Dr Brett Says: I don't know how they expect anyone to function properly on no sleep and six cups of coffee. I certainly wouldn't want that person treating me! Caffiene may help to improve alertness in the short term but longer term repeated use with limited sleep would severely impact on the health and judgement of these doctors.

 From News.com.au

SIX cups of coffee - that's the State Government antidote to sleep-deprived doctors killing and harming their patients in a haze of exhaustion.

The astonishing remedy forms part of Queensland Health's new doctor fatigue policy, currently being rolled out in public hospitals, The Courier-Mail reports.

The Courier-Mail yesterday reported the confessions of junior surgeons and medics whose exhaustion-induced errors had killed or hurt patients during "on-call" shifts of 30 to 80 hours.

But a guidelines document underpinning QH's Fatigue Risk Management System claims "solutions such as 'we need more staff' might not be achievable or effective in managing a fatigue risk."

Instead, the 102-page document deems the "strategic use of caffeine . . . to be beneficial" as a fatigue fighter for doctors on marathon duties.

"The recommended dosage for a prolonged and significant reduction in sleepiness during a night without sleep has been suggested at 400mg of caffeine . . . equivalent to about five to six cups of coffee," the document states.

As this coffee intake is "not always feasible or realistic", QH proposes caffeine tablets as an alternative. Energy drinks also are recommended.

"Compared with other psychoactive drugs, for example, modafinil (a prescription-only narcolepsy treatment), caffeine is supported in its use as it is more readily available and less expensive," the document says.

World-renowned addictions physician John Saunders slammed the advice, saying it would turn doctors into addicts.

He said caffeine addiction became clinically significant at 600mg a day.

But some people would be addicted, or on the threshold of dependence, at 400mg daily.

"They're suggesting 400mg is a perfectly fine dose? I would absolutely dispute that," said Professor Saunders, the Pine Rivers Private Hospital alcohol and drug program director.

"For a health department to suggest that doctors use caffeine like this is the height of irresponsibility."

Prof Saunders said acute effects of 400mg of caffeine a day were heart palpitations, raised blood pressure, dizziness, anxiety and hand tremors.

Doctors caught between caffeine fixes might suffer serious withdrawal consequences.

"These will include headache, depressed mood, blurred vision and maybe some degree of confused thinking," Prof Saunders said.

He said the spectrum of side-effects could mean a doctor hooked on caffeine posed a greater threat than a tired colleague who did not use the substance.

"I think it certainly could lead doctors to make potentially bad decisions when they are managing patients," Prof Saunders said.

Organisations Systems Professor Peter Smith said fostering caffeine use among doctors was "inappropriate".

"It would seem to me to be a strange way of managing long-term fatigue," Prof Smith, of Central Queensland University, said. "(Queensland Health) might be aware that nicotine enhances alertness but they probably wouldn't be promoting that. It's the same with amphetamines."

The $3.6 million FRMS is a key plank of QH human resources policy, aiming to drop the risk of patient harm from doctor fatigue to "as low as reasonably practicable".

Its overarching framework involves a suite of fatigue-reduction modules, strategies, education programs and auditing measures.

Each hospital is directed to use the guidelines document, or "resource pack," to help tailor a site-specific plan.

More than three pages of the document are dedicated to the case for caffeine in an appendix titled "Fatigue Countermeasures".

The central nervous system stimulant is extolled for "increasing alertness, sustaining wakefulness and delaying sleep onset".

"Caffeine use has been associated with (an) increase in cognitive performance such as sustained vigilance, reaction time, memory and mood."