Every doctor remembers that fear before their first night shift. I was literally s%#ing myself!. Everyone has their own ritualistic way of trying to get ready. Mine was to stay up as long as I could watching Netflix the night before and I’d usually get to around 5am before knocking out. The next challenge was food. I would have dinner (or is it breakfast?!) followed by a tea or coffee at around 7pm before the shift started at 9pm. I’d also meditate along the commute to try and get my mind right. The shifts are variable: some are hard, some less so. Sometimes if you’re lucky, you even get some sleep. 3 nights in a row is fairly manageable; but the 4th always felt like the killer. Either way, while I had a solid pre-nights routine that seemed to work well, I have never perfected how to recover after a stretch of nights.
It takes its toll too. I noticed that I would be in a state of delirium and disinhibition post-nights. I would talk more and be more emotional, almost like the effects of alcohol. Worryingly, my decision-making was off. The bigger worry, though, was that if my decision-making is off, what about my patients? The effects of shift work on my health were clear and could even impact others around me and under my care.
As well as all the data linking shift work with worse health outcomes (blog post on this forthcoming), there is data out there to show that rotas designed with more recovery time reduce the number of adverse events and errors amongst doctors and that over half of doctors have almost been involved in accidents after shifts. So yes, there is a risk to patients and we doctors are at risk too. But obviously staff are needed overnight and for what it’s worth I want to take the opportunity to salute all healthcare professionals for their dedication to all of us, putting themselves through shift work and literally sacrificing their wellbeing for the rest of us.
Now, back to what we can actually do to solve shift work health. The scalable way to solve it is more pragmatic rota design, with shift workers’ wellbeing as a focal point. Unfortunately that takes time and a lot of effort. We all know how horrific medical rotas are; plus Brexit means we will all be outcast from the EU working time directive. So what can you do immediately as an individual if you have to deal with nights shifts?
Thankfully, the BMJ has put this helpful infograph together:
Yes, it is all very simple stuff but we often forget it all during crunch time. Instead we YOLO, eat all sorts, sleep whenever and watch too much Netflix before sleeping. Save a copy of the infograph on your phone so next time your working nights you have a structure to lean on for your shift work health. If you can’t get away from night shifts altogether, then make use of the best advice currently available to help you through them, for your sake as well as the people you care for.
Dr Dilraj Kalsi uses Lifestyle Medicine and Digital Health to empower patients to reverse disease via his online clinic Hippocrates Lounge. He is a Lecturer in Digital Health at the University of Warwick and publishes regularly on patient empowerment with colleagues from Oxford University. For all his latest health tips straight to your inbox, sign up here!