On-call duties hard on GPs

Wairoa GP Ron Janes led the survey. Picture / Peter de Graaf

The demands of being on call mean some rural doctors are severely sleep-deprived and may be clinically unsafe, says a Hawkes Bay doctor.

Research conducted by Ron Janes, a rural GP in Wairoa, showed that providing on-call services was leaving rural doctors exhausted, psychologically stressed and was a significant factor in GPs and nurses leaving rural practice.

"While practitioners could identify some positive aspects to providing after-hours care, most said that the time and stress of being on call negatively impacted on themselves and their family life," Dr Janes said.

His own situation illustrated the problem.

In Wairoa, the six doctors take turns to be on call every sixth weekend and every sixth day of the week.

On Monday night it was Dr Janes' turn. He was woken at 10pm to help a man having a seizure. After he got back to bed he was woken at 1am to tend to a man with a fever.

Both callouts resulted in hospital admissions and took an hour each.

Dr Janes still had to turn up for his appointments the next day but admitted to feeling "buggered".

Although Waipukurau doctors could rely on Hastings to pick up their after-hours calls, Wairoa was too far away from a centre.

Virtually all of the 81 rural GPs and 17 rural nurses who completed the survey, commissioned by the New Zealand Rural General Practice Network, commented on negative aspects of providing on-call services.

Said one: "I love my job as a rural GP but would give up on-call immediately if I was able. I can think of no positive experiences from being on call but plenty of negative ones."

Sleep deprivation and its impact on safety was repeatedly mentioned.

Doctors described being exhausted, depressed and talked about the psychological burden of knowing they could be called out at any moment to a life-threatening situation.

"Looking back, almost all complaints about my communication and treatment have arisen from times when I've been exhausted due to long on-call hours," one doctor said.

Dr Janes said heavy hospital on-call rosters had been shown to affect performance to a level similar to mild alcohol intoxication.

"Which suggests that sleep-deprived rural providers doing frequent on-call may be clinically unsafe."

When doing weekend after-hours care, many rural GPs were on call continuously from 8am on Friday until 5pm on Monday. Some rural nurses were on call for 10 days in a row before they got a break.

"Respondents also commented about the problem of taking holidays because of the difficulties in attracting locums who would be prepared to do on-call."

- HAWKE'S BAY TODAY