Back in the EU courts again: Junior Doctors hours

MadsL

Is there any issue that any Irish government of any persuasion can deal without the threat of fines from the EU courts?

Govt is pleading that it will take three years to get Junior doctors working less than the current 100 hour weeks and under the EU 48hr threshold, and that they have been going backwards against reaching targets...

http://www.rte.ie/news/av/2012/0116/media-3169514.html#

Or do we want hospital doctors on 36 hr shifts?

MODS: is this Politics or Irish Economy? - not sure....

later12

MadsL wrote: »

Or do we want hospital doctors on 36 hr shifts?

I think that's a little misleading. I just watched the report,and it suggests that significant progress has been made in terms of breaks and rest periods.

I understand that the situation must be trying for many individuals within the health service, which is presumably why the thing was leaked, but I don't really see what sort of valid alternative there is.

The question of how the Irish government ought to respond to the 2004 European Working Time Directive is in this context actually more of a legal question than one of ethics or, as far as I can see, public safety. Just because the European Commission says that we ought to follow a certain procedure, it is not a given that not following that procedure is inherently bad. It's merely against the Commission's rules.

Perhaps this question would be better answered if we knew whether there is real risk to patients in light of junior hospital doctor's working hours, and what the financial cost of reaching the 48 hour target would be to the exchequer.

Saying it's simply against the Commission's rules is of questionable relevance in itself.

Cookie_Monster

Now that you have legal backing though why would you, as a junior doctor, allow them to make you work more than 48 hours a week now anyway? I'd be having none of it...

opinion guy

MadsL wrote: »

Or do we want hospital doctors on 36 hr shifts?

MODS: is this Politics or Irish Economy? - not sure....

I don't want the guy flipping my burgers working 36hours lest my special sauce turns out to be cillit bang instead of whatever its supposed to be, never mind my doctor

later10 wrote: »

Perhaps this question would be better answered if we knew whether there is real risk to patients in light of junior hospital doctor's working hours,

Is this a serious question ? Stay awake all night and see how good you are at your job the next day.
It documented in the UK that the odss of dying on the wekend are higher - and they DON't work 60hours in a row (which many doctors in Irish hospitals do over weekends:
http://www.bbc.co.uk/news/health-15915874

later12

opinion guy wrote: »

Is this a serious question ? Stay awake all night and see how good you are at your job the next day.

Like I said:

later10 wrote: »

I just watched the report,and it suggests that significant progress has been made in terms of breaks and rest periods.

It documented in the UK that the odss of dying on the wekend are higher

Oh come now, at first glance there are lots of possible explanations for that: less diagnostic work being available (as was mentioned in your link), increased consumption of alcohol and drugs, less senior staff on duty, heavier workloads and indeed possibly longer hours. But pretending that that statistic relates to staff longer hours alone is a bit much.

I don't know if the current working times really compromise patient safety, since it appears according to that report that the rest and break periods are being observed.

http://annals.ba0.biz/content/141/11/851.full

As well as being reasonably indecisive on the issue of working hours, that review actually seems to stress the potential erosion in consistent clinical care by disrupting the roster.

I'm not saying this is definitive, and that one can safely conclude that patient safety is not compromised. But under the current fiscal situation, I think it's reasonable to ask what the benefits are in reducing hours and presumably taking on more staff. I don't quite believe that the issue is as clear cut as implementing the EWT Directive at all cost.

AlekSmart

later10 wrote: »

I think it's reasonable to ask what the benefits are in reducing hours and presumably taking on more staff. I don't quite believe that the issue is as clear cut as implementing the EWT Directive at all cost.

One other element is worth stressing in this entire EWT mess,and it relates to somehow installing or preserving whatever work "ethos" exists in the country.

It is my experience that the implementation of this 48 hour average working week across the board has stifled much of the willingness to work which herertofore existed in many employments.

For example,it is now ILLEGAL for an individual to take a second part-time job,if it places him/her outside the average working time over the agreed time-frame,generally 48 hours over 17 weeks.

