Why are docs still working such long hours??

tallaght01

I'm lucky. I trained in the UK, and worked there for most of my career. I also worked in New Zealand, and was on a straightforward shift system, where 14 hours was the most I ever worked continuously.

I know the Irish docs are still working up to 72 hours on the trot (I think).

In Oz at the moment, in a large tertiary centre, so we're usually well staffed. but, I'm covering in a rural hospital for a while, as they have no staff. So I'm doing 24 hour on-calls. Did one on saturday and monday. On saturday i ended working 25 hours on my own with only a very brief break (20 minutes). Went home to bed on sunday. Then I went back into work on monday morning. Worked 8.30am monday until 2am the following morning. Then went to bed until 5am, when I was called back into the ward until 8.30am.

I know this is tame compared to what the irish docs are doing, but why on earth is it still happening. I'm totally banjoed writing this, as I've just left the hospital.

Are there any other professions that do this? Or are we the only ones dumb enough to put up with it?

Some people think it's a good thing, as they want as much experience as possible before they become consultants. Anyone agree with that way of thinking? Personally, I value my free time over work any day.

PS: regardless of 24 hours, Oz still kicks the arse of the NHS in terms of places I'd rather work

ronbyrne2005

I thought I'd like to have done medicine but glad I did'nt. AFAIK on mainland Europe hours are not crazy like here in Ireland. Even if you had regular hours like 6 months of 7pm to 7am six days a week you could arrange your life around it but all these irregular hours and being on-call seems to mean young doctors and overstretched ER consultants seem to sacrifice the rest of their life for medicine.
In this day and age I don't see how it could'nt be better organised and give doctors more regular hours and proper rest. You can't take in all this "experience" if you are too tired and not getting enough sleep to process and store these new experiences.

Chunky Monkey

Overheard a reg yesterday saying to some relatives that he would be on for the rest of the day and all night. Considering I'd seen him on the ward several times since early that morning I'm assuming he was doing at least twenty four hours :eek:

Was talking to an intern before christmas on a Friday night at about nine. He told me he had worked 97 hours so far that week.

Tis a bit mad all right.

thecheese

I remember last year being rushed into A&E resus. at around 6 in the evening. After I was stabilized, I was discussing the history of my condition with a doctor (2 years out of trinity so guessing he was a junior doctor). Anyway, next day at around half 11 in the morning there was a slight emergency involving me, and lo and behold the same doctor arrives on the scene (along with several others..)

I was in shock, nearly 18 hours later and he was still there and thats presuming I was the first and last patient of his shift! :O

Are doctors expected to maintain these hours throughout their careers? Or is it just a case that they throw the younger and less experienced doctors in at the deep end and see how well they cope?

Chunky Monkey

I always thought it was just interns and SHOs who did those hours but ^ looks like regs do too.

tallaght01

A lot of registrars do those hours too. Some consultants also do, too.

My neonatal consultants in the UK used to do a hell of a lot of hours. There were 5 of them in a huge centre that was always really busy. between them they alternated doing 1 day in 5. On their on-call dya they would come in at 8am, and stay until midnight. Then they would go home and be on-call from there until 8am the following morning. About 50% of the time they would be called in from home at some point during the night. Then they would work a normal 8.30-5pm shift the next day.

When they did a weekend, they would work friday, saturday,sunday 8am-midnight, and then come in during the night as required. 2 of them were in their 60s, so it doesn't always become cushy when you're a consultant.

Paeds is particularly like this. It attracts people who are obsessional. they say most of us have a touch of asbergers

I can feel myself heading that way alright, so happy to be leaving in the next year or 2 for the world of public health

donaghs

Going back to the OPs question, why are the hours so long? I presume because there aren't enough trained staff, or the HSE won't hire more and rejig the rotas?

I get the impression that there's also a certain pride in working insane hours.

eth0_

Plenty of doctors floating about but I think there's a hiring freeze in the HSE atm.

Isn't the working time directive due to be strictly enforced sometime this year?

Chunky Monkey

'Strictly' enforced? Apparently the 56 hour week is being strictly enforced in the UK atm...in terms of wages. Lot of doctors working more than that though.

nesf

It allows us to stress test young interns to see if they can handle being pushed beyond the normal limits of endurance? I'm mostly joking but there is a (very small) amount of sense in doing this early on to weed out the weaker people but even then I'm not sure it's even remotely justifiable.


It could be a chicken and egg problem. People are willing to put with these conditions as a junior doctor to get a chance at being a consultant (or help people or whatever reason they justify it) so the managers have no incentive to spend more money (which is what it would take if there wasn't a reduction in salaries most likely) to hire more people to make the hours more tolerable. Somewhat similar (but far harsher) to the situation with the pitiful wage many people are paid at the start of their apprenticeships, accountancy training etc except that instead of the money being crap the hours are crap.

Red Hand

Wouldn't someone who has been up for 25 hours straight working, be more likely to make a mistake?

nesf

Jeremiah 16:1 wrote: »

Wouldn't someone who has been up for 25 hours straight working, be more likely to make a mistake?

I found this study interesting but I've no idea of the broader literature so don't take my word on it.

In a revealing sleep study published in the September 2005 issue of the Journal of the American Medical Association, Judith Owens, MD, and her team of researchers from Hasbro Children's Hospital in Providence, Rhode Island, followed 34 pediatric residents from Brown University over the course of 2 years to compare post-call performance to performance after drinking alcohol. During this time, the residents were tested under light call (1 month of daytime duty with no overnight shift, or about 44 hours of work per week) and heavy call (overnight duty every fourth night with an average of 90 hours of work a week). The residents performed computer tasks to gauge their attention and judgment after their light call (after consuming alcohol) and heavy call shifts (with placebo). The residents who were on heavy call and had not ingested alcohol performed worse on the computer tests than those doctors who had taken alcohol and were on light call. Dr. Owens concluded that the residents were so sleep-deprived that they didn't recognize that their own judgment was impaired.

