Why Radiologists Shouldn’t Work Overnight

Working overnight shifts (ONS) is an unwritten part of a radiologist’s job description. However, burning the midnight oil only leads radiologists to make more diagnostic errors. In a recent study published in the Journal of the American College of Radiology, researchers at Emory University looked at the repercussions of ONS, and how physical and mental exhaustion influences image reading practices.

In the study, researchers evaluated five faculty radiologists’ and seven residents’ overall mental and emotional wellbeing post a “normal workday” and after ONS. They performed a Swedish Occupational Fatigue Inventory (SOFI) survey and had the radiologists examine 20 bone radiographs. They also set up advanced eye-tracking technology while they physicians were at their workstations.

The researchers found that after ONS, radiologists were impacted in five negative ways: “lack of energy, physical exertion, physical discomfort, lack of motivation and sleepiness.” They also discovered that exhausted radiologists gave more inaccurate diagnosis. During a normal workday, the study participants made a total of 56 false negatives and four false positives. However, the inaccuracy rates were worse during ONS: 72 false negatives and 7 false positives. The fatigued radiologists also spent more time reading images than those who worked during the day. Specifically, the researchers indicate there was a 45 percent increase in view time per ONS case.

Hopefully, these findings could change the way we manage physician exhaustion and clinical expectations. “Despite this 45-percent increase in time per study, the diagnostic accuracy of our subjects decreased,” write the authors. “However, in a real-world reading room setting, radiologists may be forced to continue reading at a quicker pace despite fatigue. We theorize that this could further decrease diagnostic accuracy. This is an area for further investigation.”