Both employee and employer are liable for substantial fines and perhaps jail-time,should they be found guilty of breaching the acts requirements.,so at some point,all other things being equal,in modern Ireland It WILL BE ILLEGAL TO WORK. :rolleyes:

The original impetus for the WTD came from serious abuses of staff,oddly enough, in the GERMAN rag-trade.

Tales of Turkish labour being chained to sewing machines and only allowed one day per month off were highlighted by Unions as evidence of widespread abuses by employers,oddly enough,many of whom were Turkish themselves.

The solution devised by Brussels,or at least a somewhat junior directorate of that parish,assisted by our own noble Pat Cox,was the WTD.

One of the major failings of the WTD,at the level implemented by good ol Ireland is the inflexibility of the restrictions relating to rest periods.

A second major failing,presumably cos Brusels Bureaucrats work 9-5 only,is the inability of it's byzantine restrictions to take account of cyclic or non-repetitive shift patterns.

The actual working of the WTD has in many cases resulted in a WORSENING ofd conditions for shift-workers who are now unable to arrange mutual shift-swops or modify shift patterns on an ad-hoc basis due to the WTD.

This leads to such staff being required to take leave for relatively minor family/social events when in the past a simple shift-swop would have facilitated both employee and employer with no extra costs....also it raises the question as to whether shift-workers should recieve extra leave allocation to allow for the new found restrictions which do not apply to Monday-Friday staff.

One other item is absolutely certain,the countries which will eventually lead Europe and the World out of this depression,will NOT be those who rigorously pursue,and penalize,those of its workforce who remain willing and able to work.......:(

later12

Another problem with the WTD (which I imagine may be what we're seeing here) is that time asleep at work (e.g. in an on-call room) has to be counted as time spent working.

That's why I think this issue of a "36 hour working day" is more than slightly misleading.

Peanut2011

Let's face it, it is quite possible that the number of clocked hours they have is 100 a week, however there are many sides to this. I am not in the profession so I can't speak from that side, however I can speak from the patient side.

How many doctors do you see when you are there??

I have utmost respect for the Irish Nurses and it is evident they do a really good job. Have had the pleasure to meet many of them and can't say a bad word about most of them. However doctors I have a different opinion about.

I've often been able to see doctors just wondering around with the stethoscope around their neck up and down the corridor without doing anything...

Efficiency needs to be brought back in. The doctors are a law to themselves and they are running amok... They are more interested in their own private practices and not public hospitals.

I would say this country should put the stop to their prancing and do something about it. There are plenty of Irish Doctors that have been made look for work elsewhere and having to emigrate due to the current doctors in the system. If 70% of the doctors we currently have did 100 hr's of work a week instead of just billing us for them, we would not have the queues we have.

The issue was that during the celtic tiger era any little issue that came up was met with more money and nothing was ever done to address the issue.

View

later10 wrote: »

Just because the European Commission says that we ought to follow a certain procedure, it is not a given that not following that procedure is inherently bad. It's merely against the Commission's rules.

Saying it's simply against the Commission's rules is of questionable relevance in itself.

The Working Time Directive was adopted by the European Parliament and the Council of Ministers (of the Member States). As such, it was agreed by the MEPs and Member States and is very much their rules not - as you are portraying it - the "Commission's rules".

The Commission's role in this is to ensure that the rules agreed by the Parliament and the Council are implemented as they previously agreed.

As for the claim that "it is not a given that not following that procedure is inherently bad", that is certainly true but if you are willing to accept that defense it would justify just about every piece of (domestic never mind EU) law-breaking up to the point that an accident occurs (e.g. "Drink-driving" rules etc are not inherently bad in themselves until accidents occur as a consequence).

View

Cookie_Monster wrote: »

Now that you have legal backing though why would you, as a junior doctor, allow them to make you work more than 48 hours a week now anyway? I'd be having none of it...

That's true up to a point - namely, the brave junior doctor - now branded as a trouble maker - seeking their next position.

later12

View wrote: »

The Commission's role in this is to ensure that the rules agreed by the Parliament and the Council are implemented as they previously agreed.

