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Doctors don't like medicine's power being challenged

  • 10 Comments

You know you are getting old when the junior doctor approaches you and your first thought is: ‘Ah, the school holidays have started.’ If you are over tired you may ruffle her hair and offer her a lemon Bon Bon.

Or ask him who his favourite Power Ranger is and wonder if Father Christmas brought him that toy stethoscope he is twiddling with. In short, you will think they are aged 11 and wonder where their parents are.

But no, they are the future of medicine ­ a heady mix of youthful enthusiasm, natural anxiety and occasional raw arrogance. And, up to two weeks ago, they were going to be camping near the ward, and relying on you an awful lot, for up to 100 hours a week.

‘It is hard to see how patients’ best interests are served by post-pubescent medics who are desperate to curl up for a nap while you read them a story’

We have known for over a decade that junior doctors were going to have their hours restricted to 48 hours a week because of the European Working Time Directive and yet, when the ruling finally arrived, the murmurings of discontent ranged from concerns over managing swine flu to worries over the quality of training these part-time whippersnappers are going to get.

The truth is if the NHS cannot cope without making junior doctors work more than twice the hours it is deemed safe for a bus driver to work, there is something terribly wrong with the health service. And, frankly, while some senior medics suggest that patients will suffer because of those fussy Europeans, it is hard to see how the best interests of patients are served by the delirium of post-pubescent medics desperate to curl up for a nap while you read them a story.

Maybe part of the reason senior doctors are unhappy with the change in juniors’ hours ­ apart from the obvious implication that they are going to have to work more ­ is the challenge to the long-established cultural initiation that involves working a month without sleep and living on pot noodles and very strong coffee. You don¹t arrive in doctor world until you have been worked like a dog. Until you have proved you are made of the right stuff, and the right stuff is measured not in talent but in hardiness. It always struck me as the equivalent of training an Olympic athlete and testing them by entering them for It’s a Knockout. We know you are a finely honed athlete but can you dress up like a giant banana and swing across the pit of foam faster than the Dutch junior doctors?

The ritual of pain that is the traditional lot of the junior doctor isn’t necessary or helpful.

It is disingenuous to suggest that patients will suffer if they don’t have access to a junior doctor who has gone 17 hours without rest. We know we can do better than that. We know that the New Ways of Working offer creative ways of meeting patient need without relying on old models of care or even old unhelpful habits.

Roles can be developed to cover the space left by overworked junior doctors and so one wonders if part of the reason some doctors are unhappy with the civilising of working hours is about the power and autonomy of medicine being challenged rather than the well-being of patients or services.

  • 10 Comments

Readers' comments (10)

  • Interestingly in Scotland we have dealt with this issue some time ago by employing band 6 nurses overnight to triage calls into Mental Health and therefore making the need to have Doctors on tap less necessary, and it has worked very well.

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  • It's not quite as bad as Mark Radcliffe makes out...

    The EWTD has two components - really strict rules about daily rest (>11h) and weekly rest (24h once a week, or 48h every 2w), plus rules that limit hours of work (up to 48h/w). The safety benefit comes almost entirely from the regular rest.

    And the working hours are still reasonably and safely flexible - junior doctors can voluntarily opt-out (like nurses) from the working hours limit and work up to an average 56h/w (limited by the juniors' New Deal contract); in addition, less intense jobs are suitable for non-resident on-call working.

    These two solutions - opt-out and on-call - are explained at www.RotaGeek.com

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  • Can't comment on junior doctors in hospital, as I work in Primary Care, but interesting to read about reliance/dependence on nurse's expertise and then lack of acknowledgement on achievement! I am an Independent Nurse Prescriber and get lots of telephone calls on Wednesdays - reason - surgery has a half day. Consequently, much easier to contact Matron and ask her to see patient who has requested home visit. Saves GP going to house, often grubby with anti-social family members, vicious dogs, car not safe from vandalism.... do you get the picture? Also, much cheaper for PCT, and GP can go off to play golf / work for out of hours team and earn extra money to support lowly pay, ah....
    Nurse known not to prescribe as frequently as GPs, money saving there too. Nurses known not to let patients down, so achievement all round. Bitter? resentful? Me!

