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Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a recent Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a recent Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Half of junior doctors having accidents or near misses after night shifts

More than half of trainee hospital doctors have had an accident or near miss on their way home after a night shift due to sleep deprivation, according to new evidence about fatigue among NHS staff.

Doctors have described swerving across motorways, crashing into other vehicles, being stopped by police and hitting a kerb, verge or roundabout as a result of falling asleep at the wheel on their journey home.

In all, 1,229 (57%) of 2,155 trainee anaesthetists questioned had been involved in an accident, or come close to having one, while driving, motorcycling, cycling or walking home after working all night.

“I have fallen asleep at traffic lights. I once hallucinated on the motorway,” one doctor said. Another said: “Previously experienced microsleep/nodding off on the M5. Foot came off the gas pedal and the car slowly drifted into middle lane. Woke up when driver in van came up alongside me and honked continuously.”

Some suffered injuries ranging from minor bumps and scrapes to more serious harm, but others had written off their car and some incidents put others at risk, too. Almost all doctors admitted that the incidents were their fault, though caused by exhaustion.

Another respondent recounted how: “I’ve fallen asleep and drifted towards a lorry in the other lane of a dual carriageway. I’ve fallen asleep and hit a car coming the other way with our wing mirrors on a village road near home. I’ve also pulled out of a junction when someone was coming as I was so dopey after a night [shift].”

More than eight out of 10 (84%) of respondents said that they had felt too tired to drive home after a night shift. About 90% use caffeine-based drinks in order to stay awake on a night shift.

Seven out of 10 (72%) said that work-related fatigue had negatively affected their physical health, while almost as many said it had damaged their psychological wellbeing (69%) or personal relationships (66%). Over half (53%) of the trainee anaesthetists said fatigue had impaired their ability to do their job.

The findings, published in the medical journal Anaesthesia, have prompted calls for the NHS to do more to ensure that doctors on duty overnight can get some sleep during their shift or sleep in the hospital before heading home afterwards.

“These are very worrying findings. Junior doctors are putting their lives at risk due to fatigue resulting from their shift work and the lack of rest facilities at their hospitals both during and after shifts,” said Dr Laura McClelland, a co-author of the survey.

Extreme tiredness among doctors could also lead to them making mistakes when they are working at night, McClelland warned.

“It may lead people to believe that they are able to drive when they aren’t or to misjudge a clinical situation. We’re required to make judgements about everything from the clinical presentation of a patient to the drug doses we use and also the appropriate course of the clinical care. Fatigue can lead to anything going wrong in any of those processes,” she said.


Junior doctors are putting their lives at risk due to fatigue resulting from shift work and the lack of rest facilities

Dr Laura McClelland

A typical junior doctor’s night shift lasts for 12 and a half hours. But 17% of medics said they never managed a sleep of at least 30 minutes during that time.

“That 17% figure is a worry as it highlights that people on a night shift, who aren’t physiologically designed to be awake all night, aren’t having the opportunity to have the rest breaks required so that they can function optimally and safely, so they can give patients the best possible care and drive safely during their journey,” said Dr Jon Holland, another co-author.

At least three junior doctors have died in car crashes on their way home after nightshifts since 2013, added Holland. They include trainee anaesthetist Ronak Patel, 33. He died when he crashed his car into a lorry on his way home from the third of three successive night shifts at the Norfolk and Norwich hospital in Norwich. The inquest into his death heard that he had been singing to try to keep himself awake during the journey.

Many respondents said they had no opportunity to have a short sleep mid-shift because they were too busy or there were too few other doctors on duty to allow them to do that. A third (34%) did not have rest facilities available in their hospital to have a nap in mid-shift.

The Association of Anaesthetists of Great Britain and Ireland, which endorsed the study’s conclusions, believes that the loss of rooms in hospitals in which doctors could sleep during or after a night shift has led to increased fatigue among medics.

A Department of Health spokeswoman said: “We know how hard our junior doctors work to provide world-leading care and it is absolutely vital they get proper support. And that’s why their new contract has much stricter safeguards in mandating rest days after consecutive night shifts and reducing the maximum hours worked in any one week.”