Another mention of Europe descends into longwinded pedantry. You can reply like an adult or like a primary school student. I give most people the benefit of the doubt that they are familiar with the basic structure of the European Union. If I refer this rule in the possessive case as the Commission's you can take it for granted that I mean the commission are tasked with its enforcement. Engage in this with someone else View, I've read too much of your posting to go along with it.

Geuze

http://www.esr.ie/vol42_3/04_%20Boate%20PP%20Paper.pdf

This essay covers the restrictions on entry to medicine that lead to shortages.

View

later10 wrote: »

Another mention of Europe descends into longwinded pedantry. You can reply like an adult or like a primary school student. I give most people the benefit of the doubt that they are familiar with the basic structure of the European Union. If I refer this rule in the possessive case as the Commission's you can take it for granted that I mean the commission are tasked with its enforcement. Engage in this with someone else View, I've read too much of your posting to go along with it.

Oh dear, I guess when someone calls you on a mistake (or mis-representation) of an issue you don't like it.

Questioning whether a law that we agreed to shouldn't be applied to us because it is inconvenient is a dubious defense that wouldn't be worthy of a primary school student much less an adult.

dissed doc

later10 wrote: »

Another problem with the WTD (which I imagine may be what we're seeing here) is that time asleep at work (e.g. in an on-call room) has to be counted as time spent working.

That's why I think this issue of a "36 hour working day" is more than slightly misleading.

If you are chained to a pager and must live in a hospital for 36hrs, with no breaks scheduled except when youa re able to fall asleep perhaps by chance on a res bed, that is not time off.

You have no concept of the reality and your opinion of what it is like to work 36 or more hours in a row is completely insulting. Why don't you try it sometime. Some hospital admins tried it a few years back and went home the first night. When you are a doctor you don't get to go home at 5pm - or 10pm or maybe not even 10pm the next day.

The hrs are illegal, and conditions appalling, and this is why no junior doctors or consultants want to work in Ireland.

dissed doc

Geuze wrote: »

http://www.esr.ie/vol42_3/04_%20Boate%20PP%20Paper.pdf

This essay covers the restrictions on entry to medicine that lead to shortages.

That is on primary care and therefore absolutely nothing to do with acute services or access to specialist treatment.

dissed doc

Peanut2011 wrote: »

I've often been able to see doctors just wondering around with the stethoscope around their neck up and down the corridor without doing anything...

Well let's get to work basing a 24hr national health service on your anecdotal experience. Perhaps they were going home after a 3 day shift.

Efficiency needs to be brought back in. The doctors are a law to themselves and they are running amok... They are more interested in their own private practices and not public hospitals.

Doctors do not run the hospitals or the health service or the licensing bodies that allow doctors to work here. Politicians and non-doctors do. So, why are you pointing the finger at doctors?

I would say this country should put the stop to their prancing and do something about it. There are plenty of Irish Doctors that have been made look for work elsewhere and having to emigrate due to the current doctors in the system. If 70% of the doctors we currently have did 100 hr's of work a week instead of just billing us for them, we would not have the queues we have.

The issue was that during the celtic tiger era any little issue that came up was met with more money and nothing was ever done to address the issue.

Irish doctors leave because you are treated unprofessionally by management including lack of salary payments, holidays or training time. The public takes you for granted and targets an SHO doing 80hrs a week instead of wondering why another doctor could not be found to make 2x40hr weeks.

Working in ireland as a junior doctor or consultant is a complete joke - THAT is why the doctors now do 80hr shifts. They are clocking in their 2 or 3 years minimum requirement (and then realising what is going on) before leaving the country. You'd be an idiot to stick around.

later12

dissed doc wrote: »

If you are chained to a pager and must live in a hospital for 36hrs, with no breaks scheduled except when youa re able to fall asleep perhaps by chance on a res bed, that is not time off.

