The one that is beginning to hit the headlines is the ramifications of the decision to implement the European Working Time Directive on hospital care. The untoward effect of this well-meaning piece of legislation - designed to prevent hospital doctors working excessive hours and being overtired - was flagged up quite a long time ago as having the potential for serious harms. I know John Black, president of the Royal College of Surgeons, has been warning about this for at least 3 years.
The real problem, for me as a Jobbing Doctor, is that Government does not listen. They come in with their 'ideas' and their 'advice' and implement policy without effective consultation - they have Special Advisers who, generally, have their own agenda, and "Independent" advisers - like the Chief Medical Officer and Primary Care "Tsar" who will tell ministers what they want to hear, rather than what they ought to hear.
Surgical training is descending into chaos. Don't think this is confined to surgery, either, because it is across the board. New consultants are generally callow, inexperienced and prone to poor clinical reasoning. Recently we had a widely accepted suggestion from the Tooke report to lengthen the time of training to be a GP from 3 years (wholly inadequate for some) to 5 years (about right), but this was rejected by Government (too expensive).
In the meantime, I have to pick up the pieces with my patients. I tell them that they do not need excessive investigations, they do not need unnecessary procedures, and to stop having expensive and needless interventions. This is hard work, and demands significant diplomatic skills.
Hospital care and follow-up is not better for it.
9 comments:
Those of us who have been around long enough to have woked under a Tory and Labour NHS are well aware that it makes no difference who is in power. Government does not listen to the people. Whilst no-one would want to go back to the days of 120 hour plus weeks for junior doctors it does not take a genius to realise that if you cut training hours then you need to extend training times. Big problem across all professions in the NHS is the 50 plus timebomb that will hit in the next 5-10 years as many senior doctors and clinically active nurses will be retiring. So in order to plug the gap we have the poor decision to accelerate consultant positions, whilst failing to acknowledge that thanks to the EWTD todays junior doctors are not at the same standard as their counterparts 20 years ago. The only logical way around this is to increase the number of junior training posts (this allows the EWTD to be met) and increase the length of training/supervision. Too often I come across F1 and F2s who are treading water with no-one to support them. Its not just doctors either- years ago sisters had to be qualified for 5-10 years before they we deemed competent to be a ward sister. Too often they are now qualified less than 3 years and are just not up to the job. They get no senior support as the so-called "ward managers" are no longer role models as they barely set foot on the wards. For every good one who tries there are 10 who take the money and run. These are the consultants and senior nurses who will be looking after the elderly dino and it scares the bejesus out of me.
As a current junior doctor, the EWTD annoys the giblets out of me. We still do jobs that involve 65 hour weeks or more (an SHO friend recently worked 120 hours over 10 days before having a day off) on the basis that the EWTD averages hours out over 8 weeks.
So we get crap training, and the patients still get tired doctors. Seems to me like no-one wins.
The other point that is often overlooked is that in the attempt make rotas EWTD compliant (on paper at least) when you are working you may well be the only doctor covering a number of patients that would previously have been covered by more than one doctor. This means that when training opportunities do arise you are unable to grasp them as you are too tied up doing routine ward jobs, for which you have a list as long as your arm and a box attached to your hip bleeping continuously to remind you of.
Rant over.
Would agree only in part but do not tar all trainees with the same brush. In my own speciality a good proportion by the end of their training are as good as any of my generation were, some of them better, but this is often in spite of their formal training (and all the form filling that goes with it) rather than because of it. There is no doubt though that some of the CVs that we see for Consultant posts are, when you take out the padding, decidedly thin.
Some consultants have always struggled when newly appointed. They are not and never have been the finished article. I think the same can be said for GPs.
Irrespective of whether newly appointed consultants (or GPs, or sisters) appear to struggle when taking up their posts, they will never be the finished article. I was still learning the day I retired, and grateful for it - it was my colleagues who appeared to feel that their egos would be challenged if they gave the impression of needing to know anything more that worried me!
As implied above - a lot of the reason that trainees (and particularly surgeons) are unhappy is that implementation of the EWTD has meant that the balance between training and service provision has swung decisively towards the latter - this wasn't inevitable but was the cheapest option for Trusts and the government.
As anonymous says, I can only dream of actually working EWTD compliant hours - all it means for me is less pay, less training, a more intense working day, and no lunch. The workload now is really quite intense because it is considered a shift pattern - traditional on-calls are a thing of the past (along with on-call rooms and sleep).
A big problem with work hour restrictions in the USA is not the lack of hours in training or cases seen (that is also a problem) but the change in attitude that coincided with the change. I was in the middle of training when the changes occurred and those that started residency after the change have a totally different attitude. Pre-change think, wow, it's 5pm, I can stop accepting new patients and once all my work is done, I can get home eventually. Post-change watch the clock from 4pm until 445pm and then think, by the time I get to my care it'll be 5pm. They also seem to have the same ethic when it comes to reading and it shows in their knowledge base.
Why doesn't jobdoc respond to responses?
Cos he's a very busy jobbin' doc? ... or maybe it's just too late for him, he's gone to bed already! ;)
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