There is no patient safety without healthcare workers’ safety

This article was exclusively written for The European Sting by Mr Aahil Damani, a medical student at King’s College London (KCL), intercalating in Control of Infectious Diseases. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

To provide optimal healthcare to patients who present to the clinic with the expectation that they will leave satisfied (with their presenting complaint solved) and with no additional problems, the wellbeing and safety of health workers is crucial.

There are many examples and anecdotes that support this statement.

One common theme linked to the topic is sleep deprivation amongst doctors working nightshifts. The General Medical Council’s national training survey revealed that 22% of doctors had working patterns that meant they were short of sleep.  Why is this important? Sleep deprivation has been linked to road accidents and mental health problems and the consequences of this are astonishing for the patient. In addition, there is loss of insight and focus, irritation and agitation. That doesn’t go to say that mistakes and consequences mentioned above don’t happen during the day but rather to illustrate the point that as the safety of healthcare workers is compromised, so is that of the patients. As Dr Farquhar says, “[A better understanding of sleep helps doctors cope with nights and benefit patients]”.

Using COVID-19, an infectious disease with symptoms and long-term complications as an example, it is important to cut chains of transmission by either testing or asking the individual concerned to self-isolate, as infected individuals have the potential to transmit the virus to others. This is particularly the case for healthcare providers, as the individuals they come into contact with on a daily basis are patients, often individuals with comorbidities or those presenting to the clinic for non-COVID reasons. Despite there being separate wards, one can pick up COVID-19 from anywhere and patients do not present with the expectation of catching the virus. Whilst this may occur, patient safety is compromised. In the early stages of the pandemic, cases amongst healthcare workers were common, due to a lack of Personal Protective Equipment (PPE); equipment designed to keep healthcare workers (HCWs) safe. With adequate protection, the risk of HCWs being affected by and transmitting the virus to their patients is reduced. Testing is also powerful as a negative result can help the HCW (suspected to have the virus) return to work. Similar to the PPE scenario, initially, testing capacity was limited for those admitted to hospital. This made it difficult to have a healthy and safe workforce as those with symptoms had to self-isolate, resulting in a loss of workforce. Whilst unfortunate for symptomatic but unaffected individuals, the logic behind it was to ensure healthcare workers and ultimately patients were safe. Fortunately, the testing policy has now changed to ensure healthcare workers are not self-isolating and are prioritised.

Despite the examples mentioned above, clinicians that are unwell continue to work, potentially due to the attachment associated with their job; duty to provide care.  One could argue whether working in such circumstances can be classified as providing care, but the stark reality is that in healthcare systems such as the NHS with a shortage of doctors and nurses, it may be the lesser of two evils.

References

https://mdujournal.themdu.com/issue-archive/autumn-2017/working-safely-on-nightshifts

https://www.gmc-uk.org/education/how-we-quality-assure/national-training-surveys

About the author

Aahil is a medical student at King’s College London (KCL), intercalating in Control of Infectious Diseases. His interests lie in public health, particularly health promotion and mental health as well as medical education. He has served as President of the GKT Music Society at medical school and is currently the vice-president of Students for Global Health at KCL.