Doctors know they put patients at risk when they're overworked and sleep deprived.

"When you’re tired you make mistakes. Your work gets sloppy. You can’t concentrate and you make careless errors. You don’t take a second look or stop to think twice about what you’re doing. And you can’t decide between important and less important symptoms. You misinterpret lab results. You just do things you ordinarily wouldn’t do if you weren’t so exhausted. But every doctor knows this." -- Dr. Martin Hirschler, hospital physician in Bramsche, Germany.

Sleep deprivation among doctors is extremely common, says Dr. Ingo Fietze, director of the Center for Sleep Research at the Charité University Clinic in Berlin.

"Not only the doctor, but above all the patient is at risk", Fr. Fietze says. "The safety of the patient should be our top priority. A tired doctor makes mistakes, overseas important details for an accurate diagnosis, or is inattentive during an operation. The evaluation of an EKG with a heart murmur, for example, can be easily misinterpreted."

But overworked doctors are nothing new. Twenty years ago the situation was just as bad, if not worse, says Dr. K, a retired hospital physician with a private practice in Cologne. The hospitals are short on cash and the government is not willing to give them more, so they put pressure on their doctors, especially the young ones, to put in extra hours.

When asked to describe the situation in the hospitals, Ali K. says young doctors often feel "black-mailed" to work longer hours. If they don’t put in 14 to 18 hour shifts, they’ll be overlooked when it comes to filling permanent positions at the hospital or assigning research grants.

Dr. Hirschler says that the work load is especially tough for doctors in training. "They’re putting in so many hours that they don’t have time to keep up with their studies. There’s no time to read, no time to consult with a senior doctor or stand in on an operation, or catch up on the latest developments in research. But that applies to all doctors as well. The learning factor is practically zero," he says.

Regulating the work week

In his website on sleep disorders, Dr. Fietze appeals to the medical community to reduce the number of hours doctors are forced to work. He suggests regulating the work week to a maximum of 12 hours per shift, followed by 16 hours rest time, limiting the number of night shifts, and allowing at least 24 hours between a change in shift schedules.

Dr. Fietze’s suggestions sound good, both for the doctor and the patient. But, as Dr. K. from Cologne says, doctors are not your run-of-the-mill workers. Their employment conditions don’t correspond to the normal labor practices of a 38-hour week as is the case in most German businesses. Germany’s labor law does not apply to medicine.

And there aren’t too many doctors who would simply put down their scalpel at 5:00 when their shift is over.

Dr. Hirschler told DW-WORLD why a 40-hour work week is impossible in medicine: "If I were to only put in a 40-hour week, a lot of work just would not get done. I’d have less time to talk to the patient, evaluate lab results, read up on treatment methods.... In the end cutting down my work week would mean that the patient does not receive the care and attention he or she deserves. And I wouldn’t be a good doctor any more."

In an interview with WDR television, Professor Jörg-Dietrich Hoppe, president of the doctors' organization Nordrhein, said that the pressure to rationalize personnel costs in hospitals puts a heavy burden on doctors. At the end of the day "there's hardly enough time for patient-doctor visits", he says.

Read more about how doctors plan to improve their situation in Part 3: Operation Healthcare