Sleep-deprived doctors are dying in car crashes at an alarming rate around the world. And beginning July 1, 2017 the US will now force new doctors to work up to 28-hour shifts. So the death toll is likely to rise.Thousands of lives have already been sacrificed including not only doctors, but hospitalized patients, and innocent people on the roads. Today I share the lives of six doctors and a passenger we lost to physician fatigue.
Lauren Connelly, M.D., of Scotland.
Just 7 weeks into her medical career at a Scottish hospital, Lauren died in a car crash after working a grueling night shift and100-hour work weeks. She was just days from her 24th birthday. Hospitals in Scotland (and around the world) expect doctors to work long shifts with no breaks and many have shut down their hospital sleeping quarters so doctors have no place to rest even at the end of a shift. Doctors-in-training are forced to work inhumane hours that would be unacceptable in any other profession. A colleague stated, “If Lauren had gone into law, architecture or accountancy – anything but medicine – she would still be alive today. That’s the truth of it.”
Ronak Patel, M.D., of the United Kingdom.
An anesthesiologist in training, Ronnie Patel tried to keep himself awake by singing to his wife on a hands-free phone after a long shift at Norfolk and Norwich University Hospital in Suffolk. He never made it home. He crashed just 3 miles from his house and was declared dead at the scene after crossing the median in a head-on collision with a large truck. Medical professionals have the worst road accident rates, more than double the rate of other British workers.
Naveed Farooki, M.D., of the United States.
Sheila Farooki shares, “My uncle was an ENT surgeon and was driving home after call. He crashed his Mitsubishi Montero into a house and it rolled over and he was instantly killed on Father’s Day 2002.”
Ilne Markwat, M.D., of South Africa.
After working more than 24 hours in the obstetrics unit of Paarl Hospital, Dr. Markwat, a first-year doctor, died in a car crash on her way home. She veered into oncoming traffic and killed a passenger in another car. The surviving passenger who lost his bride-to-be (Carol Mostert) stated, “I am a long-distance truck driver, if you are tired, you sleep. She was supposed to have slept when she felt tired. If she was not working those long hours, that accident would not have happened. Doctors are there to help us, not kill us.” Many doctors work an average 300 hours per month.
Jessica S. Lin, M.D., of the United States.
An accomplished violinist and fifth-year neurosurgery resident from the Medical College of Wisconsin, Jessica died in a fatigue-related car crash. Her dear friend from medical school writes, “She drove over a median into a tractor trailer after a 30+ hour shift. She left behind her family, including a twin sister and her fiance. She was 30.”
Sobby Mathew, M.D., of the United States.
A physician friend writes, “During my third year of family medicine residency, an intern died exactly the same way—she fell asleep at the wheel on the interstate and drove across the median into a semi. She was so full of life and happy. Such a cheerful, compassionate, and loving woman. We found out when she didn’t show up for work on her next call shift that morning.” Her life is now celebrated with The Sobby Mathew MD Award presented to an intern who is hard-working, open-minded, supportive, and selfless; and who demonstrates compassion and a caring attitude for patients.
All of these beautiful and compassionate people should still be with us today. This is a tribute to my brothers and sisters in medicine and those innocent lives lost in hospitals and on the roadways due to our fatigued physicians forced to work inhumane hours in hospitals that routinely violate their human rights to rest, eat, and sleep.
So what’s being done to address sleep deprivation among doctors? This week the ACGME (the governing body that controls post-graduate medical education in the USA) has actually voted to extend the work hours on first-year doctors from 16 to 28-hour shifts with up to 80 hours per week now permitted. Let the ACGME and Dr. Thomas Nasca know how you feel about their decision to allow doctors to work 28 hours without sleep. Submit your letter to the ACGME at 401 North Michigan Avenue, Suite 2000, Chicago, IL 60611 and email Dr. Nasca: tnasca@acgme.org (and please also post on the blog)
There’s no organization tracking the thousands of deaths among doctors due to unsafe working conditions. Have you lost a loved one as a result of physician fatigue? Please add your story in the comment section below.
More stories of sleep-deprived doctors dying
Why pilots & truckers don’t work 28-hour shifts
Pamela Wible, M.D., reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered. View her TEDMED talk Why doctors kill themselves. Need help? Contact Dr. Wible.
Gross negligence committed by hospitals. When are they going to be held accountable for these conditions? Guess what there are laws that limit hours of people who serve the public and if the ACGME doesn’t act right a future Congress is going to come for them. I have a suspicion the ACGME rolled back the intern hours restriction because the sitting Congress is none too labor friendly.