Source: http://www.pendulum.org/bpnews/archive/001857.html

Red Hand

So, its better to get a drunk "underworked" doctor than a sleep deprived sober hard worker?:)

It sort of confirms what I've heard...there are all these road awareness campaigns to tell people that being sleep deprived is as bad as being drunk.

sam34

worst shift i ever did was as an intern - i went into work at 9am on a saturday morning and worked until 5pm on monday, with only 1hr 15 mins sleep in all that time (and that was in 2 stretches). i will never forget it. i was like a zombie by the end of it. i was at home about ten mins when those cursed jehovahs called to the door and asked if they could come in. i politely replied no. they asked why not- at which stage i had had enough! i burst into tears and started wailing about having one hours sleep since saturday...i ended up speaking in a pitch that only dogs could hear.... those jehovahs never came back!

Red Hand

sam34 wrote: »

...at which stage i had had enough! i burst into tears and started wailing about having one hours sleep since saturday...i ended up speaking in a pitch that only dogs could hear.... those jehovahs never came back!

Haha, that made me laugh!:pac:

Traumadoc

Similar thing happened to me after an overnight shift in OZ, I asked the JWs would they not consider joining the one true holy apostolic church.
Very effective.

I also found inviting the mormons in for a beer was equally effective.

BTW my record was 147 hours in a week ( in the days of half time over 65 hours)

Dr Galen

i've written about this both here and on the blog.......its truly appalling, but in my opinion I think there is a general ignorance out there about the hours. If Doctors made a big deal about it, the public would find out and things might change. That in itself may also be a bad thing as Dr's may find their judgement being questioned by patients etc and i'd not be too sure how this may lead to a knock on effect in terms of competancy and regulatory matters.

I know that nurses have a regulatory obligation, not to work when under any influence that might effect their working standards. In fact we're actively encouraged by both the regulatory body and the unions to do this. I know of cases were nurses have been disciplined by the nursing board for not doing this. Are Dr's not regulated in the same way?

Chunky Monkey

It's not perfect for nurses either though, what do you think mystik?

A week of nights for instance, I think that's a bit much, especially considering how physically hard the job can sometimes be, heavy patients wetting the bed etc.

We aren't allowed to work more than eight shifts in a row with the agency but I wouldn't do more than five.

147 hours in one week??? Have ye been given a reason for these hours? The 'weeding out the weaker ones' is a bit of strange excuse, why does it have to be an endurance test.

I've heard the 'continuity of care' excuse but wouldn't a proper handover ensure that?

nesf

Chunky Monkey wrote: »

The 'weeding out the weaker ones' is a bit of strange excuse, why does it have to be an endurance test.

Well if you want to think of it as a series of tests, it one of many potential and present doctors go though. The academic challenges of college, the high workload of monotonous memorisation and learning etc etc.

I'm not saying it's a good way to do it or that that's the reason for it, just that it's possible to look at it in this way to some extent. Being a doctor, varying across sub-disciplines and general practice versus hospital work etc, is possibly one of the toughest and demanding jobs when you combine both the amount of stress and pressure involved with the huge gravity and responsibility of the some of the tasks taken. There are physically much tougher and mentally more stressful jobs out there but jobs that place the kind of responsibility that doctors have to shoulder are very rare. Arguably, considering the job, doctors need to be tested very hard early on to try and leave a population of tough bright people who can work well when they need to on little rest and recuperation, similar to some branches of the army forces. And similar to the army, pushing too hard can break too many people making it utterly pointless and losing you too many potentially good people.

I don't think it's right or justified, but I can kind of see some point in it. I also think that junior doctors are being ****ed over in terms of the amount of hours that they do, but that's a different side of it.

Traumadoc

Chunky Monkey wrote: »

147 hours in one week??? Have ye been given a reason for these hours? The 'weeding out the weaker ones' is a bit of strange excuse, why does it have to be an endurance test.

I was one of 4 registrars , the others were away so I had to pick up the hours. I don't think of it as an endurance test just the realities of the system. The usual working week was only 80 hours.
However I still have a strong aversion to that hospital.

Dr Galen

Chunky Monkey wrote: »

It's not perfect for nurses either though, what do you think mystik?

A week of nights for instance, I think that's a bit much, especially considering how physically hard the job can sometimes be, heavy patients wetting the bed etc.

We aren't allowed to work more than eight shifts in a row with the agency but I wouldn't do more than five.

147 hours in one week??? Have ye been given a reason for these hours? The 'weeding out the weaker ones' is a bit of strange excuse, why does it have to be an endurance test.

I've heard the 'continuity of care' excuse but wouldn't a proper handover ensure that?

oh i'd agree, its certainly no walk in the park for nurses either, but Dr's hours are in an entirely different league altogether. We have laws that forbid animals in a circus or hprses being worked as much!!! :mad:

unfortunately its the system we operate, and it will take a radical overhaul to change it, and tbh I'm not sure if the will exists within the medical profession to do much about it other than talk. Any of my mates, Registrars and below would tell ya that you simply don't want to be rocking the boat. Remember its all about getting the next job up the ladder, and it can be pretty cutthroat at times, so no one wants be labelled a troublemaker. Very much the same in nursing I'd have to say, unfortunately for me, I don't give a fcuk about the politics and have pissed off quite a few of the honchos in my own hospital, so the chances of me ever getting a management position (even if I ever wanted one) is slight. Fcuk em though I say, I'm gonna win huge money on the Euromillions or di!scover I was illegimately sired by Bill Gates and build my own hospital!!