Medicine comes with a lot of challenges, one of them being shift work. My past 1.5 years have been spent mainly doing shift work. Especially the past 6 months. I’ve done many weeks of nights, weekends, evenings, public holidays. I often rotate from nights, to days, to evenings and back again every week. It can start to feel exhausting, and you begin to wonder what the effects of shift work are on your mental and physical wellbeing? The science states that shift work is detrimental to your health, and can even lead to early death…let’s look closer

I’m going to explore my own personal view, and the actual science behind the fact that shift work is hazardous to your wellbeing.

My own personal view

From my own personal feelings alone I don’t feel great doing shift work. I have missed out on family events, catch ups with friends, family Christmas photos, New Years celebrations and more.

There is a huge level of social isolation that comes with shift work. You sleep while everyone else is awake, work while everyone is asleep, and spend the time in between playing catch up. Trying to adjust your clock.

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It can affect your appetite, exercise and diet. You start to order fast food, something quick and easy. Something delicious to make up for the long shift you just pulled in the fluorescent lights of the hospital. Some workers take up smoking, or snack all night long. Everyone seems to develops a vice.

I’ve also seen a colleague have a car accident after a night shift. He was luckily uninjured, but everyone knows it could just as likely happen to them. A senior doctor jokes about how he drives home. He puts the handbrake on at the red light and closes his eyes, he wakes up to beeping and then keeps driving. This is his normal.

What does science say?

Science suggests shift work is very bad for your health. Humans are born with a circadian clock, an in built sleep-wake cycle. It keeps you awake during the day, and asleep for about 8 hours during the night. Temperature, digestion, heart rate and blood pressure are all in tune with this circadian rhythm.

Night workers or those that start their shifts before 6am work counter to this circadian rhythm. Leading to possible long term health consequences.

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Rotating shifts

It takes a person on average 10 days to adjust to night shifts, and yet we are expected to switch between the two within days. I remember after my 7 nights straight of 12.5 hour shifts I had 48 hours to adjust to a 7am start.

All legal, but it feels physically rough.

Trying to revert to daytime routines the day after nights leads to an unstable circadian rhythm. Thus making your sleep, metabolism, and digestion off kilter.

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Health problems that arise

More likely to develop:

  • Obesity
  • Cardiovascular disease
  • Mood changes
  • Gastrointestinal problems
  • Cancer, especially breast cancer – the World Health Organization classified shift work as a probable carcinogen in 2007
  • Sleep problems – little or disrupted sleep means the body never ‘powers down’, leading to lack of rest and recuperation
  • Relationship problems, including divorce

Shiftworkers are also at increased risk of motor vehicle accidents.

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Sometimes it seems they just test health care workers to see how far they can stretch

Everything that happens is just legal. Technically, in Australia you can only work for 38 hours a week, with ‘reasonable overtime’ a loophole the government can get through. My 40 hour work weeks of the emergency department are a welcome change to the hours I was pulling before.

In intensive care I could work up to 100 hours in 8 days, in surgery about 50-60 hours a week. A strict maximum of 40 hours is quite a lovely change, but if you compare it to what is legal in Australia it isn’t that groundbreaking.

Safe Work Australia states shifts should be limited to 12 hours including overtime, or 8 hours if it is a night shift or shift that is demanding or safety critical.

I’m sure we can all agree that medicine is a demanding and safety critical job, with people’s lives at risk. And yet doctors are expected to work 14 hours shifts, to do 7 days straight of 12.5 hours, to do 10-12 hour night shifts.

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Increased risk of early death?

It sounds dramatic and scary, but a scientists reviewed 74,862 nurses enrolled in the Nurses’ Health Study since 1976. These nurses all worked in rotating night shifts for extended periods of time.

The findings include:

  • Women who worked rotating night shifts >5 years were up to 11% more likely to die early
  • Women who worked rotating night shifts for >15 years had a 38% higher risk of dying from heart disease
  • Rotating night shifts were linked to a 25% higher risk of dying from lung cancer and 33% higher risk of dying from colon cancer

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What do we do we this knowledge?

Basically, if you want to continue in medicine the facts are that you will have to do rotating shift work for the near future. Maybe when you are finally a specialist you can cut down on that, or if you choose GP you can get rid of it all together.

So how do we protect ourselves?

Scientists say we simply have to try be as healthy as possible. Eat well, exercise and have regular cancer screenings.

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References:

Shiftwork, Better Health Channel, Victoria State Government Department of Health.

Working harder – working dangerously?, in Medical Journal of Australia, vol. 168, pp. 614–616. More information here.

Why Working at Night Boosts the Risk of Early Death, in TIME, Alice Park, 2015

Feature Photo by Li Lin on Unsplash