The Sleep Rule

It’s what I base my practice on. It’s really important. It works for patients and doctors (and everyone else). And I made it up (with a bit of help).

“If anyone will sleep better having taken the next step in treatment, then that is all the justification needed for taking that step.”

“You know, Charlie,” my friend and work colleague, Simon, said as we walked down the corridor of the busy London hospital we were both working as junior paediatric doctors in, “our job is really to make sure people sleep well at night. I mean, our daytime work is all about trying to ensure no-one gets called overnight.”

He was right: A junior doctor’s job is to, amongst other things, ensure the ward work is done, ensure plans are in place for any eventuality that may happen overnight and ensure tests that need to be done are done and documented. If these things weren’t done during the day, then they’d have to be done overnight when they were suddenly needed, and that is what Simon, tired as he was from a night on-call, had found out to his cost over the previous 12 hours. I took his theory further. It wasn’t only about making sure the jobs were done, it was about making sure everyone was happy with the plan. If people were happy that things were going ok, and that they knew what would be done if events too a sudden unexpected turn, they would be less likely to need help overnight. And we’d all sleep better.

This was a big deal: as a junior doctor, quality of life could be measured in hours of sleep achieved.

A year or so later I entered GPland. The change from the supportive camaraderie of hospital to working in a room on your own in a GP surgery is daunting and quite scary when it happens. All of a sudden you are the only one making the decision about whether or not to send someone to hospital or to a specialist, and you have no quick access to tests to support your call. Asking for help takes time, and no-one wants to waste the time of a patient or hospital doctor by taking unnecessary steps. It causes sleepless nights – did that person have muscular chest pain as you thought? (or was it a heart attack?), did that child have a virus? (or should you have given antibiotics?), is that tummy ache a nothing or a something?

Then I remembered Simon’s words. It’s all about the sleep. That’s what I would focus on to gauge what to do. I would operate to maintain my sleep quality. I took it further: It’s not just my sleep that matters, it’s everyone’s. It’s the patient’s (do they feel well enough to get a good night’s sleep?), it’s the carer’s (are they lying awake worrying?), it’s the hospital doctor (avoid a night time crisis – let them sleep).

It works. Sometimes in medicine a plan is obvious, but sometimes it is less clear. Whenever I am unsure if taking a step further (be that ordering a test, or referring to a specialist, or picking up the phone for some advice, or sending someone straight to emergency) is the right thing to do, I think of the Sleep Rule.

I encourage everyone else to do the same. If you are unsure if you or your loved-one needs to see a doctor, refer to the sleep rule. If you, or anyone else will sleep better as a result of seeing someone then that is all the justification you need.

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