Half of junior doctors having accidents or near misses after night shifts

More than half of trainee hospital doctors have had an accident or near miss on their way home after a night shift due to sleep deprivation, according to new evidence about fatigue among NHS staff.

Doctors have described swerving across motorways, crashing into other vehicles, being stopped by police and hitting a kerb, verge or roundabout as a result of falling asleep at the wheel on their journey home.

In all, 1,229 (57%) of 2,155 trainee anaesthetists questioned had been involved in an accident, or come close to having one, while driving, motorcycling, cycling or walking home after working all night.

“I have fallen asleep at traffic lights. I once hallucinated on the motorway,” one doctor said. Another said: “Previously experienced microsleep/nodding off on the M5. Foot came off the gas pedal and the car slowly drifted into middle lane. Woke up when driver in van came up alongside me and honked continuously.”

Some suffered injuries ranging from minor bumps and scrapes to more serious harm, but others had written off their car and some incidents put others at risk, too. Almost all doctors admitted that the incidents were their fault, though caused by exhaustion.

Another respondent recounted how: “I’ve fallen asleep and drifted towards a lorry in the other lane of a dual carriageway. I’ve fallen asleep and hit a car coming the other way with our wing mirrors on a village road near home. I’ve also pulled out of a junction when someone was coming as I was so dopey after a night [shift].”

More than eight out of 10 (84%) of respondents said that they had felt too tired to drive home after a night shift. About 90% use caffeine-based drinks in order to stay awake on a night shift.

Seven out of 10 (72%) said that work-related fatigue had negatively affected their physical health, while almost as many said it had damaged their psychological wellbeing (69%) or personal relationships (66%). Over half (53%) of the trainee anaesthetists said fatigue had impaired their ability to do their job.

The findings, published in the medical journal Anaesthesia, have prompted calls for the NHS to do more to ensure that doctors on duty overnight can get some sleep during their shift or sleep in the hospital before heading home afterwards.

“These are very worrying findings. Junior doctors are putting their lives at risk due to fatigue resulting from their shift work and the lack of rest facilities at their hospitals both during and after shifts,” said Dr Laura McClelland, a co-author of the survey.

Extreme tiredness among doctors could also lead to them making mistakes when they are working at night, McClelland warned.

“It may lead people to believe that they are able to drive when they aren’t or to misjudge a clinical situation. We’re required to make judgements about everything from the clinical presentation of a patient to the drug doses we use and also the appropriate course of the clinical care. Fatigue can lead to anything going wrong in any of those processes,” she said.


Junior doctors are putting their lives at risk due to fatigue resulting from shift work and the lack of rest facilities

Dr Laura McClelland

A typical junior doctor’s night shift lasts for 12 and a half hours. But 17% of medics said they never managed a sleep of at least 30 minutes during that time.

“That 17% figure is a worry as it highlights that people on a night shift, who aren’t physiologically designed to be awake all night, aren’t having the opportunity to have the rest breaks required so that they can function optimally and safely, so they can give patients the best possible care and drive safely during their journey,” said Dr John Holland, another co-author.

At least three junior doctors have died in car crashes on their way home after nightshifts since 2013, added Holland. They include trainee anaesthetist Ronak Patel, 33. He died when he crashed his car into a lorry on his way home from the third of three successive night shifts at the Norfolk and Norwich hospital in Norwich. The inquest into his death heard that he had been singing to try to keep himself awake during the journey.

Many respondents said they had no opportunity to have a short sleep mid-shift because they were too busy or there were too few other doctors on duty to allow them to do that. A third (34%) did not have rest facilities available in their hospital to have a nap in mid-shift.

The Association of Anaesthetists of Great Britain and Ireland, which commissioned the study, believes that the loss of rooms in hospitals in which doctors could sleep during or after a night shift has led to increased fatigue among medics.

A Department of Health spokeswoman said: “We know how hard our junior doctors work to provide world-leading care and it is absolutely vital they get proper support. And that’s why their new contract has much stricter safeguards in mandating rest days after consecutive night shifts and reducing the maximum hours worked in any one week.”