Other government Hospitals in South Africa also work 36 hour shifts
Same excuse that the ACGME did to extend work hours on surgeons.
They’re making less and less sense. Same talking points. Sleep deprivation is physiologically incompatible with human life. Meet the 7 victims above. “Dead doctors don’t lie,” as they say.
Refardless of what the studies show, especially those like the one cited, people need to step back and just look at the situation. It is inhumane and cruel to put a person through these kind of hours. Even most nurses don’t realize how much we work, let alone the general public. I’ve driven home from countless shifts where I’ve nodded off, if even for a second. I’m lucky that it has yet to result in an accident. It shouldn’t be about what produces better doctors it should be about what produces healthier ones? How/when did our own well being fall so far from being priority?
People wonder why doctors became so cynical, have poorer bedside manner, and just have a general lack of compassion. It’s burnout…and it’s really no mystery as to why. How much longer are physicians expected to sacrifice themselves the way they do? When does it stop becoming worth it?
Agree Ned. Except “burnout” is really human rights violations. https://www.idealmedicalcare.org/blog/how-the-word-burnout-perpetuates-medicines-cycle-of-abuse/
A collection of other comments published on social media:
“My first year as a civilian physician I was on call every day for a full year. One of those nights I was stop by the police for erratic driving. While he did the background check i fell sound asleep over the driving wheel. He offer to drive me home.” ~ Aracelia Bernier
“One afternoon during my residency at Denver General Hospital, I fell asleep going 70 mph on I-25. Fortunately, it was just a brief nodding off and I woke up just in time to notice I was headed for the concrete barrier in the median. One more second of sleep and I’d have been killed.” ~ James Wilk
“Lost a fellow resident to sleep/mva during surgical residency in ’94, he was a great guy liked by everyone” ~ Stephen Schwab
Back in the day when we all worked longer hours (1970-80s) I could start work at 9 am Friday and still be working at 6pm Monday. (You do the hour maths!). I am /was an anaesthetist. One Monday morning, about 4 am, we brought a chap to theatre for a relatively minor op. I told him that I was tired, having not slept for 72 hours, and therefore probably dangerous, he still chose to have me care for him- he survived!
My first boyfriend at uni died after failing to take a corner after a weekend shift. as a houseman (first year. In those days the problem was not acknowledged and ‘suicide’ was suggested.
It’s about time we tell the truth. I’m impressed that your patient had so much trust in you? Wow!
So sorry you lost your boyfriend. We’ve got to stop the insanity.
OSHA REGULATIONS ARE CLEARLY VIOLATED .
Is it possible for them to investigate and regulate the hours a doctor/resident
works ?
A CLASS ACTION LAWSUIT
MAY EFFECTIVELY CHANGE THE CURRENT MODUS OPERANDI .
I lost a first year resident in my program to a motor vehicle crash while he was driving in the mountains and drove off a cliff. He was sleep deprived and even had 80 hour work week limitations, so making things worse in terms of work shifts and hours can only worsen the death toll and lead to the deaths of other good doctors, because as a profession we exhibit dysfunctional behavior such as ACGME has just done with it’s ridiculously dangerous decision.
I’m so sorry John. Terrible. I’m tracking these deaths so feel free to share his name, obit, specialty if you are willing. No organization is tracking these occupation-related deaths.
When I was a surgical intern at King Edward VIII hospital in Durban, South Africa in 1973 we had to work 3 24hour shifts back to back. There was one time when I keep a log and in a 72 hour shift I slept 9 hours total. An hour here and an hour there. On the non call days we still worked 8 to 10 hours a day. There were 4 of us so we were on a 72 hour shift every 12 days.
We were like zombies at the end of the 72 hours.
Hi im curious as to whether you’ve done some research into overtime shifts done in South Africa. If not it should be worth reading up on. Recently junior doctors have been standing up against overtime done beyond 24 hrs at a time…as we’ve seen the effects of fatigue on many colleagues and friends, often with disasterous consequences. Studies exist that can vouch for the negative impact of fatigue on concentration and coordination. Essentially doctors start acting like emotional drunkards after 16hrs of work. Also it should be mentioned that most young doctors are not only relocated to often ridiculously rural facilities, but that the overtime contract has a large loophole. The loophole provides that if there arent enough doctors to cover overtime shifts, the government can force you to cover more shifts and not pay you for it. This is probably one of the most debated topics in any government and im sure perspective from any developing country sounds irrelevant, but I guess more perspective points of view may well help argue against passing legislature that’ll take you back to the dark ages. I hope it proves an interesting read. Just google ‘safe working hours campaign south african doctors’
Why must they work those long hours without rest? I for one am appalled…how can it be safe for doctor or patient? I don’t want someone that has been on shift 27 hours caring for me…
Thank you for your article. This is so inhumane and saddens me. Even though I’m not a doctor I have friends who are, as well as have struggled with fatigue just from working 12 hour shifts at night as a nurse. I was hoping that you would have a petition to sign – it’s a lot harder to take time out send a letter. It seems those who care the most about the topic, doctors, are probably too busy to take time out to send a letter snail mail too, but might be able to sign a petition. Thanks!
