The Insidious Problem of Fatigue in Medical Imaging Practice

Abstract

Fatigue represents a temporary inability to respond to a situation due to inadequate recuperation from overactivity; which can manifest in mental, emotional, or physical forms [1]. Occupational fatigue has been identified as a contributing factor in numerous catastrophic events including the Three Mile Island and Chernobyl nuclear reactor meltdowns, the Challenger Space Shuttle disaster, The Bhopal Union Carbide plant explosion, and the grounding and resulting oil spill of the Exxon Valdez oil tanker [2, 3]. In medicine, fatigue has been well documented as a source of medical errors, exacerbated by the continuous (i.e., around the clock) requirements for service delivery as well as associated disruption of circadian rhythms [4, 5]. Other sources of medical error that could be exacerbated by fatigue include excessive workload, cognitive overload, imperfect information processing, poor communication, and flawed decision making [6]. One can argue that all of these sources of medical error are ubiquitous in the current healthcare practice, and steadily rising as service demands and quality expectations continue to escalate. As reimbursements trend downwards, healthcare providers attempt to compensate by increasing their individual and collective practice productivity. While computerized medical technologies offer the potential to improve workflow and productivity, there is a theoretical point in which increasing productivity becomes offset by potential quality deficiencies. At the same time, healthcare consumers are placing increasing demands on providers for access to healthcare data, collaborative decision making, and quality accountability measures [7–9]. The collective stressors of worsening healthcare economics, increased workload, and heightened quality concerns serve as inevitable source of fatigue and stress on healthcare providers. These in turn can further compromise productivity and quality deliverables. If this cycle of perpetual occupational fatigue is to be successfully addressed and circumvented, it is first essential that the healthcare community identify the sources, create proactive mechanisms for objective data collection and analysis, and develop effective countermeasures.