One big problem that no one in the medical establishment has even dared to think about addressing is the European Working Time Directive (EWTD). The phrase 'head in the sand' comes to mind when describing the attitude of the government, Royal Colleges, PMETB, BMA and other institutions to the EWTD.By August 2009 all doctors in training will have to be compliant with 48 hour a week rotas. The Surgeon has published a piece detailing what a failure the pilot introduction of these new EWTD compliant rotas has been. Not only did the new 48 hour rotas result in poorer quality training for the doctors but it also resulted in a large majority of doctors feeling that patient's care had been compromised by a lack of continuity.
The naive proponents of MMC believe that their revolutionary new methods of training, consisting of lots of paperwork and lots of hot educationalist waffle, will increase the quality of training so much that a reduction in hours will have no effect on training. Any trainee on the ground will tell you how dumb this approach is, as the reduced hours has resulted full shift rotas replacing older more training friendly rotas, while there is far more cross cover than ever before, meaning that more time is spent doing mundane admin as opposed to the juicy training bits of the job. I won't comment on the paperwork burden, other than to say that chopping down trees only trains lumberjacks.
EWTD in its current form will further worsen patient care in an already fragmented service that lacks any continuity of care, and it will arguably worsen the quality of training even further in a system which is not giving enough exposure or experience to trainees as it is. Firstly training doctors need to realise that if we are to remain highly skilled professionals then we must remain apprentices in our trade and we cannot allow our hours to drop yet further. Secondly we must force those who represent us to listen to our views, and those who represent us must then force those in government to listen. If we do not, then the effects of EWTD could be quite catastrophic.
3 comments:
... But, they do not want all doctors to be trained well. The idea is to train to a high standard the few who will secure those post CCT fellowships ... this is cheaper ... and heads will then level for real!
Ferret-I normally love your excellent blog-but I must vehemently disagree with you here.
The concept of "continuity of care" trotted out as an excuse to justify working young doctors who cannot stand up for themselves into the ground is a load of bollocks.
If continuity of care is actually being compromised, then the docs themsleves are doing a poor job note writing and handing over to the appropriate people. Every doctor goes home at some point. Therefore there is NEVER continuity of care. If we are to sleep enough to remain healthy, if we are to have any contact with our loved ones, if we are to continue to pursue our other interests-shock horror-some docs don't LIVE for medicine-they play sports, music, have hobbies etc, then we are going to have to wake up to the fact that continuity of information is what is important-effective clear communication of the pertinent details to the correct people. Continuity of care has never been a reality as no-one is on duty 24-7. And in addition, who the hell wants exhausted demoralised docs looking after them??
The complete disregard for the EWTD where I'm from just about ruined my life. I was an exhausted depressed shell. So I gave them the finger and left for NZ. Here, I work normal decent hours AND I get better training than at home. Yes, it's possible. I would never ever go back to those hours. Not ever. I think it's cruel to even suggest they are good for patients or docs. I saw so many mistakes made due to tiredness, a couple of RTAs due to fatigue, and a couple of suicides after extended shifts of 30-40 hours. I think any hospital that isn't complying should be fined and penalised so heavily that no-one is tempted to breach the directive again.
I hardly think 50-60 hours a week is working doctors to the ground.
I do take your point that excessive hours can be very damaging.
However too few hours can also be very damaging for training.
Also the clocking off clocking on shift worker culture that it is encouraging is not impressive, it has only developed here in the last few years but some doctors do not appear very professional when they can't be bothered to stay in for an extra ten minutes to finish off their work.
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