In shift workers, a maladaptation syndrome has been described, characterized by chronic sleep disturbance and waking fatigue, gastrointestinal symptoms, alcohol or drug misuse or abuse, higher accident or near-miss rates, depression, malaise or personality changes, and difficult interpersonal relationships. 3 Most of the research applicable to physicians is focussed on hospital interns, residents and house officers. Asken and Raham 4 and Samkoff and Jacques 5 have reviewed this research. Surveys of residents' moods and attitudes demonstrated deleterious effects of sleep deprivation and fatigue, including decreased work efficiency and poor relationships with patients. Psychological testing has revealed that mood disturbances such as anger and depression are negatively correlated with the amount of sleep.
Studies are scarce on the effects of being on call from home.
One study comparing 2 similar groups of French utility supervisors, half of whom were on call 24 hours a day for 1 week every 2 to 5 weeks showed the on-call group to be less socially active and to have significantly lower scores on Global Well Being and Psychological Equilibrium indices. In this small study group there was a trend for those more frequently on call to have lower scores than those less frequently on call. Existing guidelines for other occupations Pilots flying aircraft with crews of 2 or more are limited to a maximum flying period of 9 to 14 hours. With rest periods, this can be extended to 18 hours. Crew members must not work more than 7 consecutive days and should have 2 consecutive days off in any consecutive 14 days, a minimum of 6 days off in any consecutive 4 weeks of work.