Tuesday, 14 September 2010

Working time directive

There has  been a lot of comment lately about the perceived effect of the EWTD on training of specialists. Particularly from surgeons, there still seems to be considerable support for the conditions endured by doctors of my generation. This is odd. I remember thirty years ago my colleagues being almost unanimous in condemning the onerous hours we worked. Now these same people seem to have changed their minds and seem to wish to impose the same torture on those now in training. They even seem to have convinced many trainees that a return to the bad old days is desirable.

There are one or two things I would point out to todays trainees. The first is this article.

Secondly I would point out that many doctors over the years have struggled hard to consign to history working conditions for doctors that verged on paid slavery. These people endured it and felt that you should not have to. Do not be so willing to throw away what has been achieved for you.

Third, you assume that longer hours will mean better training. From experience we oldies know full well that the extra hours will mostly consist of covering the work.

Todays trainees have no experience of the conditions that they now seem to be clamoring for. Conditions that they have been brainwashed into believing will make them better doctors. I have no doubt that if the clock is turned back it will not take long before they realise they have been had.

Be careful what you wish for. You may get it.


  1. Are they mad? I remember seeing junior doctors on a Monday morning who had been in the hospital since Friday morning. Some of them would struggle to tie their shoe laces never mind look after patients. Alcoholism, drug addiction, suicide, broken relationships, all side effects of the "good old days". And, there was no training over weekends or nights despite all those hours worked.

  2. I heartily agree with your view. Some in the NHS feel that long 'on call' hours are an ordeal that shapes people into good Doctors, when the simple truth is that it makes for tired and usually dangerous one's. This view is shaped by my own experience in extremely long shifts in difficult circumstances, when I knew that the more tired I became, the more slow and ponderous became my capabilities to analyse and act.
    The STAR system invoked, stop, think, act, review, became almost impossible to process, yet it was intrinsic to safe protocols.
    Many in Medicine view their 'good old days' with a fondness seen retrospectively, through rose tinted glasses. We do not allow pilots, HGV drivers, or control room staff at Nuclear facilities to work excessive hours for good and logical safety reasons, so where would be the logic in allowing Doctors to?
    The simple and truth is that we do not have enough well trained and dedicated Doctors. To try and plug this gap by revoking a good Law for financial expediency is madness.

  3. While Dr No agrees with the sentiments expressed here - and he is old enough to have done the infamous three day 9am Friday to 9am Monday plus a full Monday to follow that Grumpy RN refers to - he rather suspects the hours problem is almost a convenient and respectable diversion from the real malaise which is that far too many junior doctors are having Rhett Butler moments far too early in their career. If they really are jumping ship at the rate of one in every four, then the NHS will quite simply bleed to death.

  4. Something also worth remembering is that management have seen what the new shift based system can deliver in terms of man-hours and they are not going to forget it - there is no real 'on-call' for anyone but consultants any more. Any extension of working hours will be service delivery not learning time.

    If we reintroduce epic 'on-call' shifts now it will just mean that you get to do the same manic exhausting under staffed on your feet shifts as under the EWTD, only there'll be more of them and longer.