tag:blogger.com,1999:blog-2482732367812174734.post7113893220107541684..comments2024-02-28T08:42:52.675+00:00Comments on The Junior Doctor: The European Working Time DirectiveDr Michael Andersonhttp://www.blogger.com/profile/05340927185641717290noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-2482732367812174734.post-24665033998695565492009-08-04T23:41:36.974+00:002009-08-04T23:41:36.974+00:00Anon: there are plenty of other things junior doc...Anon: there are plenty of other things junior doctors do which are combined service and training rather than just service.<br /><br />During my time on a plastic surgery firm, I did a lot of clinic and operating theatre time, where I began by assisting and learning the details of the operation and its followup, and then started doing some of the procedure (closing, grafting, etc) and doing followup on my own cases.<br /><br />I'm currently an F2 on an emergency medicine term, and the training aspects are when I take a sick patient and manage them under supervision. The service aspects are when I see someone who's come in with a sore throat.DHShttps://www.blogger.com/profile/00251680600047999918noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-21631964964305780632009-07-06T23:57:00.455+00:002009-07-06T23:57:00.455+00:00Please remember... doctors are getting paid a sal...Please remember... doctors are getting paid a salary. If you are getting 'trained' and avoid all banal tasks (“form-filling, chasing results, phlebotomy, re-writing drug charts, cannulation and arranging discharges from hospital”) then what service are you providing? (I can hear the screams of protestation from here!) I’m afraid that no doctor is in a position to be able to be “interpreting CT scans and making decisions based on them and diagnosing and treating medical emergencies” from the start of their career and if they need to be trained “under appropriate supervision, of course” by a consultant for all of their available training time in a week (9-5, 6 days a week means not 1 night shift)then what service are they actually providing? Essentially that would mean 48 hours of training a week with no service provision for 9 years... utopia I agree but not really meriting current pay rates. That would be the same as being a student again maybe? At present there is a need for medical coverage in hospitals. The bill for the NHS is running somewhere over the £100 billion mark with over 60% going on salaries and wages. Im not sure the government or the public would tolerate doctors working for 9 years at current pay rates without doing some independent work over that time. <br />In addition there is no good evidence to say that 48 hours working is safe and 49 hours is unsafe. There is evidence to say that TIRED workers are unsafe but no specifics about how may hours make a tired worker.... much purposeful and agenda loaded speculation exists however. (remember, the the EWTD was originally an economic bill !) Hospitals need to keep functioning and unfortunately there are few alternatives available without flooding the market with tens of thousands of consultants .. literally. This has so many problems with it that it really cannot be an option. <br />Medicine is a hard career choice and maybe rightfully so…. patients deserve doctors who are the best. Unfortunately that means not just theoretical learning (glad to hear you found the energy to look up the route of the median nerve after your shift) but also a great deal of experience. One cannot substitute for the other and as an anaesthetist you are only going to be exposed to a handful of AAA’s over your training. The more you are in hospital the more you will see. <br />There are a lot of people out there with funny agendas that are driving an intolerance of any discussion which could exempt doctors form working more than 48hours. This is actually discriminating against those who actually may want to.<br />Working over 100 hours is stupid and cannot be advocated or returned to but some sensible debate is required (without unscientific propaganda and scare stories of planes crashing) over how many hours can be worked safely so that training can be maintained to a decent standard, so that the work force problems of the NHS can be fixed and so that junior doctors can be paid properly for the hard work that they do.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-5471078594822884832008-07-21T20:27:00.000+00:002008-07-21T20:27:00.000+00:00Have just come accross your blog. One of the best ...Have just come accross your blog. One of the best argued posts I have read on EWTD anywhere. The issues of training and service (i.e. paperwork) are often confused and with the EWTD , trusts may finally be forced to value the time of junior doctors.<BR/><BR/>Don't forget that the Calman reforms (specialist registrar reforms - ie, the last run to consultant) were vigorously opposed by many, but looking back on them now they standardised and raised the bar for training to CCST.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-42041910759641641552008-06-27T15:05:00.000+00:002008-06-27T15:05:00.000+00:00When I was a surgical SHO in the mid 80s, I worked...When I was a surgical SHO in the mid 80s, I worked a 1 in 2 on call rota. In one year I did over a hundred each of appendicectomies, hernia repairs and varicose vein operations alone and un supervised. I did numerous leg amputations and circumcisions not to mention endless lumps, bumps and biopsies. When the hospital suggested changing to a 1 in 3 rota, all the surgical SHOs complained that this would reduce our operating time<BR/><BR/>When I realised that I didn't have the requisie personality disorder to become a surgeon, I switched to anaesthetics and got my FRCA. As a result of my exposure to both sides of the blood brain barrier I strongly believe that you can operate quite safely when you are tired as the adrenaline keeps you awake - you cannot however give an anaesthetic safely when you are tired because of the boring bit in the middle while the surgeon does his stuff.<BR/><BR/>So there are pros and cons of long hours - personally I think the EWTD will mean that future surgeons will have much less experience when they become consultants than the current group but there will be fewer anaesthetic disasters.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-5375127781203744832008-06-25T04:47:00.000+00:002008-06-25T04:47:00.000+00:00I agree. And I might just want to be an anaestheti...I agree. And I might just want to be an anaesthetist.Dragonflyhttps://www.blogger.com/profile/12759938692575603663noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-55220855720351032332008-06-24T15:50:00.000+00:002008-06-24T15:50:00.000+00:00The WTD is one of the few directives that have com...The WTD is one of the few directives that have come from the EU that I quite like.<BR/><BR/>I think you'll find that some doctors will choose to work more than 48 hours in a week (as is what happens in other job roles today), but that number will probably be really small.<BR/><BR/>A slight restructuring in the way Doctors are trained along with ensure the maximum number of graduates get jobs should mean the impact of the WTD in the medical world will be a positive rather than negative one.<BR/><BR/>A very good blog entry!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-89519665352418258672008-06-24T15:48:00.000+00:002008-06-24T15:48:00.000+00:00This comment has been removed by the author.Oliver Smithhttps://www.blogger.com/profile/06427115023232821493noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-38333135291822274632008-06-24T12:50:00.000+00:002008-06-24T12:50:00.000+00:00Your post reminded me of when I was going out with...Your post reminded me of when I was going out with a medical house officer in the 90s. He worked the most disgusting hours. I remember when he worked from Friday evening till Monday evening. He was tired all of the time. <BR/><BR/>I agree with everything you've said. I certainly wouldn't want a chronically exhausted doctor looking after me.SSShttps://www.blogger.com/profile/16208995711559110532noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-77303457973163126262008-06-23T21:39:00.000+00:002008-06-23T21:39:00.000+00:00I don't think going back to the old ways is the be...I don't think going back to the old ways is the best way. I do like the fact that I still feel I can love my job. <BR/><BR/>For a while I did on calls in Obs and Gynae where we got to sleep overnight - patients stopped being people I cared about and started being things stopping me sleeping. <BR/><BR/>The lack of continuity of care in medicine is perhaps due to filling rotas and a lack of medical team. The Team is dead - which means that when I admit people I don't get to follow them up by looking after them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-78133720956414981752008-06-23T13:32:00.000+00:002008-06-23T13:32:00.000+00:00A really interesting and well thought out post. I ...A really interesting and well thought out post. I was against the EWTD but mainly out of principle, I guess i'll be able to give my own, slightly more informed view soon enough.The Little Medichttps://www.blogger.com/profile/05743228690074334742noreply@blogger.com