachele.humbert@health.wa.gov.au

I hope you are now fully recovered.

Regards

Rachele Humbert

Operations Manager, Derby Fitzroy Valley Health Services.

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Response from David Gaskell, Regional Medical Director, Medical, WA Country Health Service

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Dear Be Alarmed

Thanks very much for voicing your concern about the doctors who cared for you in Derby.

You are perceptive in describing how the demands on clinicians can result in stress and fatigue all too commonly. The dilemma and challenge for all practitioners is that, to care for others, we must first look after ourselves.

In our organisation, people come first. This includes not only our patients and their families and carers but also our staff. Actually, I would say that I put my staff first. This is so they feel supported, empowered and able to care for their patients, colleagues and especially themselves. Individuals and teams are encouraged to watch out for each other, ensuring that patient care can be delivered safely round the clock.

Yet working in a hospital has so many demands and pressures on staff. As you experienced, stress and fatigue can show on our faces. So, it is touching when a patient like yourself notices and expresses concern by giving care back, and asking what's to be done. Great that you bring this issue online here for wider awareness and dialogue.

Noted, thanks, your comments about sleep (also food and water) deprivation impacting negatively on performance, with a link. Sustaining the ability to care for others by caring for yourself requires constant remedial action and balance, so we in leadership work hard to ensure this happens through safe rostering, taking breaks, having water fountains and places to eat quietly, planning and taking regular leave, and more. But I jump too far ahead - apologies.

As Rachele said, we will talk Roger Brown (Senior Medical Officer) and our other Derby doctors, then get back to you here to share our findings. I encourage you in the meantime to get in touch with Rachele as invited above.

Wishing you well and valuing your feedback.

David

Dr David Gaskell, Regional Medical Director, WACHS Kimberley

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Update posted by Be Alarmed (the patient)

Thanks Rachele for the invitation to contact you, however I do not see any benefit in doing this. The doctor fatigue I saw in Derby Hospital was widespread and appeared to me to be a well established, deliberate choice by management. It should not take much investigation to find that this is what is happening.

I want to remain anonymous so that the doctors concerned will also remain anonymous.

Response from Rachele Humbert, Acting Operations Manager, Derby, WACHS

picture of Rachele Humbert

Dear Be Alarmed,

Thank you for your response. I respect your wish to remain anonymous and appreciate you taking the time to use Patient Opinion to bring your concern to our attention and for recognising the very hard work that has been done by the Medical Team at Derby Hospital through what has been a very, very busy wet season. The senior management team at Derby Hospital are constantly mindful and watchful for fatigue amongst all staff.

To understand our doctor rostering, it will help to explain we have a variety of scenarios here at Derby. Some doctors live in Perth or other states and fly in and out of Derby. Their preference is to work anywhere from 3 up to 6 weeks on and then have an equivalent time off. We have doctors who reside in Derby who will work 10 days in a fortnight. There are also locum staff who may come only once or twice to Derby to fill urgent gaps in our team.

Fatigue can pose a threat to our doctor’s safety and subsequently the level of care they provide to patients at Derby Hospital. Along with Roger Brown, Senior Medical Officer for Derby Hospital, feedback from doctor and nursing staff is used to develop rosters and ensure fatigue is minimised. Both Roger and I are meeting with the medical team this week to talk about these concerns providing an opportunity for open communication and shared problem solving.

Patient safety, and provision of high quality medical service is our top priority, and we recognise that a critical component of that is having staff who are alert and able to work at their very best so I thank you again for providing us your feedback.

Kind regards,

Rachele Humbert

Operations Manager, Derby Fitzroy Valley Health Services.

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