Why are pilots protected from fatigue while doctors are expected to power through it? A social media debate this week revived a long-standing question about safety in healthcare.
A recent conversation on social media brought renewed attention to how fatigue is handled in safety-critical professions. A post shared by a practising radiologist and founder of DAMS, Dr. Sumer Sethi, highlighted differences between aviation and healthcare duty-hour practices and encouraged discussion about whether similar safeguards should guide medical work schedules.
Fatigue refers not just to tiredness but to decreased alertness, slower reflexes, and impaired cognitive processing.
Studies from India and other countries consistently report high levels of excessive daytime sleepiness among resident doctors.
A study from Chandigarh found that longer work hours and poor sleep habits were significantly associated with excessive daytime sleepiness among junior residents.[1] Many participants reported working more than 80 hours per week.
International data show similar patterns. A study found that hospital physicians working extended hours experienced poorer sleep quality, increased sleep disturbances, and higher levels of fatigue.[2] Reviews of resident sleep patterns further note that irregular shifts and disrupted circadian rhythms contribute to chronic sleep loss.[3]
Well defined working hours for doctors are not about reducing commitment, they’re about sustaining it. A rested doctor thinks clearer, decides better, communicates with empathy, and makes fewer errors. Boundaries protect not just doctors, but patients too.
Dr. Deepti Bahl, MS OBGY
Clinical tasks depend on attention, memory, and rapid judgment. Evidence indicates that fatigue can impair these functions and may increase the risk of mistakes. A study assessing self-reported medical errors among resident physicians found that long work hours, work stress, and inadequate rest were associated with higher error rates.[4]
Another recent scoping review discussing clinician fatigue concluded that fatigue influences performance and decision-making, although interventions to reduce its impact remain inconsistently implemented.[5]
Dr. Deepti Bahl, MS OBGY, responded to the original post, emphasizing how fatigue impacts decision-making in clinical settings.
The issue is observed across teaching hospitals, tertiary centres, and district hospitals. Fatigue becomes most visible during high-intensity rotations such as emergency postings, periods of increased patient load, and night duties. Research from 2001–2021 tracking physician work trends has shown fluctuating but persistently high work hours, reflecting ongoing workforce pressures.[6] These pressures continue to affect both sleep quality and recovery time.
Aviation assumes that human performance declines with inadequate rest. Pilots must follow regulated duty hours, mandated rest periods, and fit-to-fly requirements. These rules are designed to reduce risk by preventing impaired performance.
Aviation’s Fatigue Risk Management Systems are continuously updated based on human-factor data, while healthcare currently has no equivalent national framework.
Healthcare, however, continues to rely on extended shifts, overnight duty, and long on-call periods. While the nature of clinical work differs from aviation, both fields involve time-sensitive decisions where alertness is essential to safety.
Current studies consistently show that fatigue among doctors is widespread and associated with impaired alertness, reduced cognitive performance, and higher self-reported errors. Since clinical decisions directly influence patient outcomes, addressing fatigue becomes a patient-safety measure as well as an occupational-health need.
When the system respects time to rest, reflect, and live beyond scrubs, it preserves the very thing healthcare depends on: humane, safe, and thoughtful care. Healthy doctors build a healthier healthcare system.
Dr Deepti Bahl, MS OBGY
Monitoring and adjusting duty hours to prevent chronic overwork.
Designing shift structures that allow adequate rest.
Encouraging healthy sleep habits and ensuring rest areas during night duty.
Supporting more research that links fatigue to patient outcomes to guide policy changes.
Fatigue in healthcare is a modifiable risk factor. Addressing it through structured strategies may help promote safer patient care and better working conditions for doctors.
If healthcare demands the same precision as aviation, it deserves the same protections.
1. Mastin DF, Siddalingaiah HS, Singh A, Lal V. Excessive Daytime Sleepiness, Sleep Hygiene, and Work Hours Among Medical Residents in India. Journal of Tropical Psychology. 2012;2:e4. doi:10.1017/jtp.2012.3
2. Koike S, Wada H, Ohde S, Ide H, Taneda K, Tanigawa T. Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey. BMC Public Health. 2024 Jan 12;24(1):164. doi: 10.1186/s12889-023-17531-5. PMID: 38216962; PMCID: PMC10785398.
3. Dhusia AH, Dhaimade PA, Jain AA, Shemna SS, Dubey PN. Prevalence of Occupational Burnout among Resident Doctors Working in Public Sector Hospitals in Mumbai. Indian J Community Med. 2019 Oct-Dec;44(4):352-356. doi: 10.4103/ijcm.IJCM_78_19. PMID: 31802799; PMCID: PMC6881898.
4. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008 Mar 1;336(7642):488-91. doi: 10.1136/bmj.39469.763218.BE. Epub 2008 Feb 7. PMID: 18258931; PMCID: PMC2258399.
5. Weaver MD, Sullivan JP, Landrigan CP, Barger LK. Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk. Jt Comm J Qual Patient Saf. 2023 Nov;49(11):634-647. doi: 10.1016/j.jcjq.2023.06.014. Epub 2023 Jul 7. PMID: 37543449.
6. Goldman AL, Barnett ML. Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021. JAMA Intern Med. 2023 Feb 1;183(2):106-114. doi: 10.1001/jamainternmed.2022.5792. PMID: 36534376; PMCID: PMC9857188.
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