Just to be clear, the report quoted by the OP said that progress had been made with resting time and breaks. That's what I'm responding to. It is true that any time spent on site counts as working time under the directive, so calling a 36 hour shift a 36 hour shift may not be entirely accurate in the normal sense.

I don't think they are really remarkable nor offensive points in themselves.

You have no concept of the reality

your opinion of what it is like to work 36 or more hours in a row is completely insulting

.

Why don't you try it sometime.

This is the internet. I don't see the value in exchanging anecdotes in a serious thread.

If there is a statistical breakdown of junior doctors' hours I think that would be interesting. If there is some link to diminished patient safety on account of junior hospital doctors' working hours, that would be pretty damning. All anybody is actually asking for is evidence that there would be some material benefit in reducing junior hospital doctors' hours.

It would be irrational to accept this on face value because of the difficulties mentioned in how the EWTD assesses working hours. It could also be irrational to accept the benefits on face value in light of the report I posted earlier in the thread.

The hrs are illegal,

That so many cases are indeed contrary to the EWTD is not being disputed.

this is why no junior doctors or consultants want to work in Ireland.

No. In a recent recruitment drive, something like 180 junior hospital doctor posts have recently been filled in Ireland by medics from India and Pakistan.

opinion guy

later10 wrote: »

Just to be clear, the report quoted by the OP said that progress had been made with resting time and breaks. That's what I'm responding to. It is true that any time spent on site counts as working time under the directive, so calling a 36 hour shift a 36 hour shift may not be entirely accurate in the normal sense.

From the docs I know - that statement of "progress" is a statement of fantasy. Nothing is changing on the ground - in fac tI hear it is worse as so many jobs are empty.

If there is a statistical breakdown of junior doctors' hours I think that would be interesting. If there is some link to diminished patient safety on account of junior hospital doctors' working hours, that would be pretty damning. All anybody is actually asking for is evidence that there would be some material benefit in reducing junior hospital doctors' hours.

You think the HSE will publish data showing the extent of their law-breaking ???? You really are in a fantasy world friend.
You want evidence:
http://www.ncbi.nlm.nih.gov/pubmed/20815185

boffins wrote:

In a systematic review, we found that reduction or elimination of resident work shifts exceeding 16 hours did not adversely affect resident education, and was associated with improvements in patient safety and resident quality of life in most studies. Further multi-center studies are needed to substantiate these findings, and definitively measure the effects of eliminating extended shifts on patient outcomes.

No. In a recent recruitment drive, something like 180 junior hospital doctor posts have recently been filled in Ireland by medics from India and Pakistan.

Ahem - have you not been paying attention:
http://irishexaminer.com/ireland/asian-junior-doctors-drive-cost-2m-178527.html

Firstly - they spent €2,000,000 on the drive.

Secondly:

"Doctors who travelled here on invitation by the HSE believed they would sit exams necessary for registration within a week or two of arrival, but this process was held up to such an extent that just 15 out of approximately 300 were working two months later. Another approximately 130 doctors had to wait until November to sit the relevant Medical Council exams, during which time the HSE funded their living costs."

Thirdly it hasn't even fixed the problem:

"However, the HSE has confirmed that 140 vacancies are likely to arise come the next training rotation, which starts in the week beginning on January 9.The HSE also said many posts were currently covered by locum/agency staff and it did "not anticipate service issues arising"

Also I thought there was a ban on agency doctors....huh.....weird.



But wait!!!!! There is more!!!!!!
http://www.imt.ie/news/latest-news/2012/01/foreign-recruits-unite-over-pass-rates-and-criticism.html?dm_i=HSN%2CNTBU%2C4BM3QK%2C1X97Y%2C1&fb_source=message

IMT wrote:

Less than half of the candidates who last month sat clinical examinations for registration under the Supervised Division passed, Irish Medical Times has established. This compares to an 88 per cent pass rate in the previous sitting in August.

These guys aren't even passing the exams.

Imagine if they spent that 2 millon on improving conditions for their own staff and stopping the tide to australia, instead of blowing it on a botched recruitment drive !?