Doctors using Snapchat to send patient scans to each other, panel finds

Doctors are using Snapchat to send patient scans to each other, a panel of health and tech experts has found, concluding the “digital revolution has largely bypassed the NHS”.

Clinicians use camera apps to record particular details of patient information in a convenient format, the panel said in a report, describing it as “clearly an insecure, risky, and non-auditable way of operating, and cannot continue”.

It also notes that the NHS still holds the “dubious” title of the world’s largest purchaser of fax machines.

The report was commissioned by DeepMind Health (DMH), which is owned by Google, for an annual independent review of the company’s work. DMH’s work involves introducing and testing new technology for the NHS.

This week the Information Commissioner’s Office (ICO) found that London’s Royal Free hospital failed to comply with the Data Protection Act when it handed over personal data of 1.6 million patients to DMH.

In its review, the panel, chaired by the former Liberal Democrat MP Dr Julian Huppert, said: “The digital revolution has largely bypassed the NHS, which, in 2017, still retains the dubious title of being the world’s largest purchaser of fax machines.

“Many records are insecure, paper-based systems which are unwieldy and difficult to use. Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes.

“They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.

“It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue.”

The panel also features Richard Horton, editor-in-chief of the medical journal Lancet, Prof Donal O’Donoghue, a consultant renal physician at Salford Royal hospital and Matthew Taylor, the chief executive of the Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA).

The ICO ruling against the Royal Free hospital was related to its plans with DMH to create the healthcare app Streams, an alert, diagnosis and detection system for acute kidney injury. The ICO’s ruling was largely based on the fact that the app continued to undergo testing after patient data was transferred. Patients, it said, were not adequately informed that their data would be used as part of the test.

Harsher words were reserved for DMH’s public and patient engagement: specifically, that the company has not adequately reassured the public about the nature of its relationship to Google.

“As far as we can ascertain, DMH does not share its data with Google, yet the public perception that this might be the case, now or in the future, will be difficult to overcome and has the potential to delay or undermine work that could be of great potential benefit to patients,” the report said.

The panel had one final criticism of DeepMind Health: its members would like to be paid for their work. Noting the “significant and complex workload” required to oversee the company, the report recommended the introduction of an honorarium for each member, paid in exchange for the time commitment, alongside an independent appointment process.

Doctors using Snapchat to send patient scans to each other, panel finds

Doctors are using Snapchat to send patient scans to each other, a panel of health and tech experts has found, concluding the “digital revolution has largely bypassed the NHS”.

Clinicians use camera apps to record particular details of patient information in a convenient format, the panel said in a report, describing it as “clearly an insecure, risky, and non-auditable way of operating, and cannot continue”.

It also notes that the NHS still holds the “dubious” title of the world’s largest purchaser of fax machines.

The report was commissioned by DeepMind Health (DMH), which is owned by Alphabet, the parent company of Google, for an annual independent review of the company’s work. DMH’s work involves introducing and testing new technology for the NHS.

This week the Information Commissioner’s Office (ICO) found that London’s Royal Free hospital failed to comply with the Data Protection Act when it handed over personal data of 1.6 million patients to DMH.

In its review, the panel, chaired by former Liberal Democrat MP Dr Julian Huppert, said: “The digital revolution has largely bypassed the NHS, which, in 2017, still retains the dubious title of being the world’s largest purchaser of fax machines.

“Many records are insecure, paper-based systems which are unwieldy and difficult to use. Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes.

“They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.

“It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue.”

The panel also features Richard Horton, editor-in-chief of the Lancet, the medical journal, Prof Donal O’Donoghue, a consultant renal physician at Salford Royal hospital and Matthew Taylor, the chief executive of the Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA).

The ICO ruling against the Royal Free hospital was related to its plans with DMH to create the healthcare app Streams, an alert, diagnosis and detection system for acute kidney injury. The ICO’s ruling was largely based on the fact that the app continued to undergo testing after patient data was transferred. Patients, it said, were not adequately informed that their data would be used as part of the test.

