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Author Topic: Are doctors hours a danger to patients??  (Read 1599 times)

Offline Variola

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Are doctors hours a danger to patients??
« on: 31/07/2009 11:06:34 »

Mr John Black, president of the Royal College of Surgeons

The European Working Time Directive was designed for the wellbeing of manual industrial workers and lorry drivers. Other workers such as those on oil rigs and in domestic service are not covered. Yet doctors are bound by it. For some medical groups this is not an issue because they can work 48 hours a week comfortably — GPs who are not on call, for example.

But surgeons have to do both elective surgery and have an out-of-hours responsibility for emergency surgery. In accident and emergency centres (A&E) the work is intensive, 24 hours a day and doctors need to work shifts. There are not enough doctors to work a 48-hour week.

Out-of-hours operations are urgent cases and you need to have senior people instantly available. Whereas you might have had a team of three in the past, now you might have just one doctor having to work frantically. The patient sees thin layers of cover and frequent handovers between doctors.

Handing over a patient is complicated. Patients get confused and frightened because they have to repeat their stories. This is dangerous — as was demonstrated in Mid Staffordshire where there was only one doctor working for 12 hours with a consultant covering from home. Another inquiry into post-operative deaths for renal failure found the directive was implicated in half the cases. High frequency handovers and rushed doctors on exhausting shift systems are real risks to patient safety — far more than the total number of hours worked. There is no credible evidence that a 48-hour limit offers any benefit.

Another EU directive states that when you are in the hospital you are in work. When it is quiet, doctors are often resting or asleep. But if you sleep for eight hours it is counted as “work”.

The directive will be a disaster for training. Surgery is a craft. When training you need to be shown procedures and carry them out under close supervision for a large number of operations. Under the directive, most junior doctors’ hours are used to provide out-of-hours calls. We heard about one trainee who in one four-week period had just one session with a consultant.

In America they have had the same debate and decided on 80 hours. We think 60-65 hours (including time spent on-call) is workable with fewer handovers and it is much safer for patients. The Government could negotiate an “opt-out” or choose to ignore the directive as many other European countries have. Many EU directives have been broken in the financial sector, eg, nationalising the banks. If they can do it to save the economy, why not the NHS? It is better that doctors opt out as a group. NHS Trusts do not like individuals opting out. They cannot organise rotas unless everyone works the same hours.

If there is a swine flu epidemic the directive will cause mayhem. Beds will be needed, operations will be delayed and the extra hours that doctors need to work will have to be paid back later, closing down large areas of the NHS.


Dr John Coakley, medical director at the Homerton Hospital in London

When my father was training as a doctor he used to work 120 hours a week. Most of my training was 72-84 hours a week and he thought I was getting an easy life. Now my son is a doctor and I think he is getting an easy life. The hours are being whittled down as expectations change. This is a good thing for work-life balance.

For a junior doctor at the start of his or her career, the new directive is good, but senior doctors have a tendency to look down and say “these young doctors are not getting enough training”.

Working too much is bad for anyone. If a surgeon has worked for more than 12 hours I do not want him operating on me. Doctors are no different to lorry drivers. They have the same body clocks: they are dangerous when tired. There have been several deaths attributed to tired doctors. Working a 48-hour week with limited shift lengths is safer for the doctor, which means less harm to patients.

The directive doesn’t apply to senior executives but is there to protect employees. Typically junior doctors have no control over their work. Consultants are capable of putting pressure on juniors to work excessive hours. A lot of the time I spent doing an 80-hour week I was in bed in the hospital. As a taxpayer I don’t want to pay a doctor to lie in bed on the off chance they might be called. They can go home and be called in as necessary. Again a better work-life balance.

Long hours do not deliver better training or experience. When I was training I did the occasional 100-hour week, but most was not in the presence of the consultant. We were hanging around for long hours picking up experience as we went, with very little senior support. With the right system you should be able to deliver good training in a shorter working week.

We cannot carry on doing things as we used to. At Homerton we have changed the way we deliver training and emergency admissions in preparation for the new rules, by allowing junior doctors to spend four and a half months doing their speciality with no on-call, weekends or emergency admissions — only training. They then spend six weeks doing only emergency admissions. Training has improved and our mortality rate has gone down.

Handovers have been with us since 2003 when the maximum shift length was set at 13 hours. The key is to supervise them properly. If you look at the directive as employing more doctors to plug the rota gaps you will fail. It will lead to huge financial overspend and poor training.

The 48-hour week is averaged out over six months. If there is a particular night you stay longer because something interesting happens or you want to learn something that is fine.

Most of Europe does less than a 48-hour week. These are health and safety rules for protecting employees. Doctors are human beings, therefore they should be subject to the same rules as everyone else.

So what do we all think???

I have a friend who is on surgical rotation at the moment, and I have been stunned at the lack of support/supervision he said he has had at times, when he has mentioned it to the registrar, it's met with a shrug of the shoulders and a mumble thats its the way things are.


Offline Make it Lady

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Are doctors hours a danger to patients??
« Reply #1 on: 31/07/2009 14:50:52 »
I had a student doctor for my pre-op. He hadn't got a clue and gave the wrong answers to a lot of my questions. I signed the patient consent form without being given the correct information about the possible side effects of the operation which included facial paralysis. I was finally told these things one hour before I was due to go down on the trolley. I then had the urge to run out of the hospital screaming.

Offline Karen W.

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Are doctors hours a danger to patients??
« Reply #2 on: 02/08/2009 08:17:42 »
Thats scary!

Offline LeeE

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Are doctors hours a danger to patients??
« Reply #3 on: 02/08/2009 13:47:21 »
Those two arguments seem rather confused to me but...

A lot of the time I spent doing an 80-hour week I was in bed in the hospital. As a taxpayer I don’t want to pay a doctor to lie in bed on the off chance they might be called

really seems to sum it all up.

If a doctor who is on-call doesn't need to get up and do some work then it's actually a good thing; it means that no one is in danger of dying.  The sentiment expressed above ignores the whole point of providing cover, the point of which is to provide for unforeseen events.  It is that of someone who thinks that, having paid for insurance, thinks that they should be able to claim their payments back if they don't need to make a claim.

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Are doctors hours a danger to patients??
« Reply #3 on: 02/08/2009 13:47:21 »


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