You can post a comment and an email. Petitions often disappear and comments are not always publicly available. I encourage you to post a public letter. > 130,000 signature were delivered on various petitions and despite the public outrage the hours were extended from 16 to 28 hours. See petition delivery here: https://www.idealmedicalcare.org/blog/pilots-doctors-truckers-work-28-hour-shifts/
This is insane and must stop! And if it continues, why stop truckers from driving? They should be able to drive 28 hours as well. Let’s use some common sense! And if I went into the emergency room, I want a fresh doctor, not one who has been up 28 hours! Please rethink this.lives are depending on it.
Not only is sleep deprivation bad for cognition but also it can lead to mental health issues such as hallucinations. I know this is a taboo subject but this needs to be addressed. I just wished the law would change to protect all Doctors and nurses. The best way to explain how sleep deprived a Doctor is, is torture. Yes it does fall into this gap and that’s why we need to sit up, take note and do something for our Doctors.
Donna,I’m no dr. either but see plenty.I know the sleep deprivasion. In my early 20’s had to work 3 jobs to live in an expensive large city.1-2 hrs. Sleep a day, had a paper route 3rd shift & it got so I would be at a mailbox and have no idea where I had been Nothing. Finally I would not know I’d done the route at all and had to call my boss for her to say I did go.Now I know people do black out and have no memory of 8 or more hours.Now if I pass out cold I’m told I talk the whole time and say things I never would say my husband told me. The whole thing is terrifying.
Carol Mostert is my cousin. The loss of her is indescribable. She left behind 3 children, the youngest, Chloe turned 8 the week after her mom passed. Carmelita was in matric, her final year of high school. Armando was in America. The girls are now orphans as their dad passed away 3 years prior. Thats Carol’s story. Where is the fairness in that? Ripped away when she was needed most by her family. Who is accountable? Ilna, who paid the price with her own life? Or the system that see our doctors as just another number!
Elize ~ I am so so sorry and if there is anything I can do please let me know. I would be happy to do a blog just on Carol and what has happened as a result of these ridiculous and inhumane working conditions that put all of our lives at risk. I am so very sorry. I have no words to describe the pain that I feel “health care” training inflicts on other innocent people (and our own idealistic humanitarians who only wanted to help people). Tragic from every angle. What happened to the lawsuit that was planned by her fiance?
Great article highlighting what is a worrying issue. I am a UK anaesthetist (anesthesiologist) in training and commute 40 miles on the motorway (like an interstate). Sometimes after night shifts I have had to come off the motorway and take country roads, even though it takes longer, because that is more stimulating and I have felt that getting into an accident would have been inevitable if I’d stayed on the motorway. Sometimes I get home and have no recollection of the drive. It is frightening, and every time I hear of a doctor dying on their way home I think “there but for the grace…”
(As a side note, MD is not the medical qualification in the UK; MBBS or MBChB are usual.)
Terrifying. Thanks for the info on MBBS and MBChB – hmmm . . . mot sure if folks in US would know what that means. What does it stand for?
Bachelor of Medicine and Bachelor of Surgery. Medicine is an undergraduate qualification in the U.K. Some doctors will go on to gain MD as a post graduate qualification
I read an incredible article recently which said that it was almost impossible to do research on the effect of sleep deprivation in doctors because all doctors suffered some element of chronic sleep deprivation so they couldn’t have any controls.
I used to work in the same area of the UK as Ronnie Patel and the department I worked in was devastated when they heard about his death. And since I heard about it I no longer will drive my car if I have had a heavy/disturbed night shift. Mostly because I don’t want to die but also partly because if was tired driving and managed to kill someone else on the road but survive myself, I doubt the relatives or the victim or the law or myself would accept the fact that I was working to save lives all night as an excuse for getting behind the wheel of a car in an unfit state to drive.
