In the last couple of weeks there have been serious discussions in the social media regarding medical doctors being involved in fatal motor vehicle crashes when returning home after long hours of work.

Malaysian Medical Association (MMA) and several other medical NGOs held a meeting together with the representatives from the Road Safety Council, Malaysian Institute of Road Safety Research (Miros), Occupational Safety and Health Unit of the ministry of health (OSH) and the Road Transport Department(RTD) to discuss this.

After much discussion it was decided that further research is needed to gather data on post call fatalities but acknowledging interim measures must be taken immediately. Miros will under take this research together with the assistance of the medical associations, the police department, OSH and RTD.

The findings from this study and the remedial proposals would be presented to the ministry of health to act upon.

In the mean time, the medical associations and the RTD will launch an awareness campaign among healthcare workers on the dangers of fatigue and driving.

On May 30, 2017 the director general of Health issued a press statement titled ‘Isu Kemalangan Jalan Raya di Kalangan Anggota Kesihatan’. In this statement he mentioned that during the period 2014-2016, there were a total of 554 cases of road accidents involving various categories of health care workers from the ministry of health, and of which 69 involved those who were returning home after extended work hours. He urged the staff to be careful and observe safety precautions like adequate rest before driving home.

Malaysian Medical Association welcomes the good advice given by the director general but we feel that he has not gone all the way to address the root cause.

Many studies have been done internationally on the impact of health care providers’ work hours. The evidence suggests that work schedules do have a profound effect on health care providers’ performance, as well as their own safety and that of their patients.

Recent studies have shown that doctors in training working traditional schedules with recurrent 24 hours shifts have demonstrated the following:

-Suffer 36 percent more needle stick and other sharp injuries when work schedule is limited to 16 hours but increases to 61 percent after 20 consecutive hours of work.

- Make five times as many serious diagnostic errors.

- Have twice as many on-the-job attention failures at night.

- The risk of motor vehicle crash doubles when driving home after 24 hours of work.

- Performance decreases similar to that induced by a blood alcohol level of 0.05-0.10 percent.

While there are many more studies that show similar impact of long duration of work, MMA is of the opinion that we do not have to wait for any locally conducted studies which may take time due to infrequent but nevertheless heart-breaking incidents, and urges the ministry of health to take proactive steps immediately to enhance the safety of the health care providers who work long hours and those who do night shifts without sleep.

1. Review the work hours of the doctors especially the front liners like house officers and medical officers in the hospitals. Special attention must be given to those in highly stressful specialities like anaesthesia and critical care, emergency medicine and trauma, obstetrics and paediatrics.

2. Make it essential for a supervisor to identify who may suffer chronic fatigue syndrome as a result of recurrent sleep deprivation after reviewing the work schedule and to give time off to rest.

3. Establish and enforce safe work-hour limits for health care providers.

4. Provide adequate and comfortable facilities for the doctors to rest in between activities while on duty and after the shift. This would include providing good nourishment and beverages.

5. Enforce mandatory rest in hospital or provide alternate transport, other than self-drive, for those who have worked more than 16 hours continuously.

In the long term it may be necessary to increase the number of hospitals and beds to reduce the burden on the existing hospitals which have high work load that result in highly stressed providers compounded by fatigue of long working hours.

The confluence of all these factors would affect the well being of the providers and the patients they look after.

DR RAVINDRAN R NAIDU is the president of the Malaysian Medical Association.