So I have a question for you later10 - do you work for the HSE ? You've been proved wrong so many times in this short thread yet still you persist, I can only assume by the twisted logic you exhibit that you have some vested interest in this issue.

later12

First of all, why don't you relax.

I just want to repeat that all I've asked for is clarification on the statistics of how breaks and rest periods are accounted for in the figures presented to the Commission by the Irish Government, and for other information like the possible cost of rectifying the current situation.

I'm a little surprised at some of the hysteria that such a question inspires. Or the hysteria in asking for evidence that patient safety is compromised before major reforms are made. As I'm sure you know, I posted an review earlier which suggested very dubious benefits - or indeed perhaps even disadvantages - in shortening shifts for clinicians as opposed to granting them adequate rest periods on slightly longer shiftwork.

If you missed that,here it is again

http://annals.ba0.biz/content/141/11/851.full

You think the HSE will publish data showing the extent of their law-breaking ???? You really are in a fantasy world friend.

They did.

It's the report that features in the OP, and which was sent to the European Commission.

Why don't you acquaint yourself with the facts of the OP before you accuse me of living in a fantasy world.

Ahem - have you not been paying attention:
http://irishexaminer.com/ireland/asian-junior-doctors-drive-cost-2m-178527.html

Firstly - they spent €2,000,000 on the drive.

Irrelevant. In bringing up the issue about the Indian and Pakistani doctors, I am pointing out the error of another poster's suggestion that no junior doctors want to work in Ireland.

Clearly, that is not the case.

The rest of your post is largely irrelevant; I have no idea why you wasted your time posting it.

I don't have any bias with regards the public service or HSE working arrangements. But I really don't think it's too much to ask what the true structure of the working day tends to be, or what the rectification cost is likely to amount to, and whether that is realistic in the current economic climate.

I presume there are no reliable figures on the damage that the current working arrangements are having, if any,on patients.

Those seem simple enough questions or observations. I haven't been able to find the answers online, but I really have no idea why you are responding in the above manner. I feel it must have something to do with the fact that the '36 hour shift' does not look very much like a 36 hour shift at all, but it's hard to be certain.

Dannyboy83

opinion guy wrote: »

http://irishexaminer.com/ireland/asian-junior-doctors-drive-cost-2m-178527.html

jesus........

Peanut2011

dissed doc wrote: »

Well let's get to work basing a 24hr national health service on your anecdotal experience. Perhaps they were going home after a 3 day shift.

The examples I was talking about are not what you are referring to. Sitting on a trolley for 8hr's seeing the same doctor pass up and down the corridor god knows how many times without once seeing a patient is most certainly not someone who is going home.

Furthermore why is it that it takes hours for a doctor to make an assessment when the nurse is most probably done all the work already. Look at the A&E? You come in, you are seen by the nurse fairly quickly. Why does it than taken hours (8+) to get the doctor to ask you the same questions and than say, we need an x-ray or bloods?? I'm sure if someone comes in with swollen ankle x-ray will be needed. In most cases x-ray or bloods are needed but it takes hours for the request to be done cos there are only 3 doctors on call and 20 nurses.

Is that not waste of the doctors time?? Than the patient is again asked to wait for another 3-4hr's if not more for the results, when if that was done at the beginning doctor would only need to see you once when the results are back instead of at least two times.

A lot can be done, this is what I am talking about when talking about efficiency. Unfortunately it would seem you are very clouded in how you see the problem.

dissed doc wrote: »

Doctors do not run the hospitals or the health service or the licensing bodies that allow doctors to work here. Politicians and non-doctors do. So, why are you pointing the finger at doctors?

If you have a look you will find the people in charge of the hospitals are the very people who used to be doctors or consultants in the hospital. Pardon me but just cause you worked in the service for how many years does not make you a good manager. Hospital is a business and if you ever compare it that way with any other business I would wonder what your "customer" retention would be. If people had choice they would never step a foot in to the public hospital.