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  • Hi, Have been nursing for 30 yrs in Feb, 2010-nearly all of which in A/E -Scotland, Sussex, London, Southern + Northern Ireland(although they like to call it E/D where I now work!!!)Still love it and am glad that I do! Every story above is sooooo true though, having listened to/read Mark's stories for years I can see exactly what he is saying-I laugh for ages every time i read his tales-but-know that he is sooo brilliant and has insight into what is happening now-today-in nursing/medicine. P.S. all of the other stories were so000 true also, even if cynical!!!!-Sorry, regards, Betty

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  • I ask the same question as Mark regarding medicine's professional hegemony in health care. My thought on this is that medical practitioners resent this. Their attitude reflect the over-aching sociocultural perceptions which informed their choice of profession; 'the doctor is the top dog'. Incidentally, medicine is being gradually de-mystified, and long overdue in my opinion. Their percieved challenge rocks their boat, because it has a ripple effect which extends to financial reward and social status. I feel their reaction is natural, so let us not be too hash on them. If we were in their shoes as nurses, we would do the same. Give them a pat on the back and tell them they will be alright. But move forward we must! for the patients, and for our own self esteem. As a nurse, get as much training and academic qualifications as you can. The rewards will come in due course.

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  • I agree with Charlene O'Hare. I started my nursing 'career' for 20 years ago , and am finding that many junior Drs have even less respect for their nursing colleagues than they did back then. They dont have the same excuse now of the long hours for their rudeness, and take many extended roles for granted & almost throw a tantrum if they have to take blood or site a cannula!
    I really would not recommend nursing at the moment. Despite attempts to raise our status, by all nurse training to be degree couses, 5 years after qualifying, even if their lucky enough to have had extensive post-reg education, they'll be stuck at the top of Band 5 with the rest of us, as Band 6 posts are few & far between & likey to be fewer with the current economic climate! After 5 years the junior Dr.s are Registrars.

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  • You also know you are getting old when you read the same tired, second rate, and hackneyed ideas being regurgitated by the same tired and second rate journalist ten or fifteen years after you first heard them. This article is soooooooooooo not true (Elizabeth did you realise you sound about 14 years old when you express yourself in this way?)

    The junior doctor’s I have worked with recently are generally speaking well educated, hard working and grateful for any help and support that I, as a senior and relatively well experienced nurse, can offer. They are not post pubescent, nor are they desperate to curl up for a nap while I or anyone else reads them a story.

    I feel very sorry for any junior medic encountering the sort of unpleasant iatromisia expressed soooooooooo eloquently in this particularly poisonous piece of journalism. I can only assume that it has been soooooo long since the author had a proper job in nursing he simply does not know any better.


    Regards,
    E

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  • I entirely agree with the comment above by 'E'. I agree that doctors (junior or otherwise) may at times be rude, however I don't see why age should come into it? I have met plenty of rude 'senior' doctors and plenty of rude older nurses. It is highly unprofessional to dismiss someone because of the way they look, i.e. young.

    Does the author of this article feel the same way about student or junior nurses? Recentely I have been working with a nurse who must be in her mid twenties (the same age as alot of junior doctors), she is nothing but proffessional, knowledgable and caring. I'd like to see you try and 'ruffle her hair and offer her a lemon bon bon'!

    We should be glad that young people want to work in medicine and nursing, they are trying to learn and make themselves better practitioners for the benefit of our patients. One day you might be grateful for that junior doctor looking after you or your loved ones.

    The attitude expressed in this article is an 'old unhelpful habit' which is patronising and quite frankly unproffesssional. Don't you remember what it was like to be young and new to the professsion? Get some respect and take a little time to judge people on how they work, not how they look.

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  • THe above poster is entirely wrong. The DISPENSING nurse would be held accountable first and foremost by all courts anywhere.
    Prescribers of any kind hold responsibility for the prescription only, and in hospitals pharmacists and nurses constantly vet prescriptions for errors, thus it is almost certain unlikely that the prescriber would be first blamed because of the sheer number of dispensers (nurses and pharmacists) who stand between the prescription to dispensing line. So please read up. you and you alone are responsible for drug administration errors.
    your argument would not and has almost never stood up in court particularly for rotuine prescriptions and administrations.

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  • i haver read with interest the comments that marks article has generated and although i can see that some of his comments are said with tongue in cheek 4years ago a family member spent 6 months in 2 acute hospitals and i as a trained nurse was spending up to 18 hours and longer a day by their bedside from personal experience i witnessed junior doctors and their seniors arrogance at first hand, very often they failed to disclose that they were practicing had never carried out painful procedures previously and were quite arrogant when challenged and there still appears to be a close ranks situation when family or patient complain (this also applies to nurses as well) whilst i welcome the limit to hours junior doctors work but we still have a long way to go in the NHS to get a fair system where by patients and all staff are treated with the same respect by their peers and i dont see that happening any time soon

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