Everyone in medicine knows. Fatigue increases the risk of error.
So it is not a question of working harder.
The challenge is to figure out how to expand the system without further exhausting the same people.
This is the real question facing the health system today.
Population is growing. Patient time is decreasing. People are finding it difficult to find appointments.
But the real jam is in the operating room.
Lists are getting longer. There are not enough operating days. Some patients wait for months.
It is not just a question of organization. It is a question of capacity.
And there is a clear contradiction.
On the one hand, there are surgeries that cannot be completed, and on the other hand, the number of assistants has increased.
So there is manpower. But there is no time.
That is why we need to ask the question.
Can we expand time
That's why we talk about the night.
“The question ”Can surgery be performed at night" is actually asked from the wrong place. Because it already happens. In emergencies, in trauma, we operate at night to save lives.
So it's not about the night.
The question is how we use the night.
This debate is not new in the world. Operating room hours are being extended in many countries. In some centers within the NHS, surgeries have been shifted to evening blocks. In the US, there are hospitals working with planned night teams. But they all have this in common. They do not extend the night, they redesign the night.
Because the clock is not the source of risk.
Fatigue.
Overnight surgery with a team that has worked all day is risky.
But surgery is not the same as a rested team that is only on duty for the night.
In medicine, safety is a system, not a clock.
What is critical here is this.
Not every surgery is performed at night.
Cases with a predictable duration and manageable risk of complications are moved to overnight. This is not a gap-filling approach. On the contrary, it is a more selective, more disciplined approach.
But will the patient accept it?
Two things are decisive for a patient. Waiting time and trust.
When faced with the choice between waiting for months or having surgery earlier in a planned system, most people choose the latter. But there is a condition.
Transparency.
The patient should know that surgery is scheduled for the night. An alternative should be offered. The right to choose must be protected.
This is how trust is built.
If this model is set up correctly, three outcomes emerge.
Waiting times are shortened. The burden on the day is reduced. Education is strengthened.
The education part is perhaps the most critical.
Today, the number of residents has increased, but the opportunities for surgery have not increased at the same rate. More people are trying to receive training with fewer cases.
This is not sustainable.
Planned night operations open a controlled and teachable space. There is no rush, no jamming. The possibility to teach increases.
But let's be clear here.
This is not an easy task.
The team working at night must be really rested. This team should not be an extension of the day.
Case selection must be clear.
The senior surgeon should be in the field.
Anesthesia, nursing, technical team should be established with the same discipline.
And the process must be measured.
Complication rates, operation times, patient satisfaction should be monitored regularly.
Another critical issue is incentives.
This system will not work if the team working at night is seen as a leftover from the day. It should be planned separately, the compensation should be clear. This can be an additional payment or a different model, but if the return for labor is left uncertain, the system will collapse.
It is also necessary to draw a line.
The aim is not to empty the day and move everything into the night.
The aim is to expand the system enough to give it breathing space.
This is why this model cannot be applied everywhere at once.
Start in selected centers. Results are monitored. Errors are seen. The system is corrected accordingly.
The most dangerous thing in medicine is unplanned growth.
But not growing at all is equally dangerous.
Today the picture is clear.
If the number of patients has increased, the need for surgery has increased, the manpower has increased, the system's time has to increase.
That's why the night shift is not a choice.
An opportunity about to become an obligation.
Health systems do two things when demand increases.
Either he keeps the patient waiting.
Either it expands time.
It is easy to keep it waiting.
Expanding it requires wisdom.