Doctors using Snapchat to send patient scans to each other, panel finds

Doctors are using Snapchat to send patient scans to each other, a panel of health and tech experts has found, concluding the “digital revolution has largely bypassed the NHS”.

Clinicians use camera apps to record particular details of patient information in a convenient format, the panel said in a report, describing it as “clearly an insecure, risky, and non-auditable way of operating, and cannot continue”.

It also notes that the NHS still holds the “dubious” title of the world’s largest purchaser of fax machines.

The report was commissioned by DeepMind Health (DMH), which is owned by Alphabet, the parent company of Google, for an annual independent review of the company’s work. DMH’s work involves introducing and testing new technology for the NHS.

This week the Information Commissioner’s Office (ICO) found that London’s Royal Free hospital failed to comply with the Data Protection Act when it handed over personal data of 1.6 million patients to DMH.

In its review, the panel, chaired by former Liberal Democrat MP Dr Julian Huppert, said: “The digital revolution has largely bypassed the NHS, which, in 2017, still retains the dubious title of being the world’s largest purchaser of fax machines.

“Many records are insecure, paper-based systems which are unwieldy and difficult to use.

“Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes.

“They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.

“It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue.”

The panel also features Richard Horton, editor-in-chief of the Lancet, the medical journal, Prof Donal O’Donoghue, a consultant renal physician at Salford Royal hospital and Matthew Taylor, the chief executive of the Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA).

The ICO ruling against the Royal Free hospital was related to its plans with DMH to create the healthcare app Streams, an alert, diagnosis and detection system for acute kidney injury. The ICO’s ruling was largely based on the fact that the app continued to undergo testing after patient data was transferred. Patients, it said, were not adequately informed that their data would be used as part of the test.

‘I cried every day at work’: mental health among doctors is still taboo

We asked Guardian readers to share their experience about a prevalent issue among Australia’s doctors and medical students alike: unrelenting pressure, inhumane working hours and brutal competition is driving health professionals to the brink of suicide. Readers report depression, anxiety, burnout and post traumatic stress disorder.

Our call-out revealed a toxic mix of a culture of bravado, antisocial shifts and the feeling of not being able to show weakness and fragility in a profession that is expected treat the most vulnerable members of our society.

‘At my lowest I cried every day at work because I was so snowed under’

Laura (not her real name) says she had her mental health concerns laughed at and leave denied when she raised her struggle with superiors.

“I didn’t have time for meal breaks. I developed an eating disorder and lost nearly 12kg in a year because that was the only aspect of my life I had any control over. There isn’t an out – you’ve worked at least 6+ years and there is so much pressure to be better than everyone else so you’ll be accepted onto a program.”

Now halfway through her specialist training, Laura is told to diversify and consider other options because there is a high possibility that once she finishes her (very expensive, stressful and time-consuming) training, there won’t be a consultant job for her at the end of it because of oversupply.

‘I did not feel like myself on the inside anymore’

Nancy experienced severe burnout while working as a fellow overseas. Exhausted from sleep deprivation and regularly serving 100 hour weeks, having to make critical decisions and doing procedures became increasingly difficult.

“The final straw came when I worked 17 days in a row including five 25-hour shifts. […] Never had I experienced such darkness and hopelessness. I found myself angry at the patients for being sick, and another night wishing that a sick patient would die so I could close my eyes for 10 minutes because I was so desperately tired.

“The only way I could think of escaping this was to quit my job and I felt if I didn’t quit my job I would go ‘crazy’”.

‘The root cause is not being looked at’

“Doctors are depressed because the shifts are antisocial,” says David.

“The training programs are taxing and take us away from our support base (family and friends). The senior doctors say, ‘This is what we’ve had to go through so stop complaining.’ It helps if we get a toilet break, I don’t care about a meal break anymore. There are things that make me feel worse: ‘You can’t hand over this patient until you do so and so. Thirty minutes after my finish time.”

‘Not being able to be on call goes right to the core of masculinity in medicine’

As acting medical superintendent in a small town in Queensland, Laura (not her real name) was the only doctor in town outside office hours. She was thrilled to be there and, despite her profound and constant fatigue, loved being able to use her skills to help people.