I knew Ronnie as I’m still a consultant at the same hospital and I met him on induction day as we both started simultaneously. Unfortunately he’s not the only trainee who had an accident. He could have used his on call room in the hospital after she shift, but I understand he was desperate to go home to his pregnant wife. Other hospitals don’t supply on call rooms anymore. One girl (anaesthetist) about 10 years ago crashed on the way back home from an ICU shift at Addenbrookes Hospital Cambridge and ended up with severe brain damage & one of my best friends (also anaesthetist) fell asleep on the dual carriage way and collided with a cardiology registrar. Luckily just damage to the car and a few bruises and grazes. We have a large training area and you can’t move houses every few months. During training the longest commute I had was 1hr 20mins. It’s tough, but having know about the girls accident many years ago I always made sure to either sleep (even if in the car) or at the very least have a coffee right before departure, though a few of my own trips were still borderline & it was probably also luck that nothing ever happened.
This is heartbreaking. I had no idea his wife was also pregnant. And so many others have been injured or killed from sleep deprivation. I can’t believe no call rooms as made available now. What is the reasoning for that?
Yes, she was around 5-6 months at the time and was working at my local hospital.
We used to be on call, but now for many years it’s shift work on site, so you either work the day or the night, but never more than 13hrs at a time with at least 11hrs in between shifts (European Working Time Directive – what will happen to that post Brexit nobody knows). The trouble is that some training areas (like ours) are widespread and you just cannot afford to move every 6-18 months because you change the hospital in your rotation.
As it’s a shift rather than an on call strictly speaking and a lot of hospitals are short of money plus need more space for offices etc. In short, they technically don’t have to supply a room. However ethically it’s taking trainees the chance to rest between shifts or after a busy shift and puts lives at risk. Compared to nurses that only ever work at one place during their training we are very different in that aspect.
The irony of all this is that people would assume us to function as a compassionate, health-restoring, health-promoting profession. Then we find so many excuses to continue this abuse. What kind of physician does this select and/or create? The old answer of “resilient” immediately fails any logical test. The selection effect can only be bad. There is nothing in that ethos to promote compassion or altruism.
There are related stats on physician stress, anxiety and depression, overlapping with sleep-deprivation (but there are other factors too).
It relates then to larger system-design issues, and why it is nigh unto impossible to have reasonable conversations about them … with ourselves …
Let’s start treating ourselves humanely. That would however be a huge shift.
I see a lot of comment regarding the ACGME decision and new doctors. It seems we don’t address those established doctors in private practice. I see 3-4 shifts of students and residents come and go before my shift is up. I would be ecstatic to only work a 28 hour shift!!!
I live in a small community where there is limited options for call coverage. I take approximately 350 hours of call a month. If I didnt work these hours, it would constitute patient abandonment, because there isnt anyone else. When I come home I dont get to sleep, it’s time to be a mom. Talk about burn out and sleep deprivation.
We need to take care of all doctors, not just focus on residents and students. We need to realize here are a lot of attending physicians who are working significantly more than 28 hours.
Let’s not role model these terrible behaviors and self-abuse fir the next generation. Human rights violations in medicine should be a never event. We need to stop abusing ourselves and agreeing to such intolerable and inhumane (and unsafe) working conditions.
I received this update I’d like to post from a family member of Dr. Markwat and I am sorry for any inaccuracies in the story as I researched what I could and obviously do not have all the facts:
I think if you write about someones death at least get the names and facts right before you spred falseness causing greater pain to those surviving these amazing poeple who lost their lives. And writing half truths falls under same category as lying and it slanders names and uses the dead in a dishonouring way to be pawnsand entertainment for the living. Whatever you wright as thruth should be so truthful that not even God can find a twist in the story.
First of all her name was Ilne not Ilene. She would never get into a car tired. She made a call just before she drove saying shes wide awake. The partner of the fiance is not a truck driver. There was a truckdriver (Diff guy) that witnessed the accident was not caused by her.
The guy that lost his fiance later told many stories of which all were different, even by it being daytime or nightime and rain and sun. And acc to police he commited suicide a few months ago – can speculate guilt over all theismatched stories and possible role in accident acc to eye witnesses or just grief over fiance. But that speculation, not fact. Fact is she was responsible and would never get into a car if tired, rather sleep or ask a friend to fetch her. I can go on. Just be careful of what you wright. Its a good cause to decrease working hours but it tortures those left behind reading inaccurate pictures paimted about their loved ones to get a cause accross.
“My previous chief resident, the co-chief resident, of the doctor who was years later found dead at this house had had 3 car accidents due to falling asleep driving. Therefore, falling asleep driving was a norm, not a cause for alarm… I am not sure when, but sometime during my internship they declared that you could not wake up patients for pre-rounds prep before 6am!! Therefore, that ended my seniors need and desire to wake up patients before that. Yes, patients complained about the middle of the night intrusions into their sleep! I also remember a different chief resident falling asleep in the OR during a case and being excused; he was upset that they wouldn’t let him stay and do the case!!!” (per doctor who wishes to remain anonymous)
Great article, you’ve done a good job on discussing this worrying issue of our beloved doctors.
