Workin’ 9-5….how not to become a surgeon

..er...I'm afraid the doctor had to get home
..er…I’m afraid the doctor had to get home

When they ran it a couple of days ago, The Mail‘s article on junior doctors‘ hours referred to Professor Normal Williams. It’s happily now been corrected – Norman of course. The typo is telling however, as what Prof Williams was saying was indeed what surgeons of a certain vintage (including The Knife, and quite a few younger colleagues) did regard as ‘normal’, and we still do. Even though the EU (through the dreaded European Working Time Directive) and the politicised BMA Junior Doctors Committee (via the New Deal legislation), think otherwise.

The Prof was simply reiterating that good medical care requires long hours quite often, as does good training, particularly if you fancy being a surgeon. It’s true that a few other countries seem to have moved to a successful model for surgical training on shorter hours, France for example, but there’s an inescapable truth: surgery requires authentic practical experience, and as anyone who’s been a patient knows, you may need that surgical input at any time of day or night. It doesn’t slot into the 9-5 day necessarily, and especially emergency surgery.**

Such is the demented government obsession with waiting list targets, it’s often overlooked that emergencies are our raison d’etre. Always have been, and always will be. Then comes life threatening stuff like cancer. And only after that should we be fretting about the elective work, however beneficial it appears to be. The latter is the bit that you can pick up over the working day. Anyone can learn an uncomplicated  hip replacement or a cholecystectomy.

None of this is a revelation. Everyone wants a genuinely experienced battle hardened surgeon, don’t they?  This doesn’t have to mean “100 hour weeks” either. Says the Prof (who is the real deal, and the current President of the Royal College of Surgeons of England to boot):

‘No matter what the European Working Time Directive says you are professionals, you have a duty to your patients…You cannot have a clock in and clock off attitude.’

and in the Telegraph:

“You go into medicine to serve and make people better that should be your overriding interest and if you are not prepared to be like that you shouldn’t do it, you should go off and do something else…Medicine is about giving of yourself, the patient must be the centre of your universe”

As the Telegraph article points out, all these exciting new shifts create substantial safety issues of their own:

Prof Williams said the ‘chickens were coming home to roost now’ as patients were seeing four or five different teams of doctors in a day due to shift patterns and the lack of continuity was putting them at risk of mistakes.

Sounds eminently sensible. But wait…here’s what he’s up against (with my comments in brackets):

‘Before the introduction of the EWTD it was not uncommon for junior doctors to work 100-hour weeks (this did happen a bit, not every week of course, you would need a LOT of on call to get there)

‘The directive seeks to protect doctors and patients as there is clear evidence that tired people make more mistakes (hmm..this one is overplayed. I did all this stuff, serious mistakes were no more frequent than they are now)

 ‘The 2010 Time for Training review concluded that these problems will not be solved by either increasing hours or lengthening training programmes (bollocks, but I’m sure the review did say that, as that is why they have these reviews).

Many junior doctors already work long shifts and they should not be pressurised to work longer hours just to get training that they are entitled to (ah of course, entitlement culture strikes again. Don’t bully me!).

The focus on overturning the directive is an unnecessary distraction. We should instead concentrate on improving training to ensure doctors can deliver high quality patient care (one of the most clapped out, pathetic platitudes in existence, one doubts it’s truly possible, given my comments above. However, a pious appeal to ‘quality’ never fails)

Well, who is this paragon of clinical practice? It’s apparently a Dr Ben”I resent my working hours being used as a stick to beat Brussels”  Molyneux, inevitably the Chairman of the Junior Doctors Committee, and just as inevitably, now a Guardian contributor. The Knife has no idea what young Ben’s career ambitions are, but it seems unlikely to be surgery.

No doubt Ben would regard me as an ignorant dinosaur, lacking the empathy and training skills needed in 2013. Naturally I would disagree.

The trouble looming for Ben and his peers though, is exactly what Prof Norman alludes to in his comments. What do you think will happen when you step out of that training cocoon, and start actually being responsible for continuity of care, serious clinical decisions, and for patients’ lives?

That’s right, you will be working, as The Knife does to this day, far more than 48 hours per week, with no compulsory rests etc, because when the buck stops with you, that’s what you have to do. That’s medicine.  It’s going to be a rude shock, boys and girls.

 

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