“In the last couple of years, due to complex workplace issues, I had taken up a mindfulness and meditation practice. This resulted in me paying much more attention to the sensations in my body.”

“I came to appreciate that when I was on call, what actually happened is that when the phone beside my bed rang, I leapt out of bed like a person possessed. I answered the phone, now fully alert and hypervigilant. I had chest pain, palpitations and nausea. I felt like vomiting.”

“So, when I realised this – thanks to my mindfulness practice, I suddenly had a new insight into why I found being on call so difficult, and so exhausting. If I was ever called, I just didn’t get back to sleep. My doctor decided I was not to be on call, and have told me that I should never be on call again. I’m not sure about that. I will see how I go.”

‘Having a good GP, and psychologists help’

“Also having a strong family and friendship group, and a loyal colleague or two. Also a knowledge of industrial psychology.

“Finally a union whose delegates have seen this before, and even some legal advice that recognises what is going on. Breaks by the seaside and with my family, friends, ie outside the medical culture can nurture the soul. Exercise and having a pet, and a creative outlet helped too.”

‘A fundamental change in the way Australians deal with doctors’ is needed

“Doing medicine remains unquestionably the worst decision I have ever made. It has brought me nothing but anger, frustration and sadness.”

Mike, a junior doctor in Queensland also says that for things to improve, “a fundamental change in the way Australians deal with doctors” is needed.

“I have been hit, abused, screamed at, threatened with murder. I am frequently filmed by patients or their family ‘just in case’. I’m looking to leave the profession as quickly as possible.”

‘I am able to choose how much or how little I work and I have found a balance’

Greta developed an eating disorder, depression and anxiety. Having regular visits with her own doctor and taking medication helped.

“A couple of people know a little bit about my issues but not the details, so have given support on the handful of times I have needed it. I have healthy boundaries with my patients and don’t take work home with me. If I find myself thinking about work too much in my own time, I know that there is an issue I need to confront.

She now makes sure to have lunch and to exercise every day. Learning over many years to recognise her triggers and early signs of exacerbations have also helped to stop it progressing.

“It has taken many years to get to this point.”

‘I felt completely unable to reveal my distress and emerging depression’

“Medicine would be transformed if doctors were able to admit freely to vulnerabilities, fears and failings. Yet no one does, despite the terrible costs. If even one of my peers had taken me aside and encouraged me to seek help, or even just let me know they were concerned and cared for me, I might have been able to halt the march of my depression before it became utterly devastating.”

The prevailing culture of medicine measures success as working excessive hours, encouraging intense competition between peers from the very outset of training.

“In my dual role as doctor and patient I feel the obligation to speak out about the terrible burden of mental illness within medicine. However, I remain to be convinced that this will truly change anything and have so far chosen to remain silent rather than risk my colleagues’ judgement and possible derision.”

‘The stigma of mental injury … allows institutional abdication of responsibility that needs to change’

Adequate staffing, honest appraisal of the workload, reallocation of tasks, proper debriefing – these are some of the solutions junior doctor Carly (not her real name) suggests. But what’s needed above all, she says, is a “narrative shift from personal to institutional responsibility. Even when colleagues and bosses are sympathetic to someone managing mental illness, I have observed that the onus remains on the individual to find a solution and make themselves well enough to work.

“This is despite the fact that in many cases our working environment has contributed to our illness. There needs to be more meaningful concessions by hospitals to shared responsibility, just as with other OH&S issues.

“When I reported my depression to my employer, I was told that I was not the first person to have become unwell working in that unit. This was meant kindly (‘It’s not you; it’s the job’) but on reflection I realised this meant my employer was knowingly subjecting staff to an unsafe working environment, without protective measures or even warnings.”

‘The AMA and health department’s stance on zero tolerance to bullying in medicine is trite’

The husband of one doctor says that everyone knew the truth about the bullying happening to his wife but through their silence condoned it.

“We know now that these senior people actively colluded with the antagonists. Until this is resolved nothing will change.”