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Time for change?

Shortly before Christmas, the seemingly perennial issue of junior doctors’ hours was once again in the news. This time, the reason was the result of a Crown Office ruling regarding the death of junior doctor Lauren Connelly in September 2011. Dr Connelly had started working at Inverclyde Royal Hospital in the August, and had worked the first 10 days straight, including 4 long days. She then worked a regular week, which was then followed by a 12 day stretch. The week she died, she had completed 4 days, and had just finished the first of her 7 consecutive night shifts. Her father Brian Connelly, who has called for an overhaul of junior doctors’ working practices, felt that she was suffering from fatigue as a result of her working pattern, and that this was a factor in her death. Any junior doctor who has worked these sorts of rota patterns is bound to agree.

The introduction of the European Working Time Directive, which theoretically limits doctors’ hours to 48 per week, was set up to try and end the days of extreme hours worked by juniors. However, most trusts accomplish this by averaging the hours out over a 6 month period. You work intensely hard for days or weeks on end, but then you get some compensatory time off down the line. This is supposed to balance things out.

As nice as it is to have a chunk of time off, however, this doesn’t stop you from being exhausted at the time. As medics, we are always advising our patients on the virtues of moderation: n occasional glass of wine with a meal, rather than a weekend binge drinking, for example. Or an active lifestyle, rather than working out like a demon for the entirety of January, then remaining inactive the rest of the year. We know this. And anyone who works outside of medicine, and who looks at these sorts of working patterns, instinctively knows this is not a good way to work. And yet it continues. You will always hear, ‘it was worse when I was a junior, we did 24 hour on-calls, for weeks at a time.’  Historically, it has always been the thing that junior doctors did. There is a certain acceptance, both in the medical profession, and in the general public, that you should expect to work these near-impossible hours. But working an unsafe rota then does not justify working an unsafe rota now.

There are various arguments against reducing hours (or, rather, spreading the hours more evenly), for example a lack of clinical exposure. But I would argue that by the end of a 12 day stretch it’s hard enough remembering your own name, let alone learning anything.  And this is particularly true for very junior doctors. After some time on the job you become better at prioritising your work, but at the beginning you can be easily overwhelmed by the amount that is asked of you.

The Crown Office ruled that there would be no fatal accident inquiry into the death of Dr Connelly in part because she had made the decision to drive when she was feeling tired.

But, I would argue, she made the decision when she was tired. Who has worked these sorts of shifts as a junior doctor and felt capable at the end of them? Not me, and not anyone I’ve worked with.  There but for the grace of God.

Dr Tim Cassford is a GPST1 in Chichester