How come it's easier to see the consultant or a doctor in their own personal practice than it is in the public hospital he or she works in?

dissed doc wrote: »

Irish doctors leave because you are treated unprofessionally by management including lack of salary payments, holidays or training time. The public takes you for granted and targets an SHO doing 80hrs a week instead of wondering why another doctor could not be found to make 2x40hr weeks.

Public does not take the doctors for granted, the issue is that many who are still around have no people skills. Rushing to see as many people in as little time as possible and not listening to people will make them resent you.

What happened with the love for the job??? All you have mentioned is money and remuneration! Perfect example!

dissed doc wrote: »

Working in ireland as a junior doctor or consultant is a complete joke - THAT is why the doctors now do 80hr shifts. They are clocking in their 2 or 3 years minimum requirement (and then realising what is going on) before leaving the country. You'd be an idiot to stick around.

That is the reason the issue is so big. The attitude like that. Nothing will ever change if all of our junior doctors have the same mind set as you. It's always easier to QUIT!

later12

Peanut2011 wrote: »

The examples I was talking about are not what you are referring to. Sitting on a trolley for 8hr's seeing the same doctor pass up and down the corridor god knows how many times without once seeing a patient is most certainly not someone who is going home.

In fairness that doctor may have a patient list which is in order of priority. Staffing issues and hospital structure is probably no more under the influence of junior hospital doctors any more than it is under the nurses aide's... all of whom tend to be very hardworking people in a pretty awful system.

Peanut2011

Peanut2011 wrote: »

The examples I was talking about are not what you are referring to. Sitting on a trolley for 8hr's seeing the same doctor pass up and down the corridor god knows how many times without once seeing a patient is most certainly not someone who is going home.

Right, so unless the doctor is seeing patients in the small part of the hospital right in front of your eyes he is not seeing patients at all. Walking up and down a corridor several times? Good Lord, the fcuking cheek of them, using a corridor as a means to get from one place to another within a building.

Furthermore why is it that it takes hours for a doctor to make anassessment when the nurse is most probably done all the work already. Look at the A&E? You come in, you are seen by the nurse fairly quickly. Why does it than taken hours (8+) to get the doctor to ask you the same questions and than say, we need an x-ray or bloods?? I'm sure if someone comes in with swollen ankle x-ray will be needed. In most cases x-ray or bloods are needed but it takes hours for the request to be done cos there are only 3 doctors on call and 20 nurses.

The nurse you see first is for triage. They decide which patients need to be seen urgently and which don't. In the example you gave of a broken ankle, a doc needs to examine the patient to be sure that that's what is. It could be a simple undisplaced fracture that will heal with immobilisation. It may need surgery to reduce it. There may be neurovascular compromise. It may be a sign of an underlying disease, e.g. an osteolytic lesion due to multiple myeloma or bony metastasis from a prostate cancer. There may be secondary osteomyelitis etc etc. Nurses are not trained to diagnose these conditions, which is why pretty much every patient needs to see a doc, so that these things aren't missed.

Is that not waste of the doctors time?? Than the patient is again asked to wait for another 3-4hr's if not more for the results, when if that was done at the beginning doctor would only need to see you once when the results are back instead of at least two times.

Again, nurses do not have the training to know which tests to order for which condition. There are more highly trained nurse practitioners who can order tests and make dignoses but research shows they tend to order more investigations, which take time

If you have a look you will find the people in charge of the hospitals are the very people who used to be doctors or consultants in the hospital.

Wrong wrong wrong wrong. The vast majority of management in the HSE has no medical training or knowledge whatsoever. Indeed if it were the doctors that ran the hospitals, things would probably be much better.

How come it's easier to see the consultant or a doctor in their own personal practice than it is in the public hospital he or she works in?

Because we have a two tier health system.

Public does not take the doctors for granted

Your ill informed ranting would suggest otherwise.

What happened with the love for the job??? All you have mentioned is money and remuneration! Perfect example!

Many docs don't care all that much about the money. It's the horrible working conditions and poor career prospects that drive most Irish docs away.