Dr. Wible. Another one to report:
Burr Ridge physician dies in Indiana Toll Road crash (May 28, 2018)
A Burr Ridge, Ill., physician died early Monday morning on the Indiana Toll Road in Porter County when his car veered off the highway and struck a guard rail, according to reports.
Indiana State Police reported the crash happened shortly after midnight, two miles west of Indiana 49.
Authorities identified the victim as 41-year-old Dr. Ashay V. Kparker. Police said he was unresponsive at the scene and pronounced dead from blunt force trauma by a Porter County deputy coroner.
Kparker was a practicing urologist affiliated with the University of Illinois Medical Center, among others. He graduated from University of Illinois College of Medicine in 2003, according to the website.
Coroner Chuck Harris said Kparker had just left Porter Regional Hospital and was westbound on the toll road.
Police said after Kparker’s 2018 Infinity hit the guard rail, it nosedived into a grassy median where it came to rest facing the eastbound lanes in the center of the highway.
Police said Kparker wasn’t wearing a seat belt, which contributed to his injuries.
Harris said routine toxicology tests would be run, but drugs or alcohol weren’t suspected of being factors in the crash.
I’m curious in the US if this type of “conditioning” and no sleep mindset actually stems from medical school training. I know on rotations we are expected to be 100% obedient and bend over backwards for our attendings. As a result we had a few students get Seriously injured,from car accidents. Not only were we not informed of this but the school turned it back on us saying . ” it’s your responsibility to take care of yourself ” or “you should know better” . Fact is we do , but we have already committed our lives to medicine , and frankly many are afraid to stand up to attendings, for the reprecussions of a bad eval, failing grade , etc.
Read history of medical education. William Halstead I believe is his name. Cocaine-addicted surgeon set this thing up.
why is no one starting to lobby against these long hours. We should gather and for the sake of those who lost there lives fight forless hours, demand a place to sleep if doing a double shift.
While I’m reading the article and the comments, a solution pops into my mind. Society has volunteer groups that organize drivers for senior citizens, why can’t these volunteer groups and hospital auxiliary groups organize drivers for the young doctors?
Great idea. Medical institutions would have to admit that this IS A PROBLEM. And then accept volunteers to help their overworked doctors. Hard to admit that your workplace (a hospital) is so unsafe that you may be responsible for doctor suicides & patient deaths (via medical mistakes). All described here in Human Rights Violations in Medicine: A-to-Z Action Guide.
Is there an organization that is in a position to fight more effectively against the acgme on their fake resident work hour rules?
Fake because:
-A 30 hour work week is the same as no limit at all because people are about ready to collapse at 30 hours regardless.
-They state the limit on shift hours is 24 hours then allow for 6 more hours to finish work. In the real world a shift is always about finishing work, so it is a 30 hour limit not 24. Its an example of deception, slight of hand, a shell game.
-80 hours per week is still egregious.
-There is no enforcement. Self reporting does not work. There are many more programs violating the rules than following them, with no consequence whatsoever.
It’s a joke.
Clearly the acgme falls in line under the influence of the program directors, academic physicians and hospitals that benefit from the slave labor.
And accept no input from the students and residents they are supposed to be serving.
And make no consideration for human decency, human rights.
The trainees are simply being abused and it’s happening because they cannot fight back. The programs and the academic physicians running them have the trainees in a complete bind because all of the trainees want to become doctors and will never do anything to jeopardize their career path.
This is the single most deplorable issue in all of medicine, in my opinion.
I highlight all the organizations that help (free agencies in the US to protect citizens) here in the book: Human Rights Violations in Medicine: A-to-Z Action Guide. Highly recommend that residents follow the medicolegal action steps there (divided into the top 40 violations they may encounter in training).
It is the height of hypocrisy to advertise and promote the medical organization(s) that employ these well meaning doctors and other medical staff by advocating to the public the well being of patients in an attempt to recruit more patient business. But ironically, not advocating for the well being of the doctors and/or the staff that keep these insensitive organizations running and in business in the first place. Doctors (like patients) are humans too and they need food, water and most of all “rest” just like anyone else.
This is so important- hours and shifts need to be addressed. Losing these precious people to fatigue and stress, is just criminal. I bet the politicians would soon change the conditions if one of their children, daughter,son or relative died in this situation. They would start to protest against these disgusting rosters.
Please correct the spelling of her name to “Ilne Markwat”. She was a friend and colleague and is sorely missed. Her loss was preventable.
Thank you for this article.