Nothing will ever change if all of our junior doctors have the same mind set as you. It's always easier to QUIT!

Wrong again. It's because so many NCHDs said nothing as the health service here went to the dogs. If more of them took a stand we'd all be much better off.

dissed doc

later10 wrote: »

No. In a recent recruitment drive, something like 180 junior hospital doctor posts have recently been filled in Ireland by medics from India and Pakistan.

I was referring to irish trainee level and specialist doctors (consultants).

The recruitment drive sold completely false information with regard to working conditions and salaries, and many of the recruited left and returned to India and Pakistan.

And recruiting from there because the 500 million person EU job market for doctors still leaves hundreds of vacancies is not exactly a good advertisment, is it.

dissed doc

Peanut2011 wrote: »

That is the reason the issue is so big. The attitude like that. Nothing will ever change if all of our junior doctors have the same mind set as you. It's always easier to QUIT!

Well you only ever get a temporary six month contract in Ireland so you don't really quit, you just don't choose to re-apply and instead get a job with proper employment rights in some other country.

Tunemaster

AlekSmart wrote: »

later10 wrote: »

I think it's reasonable to ask what the benefits are in reducing hours and presumably taking on more staff. I don't quite believe that the issue is as clear cut as implementing the EWT Directive at all cost.

One other element is worth stressing in this entire EWT mess,and it relates to somehow installing or preserving whatever work "ethos" exists in the country.

It is my experience that the implementation of this 48 hour average working week across the board has stifled much of the willingness to work which herertofore existed in many employments.

For example,it is now ILLEGAL for an individual to take a second part-time job,if it places him/her outside the average working time over the agreed time-frame,generally 48 hours over 17 weeks.

Both employee and employer are liable for substantial fines and perhaps jail-time,should they be found guilty of breaching the acts requirements.,so at some point,all other things being equal,in modern Ireland It WILL BE ILLEGAL TO WORK. :rolleyes:

The original impetus for the WTD came from serious abuses of staff,oddly enough, in the GERMAN rag-trade.

That is true of the European Working Time Directive, but not true of its enshrinement in Irish law, ie the Organisation of Working Time Act(s). The Irish government chose to eschew the issue of the second job when it enacted the legislation, thus a worker may chose to work more than 48 hours, but no employer can schedule an individual for more than an average of 48 hours per week.

Tunemaster

Thanks to JamesL for answering those points. Excellent job.

A brief word on these 36-hour shifts.

It was mooted by the European Commission in the last few years that time spent in bed should not count as European Working Time Directive working time. Also, I think the public are right to be sceptical of a group of professionals moaning about long shifts who it turns out are in bed. It's certainly easier to believe that they are well-rested by morning rather than actually on their feet for that time.

The truth is somewhere in the middle. My experience as an SHO in a busy north Dublin general hospital was that I would got two to three hours' sleep. In two years, I don't think I ever beat three hours and there were a few times when I literally got none. The days after those nights were not productive. There is scant enough evidence that long shifts adversely patients, but I am not at the top of my game on day two, there's no doubt about it.

Also, the quality if sleep is not good. You know when you have to be up early for a flight and you wake up every hour and check your watch so then you're really tired in the morning? It's that kind of sleep. Awake every hour checking the bleep. It's not refreshing.

As to whether it should be EWTD time? Well, the Permanent Working Group of European Junior Doctors were quite adamant that it should be. Never mind that recording asleep time and awake time is unworkable from a practical sense, the ethos of the EWTD is to protect workers from employers. Thus, the limit of time you should be in work should not exceed 48 hours per week average and the shift length should not exceed 13 hours average. The efficiency with which you work while you're at work is up to the employer.

One last point - people are writing about whether long shifts lead to adverse events for patients, which hasn't been well proven, but it has been proven to be bad for doctors. I have one friend who was very badly brain-damaged after a crash driving home post-call. If nurses had to work those shifts, they'd demand the hospital pay for taxis, and they'd be right to. It's a a barbaric practice and it should end very soon.

Never mind EWTD, it's common sense.