'Current generation of doctors work less hard for more money and fewer hours'
Dr Henry Goodall, a retired Consultant Occupational Physician, gives his personal perspective on the junior doctors' strike in England that saw thousands picketing in response to government changes to working hours.
I read with sadness the ITV News article by the junior doctor Dr Aoife Abbey. I thought that it would be informative to compare her experience with mine, as a junior doctor in Southampton in 1970.
I qualified as a doctor at King's College Hospital in London in 1969 and worked first in a six-month surgical and orthopaedic post at Bromley Hospital in Kent. Working hours were usually 7.30am to 11pm Monday to Friday, plus alternate nights and weekends ‘on call’ for admissions (including emergencies) and covering the wards.
Two 'housemen' (pre-registration junior doctors) covered 100 beds, with two Registrars (older junior doctors), one of whom was 'on call' at night.
In addition to caring for our own patients, we were expected to carry out all necessary preparations for the eye surgery patients, prior to their operations, which often involved detailed X-rays, ECGs and other tests, as many were in poor health and 'at risk', when having a general anaesthetic.
An 'on call' night would usually include at least two to three phone calls from nursing staff, requesting advice or action on the wards, as well as emergency admissions, which could take up to two hours at a time, or longer if emergency surgery was necessary during the night. We still had to do a full day’s work the next day. We learned fast and became competent quickly.
My next six month medical post was at the Royal South Hants Hospital, in Southampton, under a very experienced Consultant Physician, Dr Kenneth Robertson.
The General Medical Team consisted of two 'housemen' (both me and my colleague were qualified less than a year), one Senior House Officer and an experienced locum Senior Registrar, working for two consultants.
We had 72 beds, and were on call alternate nights and weekends, rotating the General Medical 'take' (admissions) equally with the Southampton General Hospital, which had the much larger resources of 110 beds and 7 junior medical unit doctors.
I was on call 128 hours a week, actually working between 70 and 90 hours every week, excluding eating, sleeping and toilet/bath necessities; normally working from 8am until 1.30am or later, when 'on call'. I hardly ever had an unbroken night’s sleep when on call.
Weekends on General Medical 'take' lasted continuously from 9am on Friday to 9am on Monday, during which time we were the sole admitting hospital for the 250,000 plus population of the whole Southampton area.
Usually, the Senior House Officer or Senior Registrar on call would come in and cover me, on Sunday afternoons, as by then two to three hours’ sleep was necessary, to enable me to work effectively through to Monday morning, when the routine consultant’s ward round would last all morning. After a weekend on 'take', we were allowed Monday afternoon off-duty.
I had one hour per day to eat three meals. We ate, worked and communicated fast and effectively. We admitted an average of 15 to 20 new patients in an 'on take' 24-hour period and five to 10 on a 'non-take' weekday.
The A&E unit was then sited at the South Hants, so we also admitted all 'medical' patients from A&E, including all their patients with strokes and heart attacks.
Most admissions were seriously ill; the highest number that I admitted in one 48-hour weekend period was 37. To my knowledge, no-one died in that time under our care, on my watch, due to 'tired doctors'.
Holiday cover (two weeks in six months) was rarely advertised and arranged in time by administrators, so often junior doctors found themselves covering for absent colleagues, during their leave, on top of their own workload.
It was a demanding schedule, but we learned quickly and well, taking responsibility and decisions, of necessity, as our more senior colleagues were often 10 to 20 miles away running clinics all day in outlying hospitals. I only recall one patient dying of a relatively rare medical complication because of my own and the Senior House Officer’s inexperience, in nine months in the post (I stayed on in the post for a further three months to dovetail with my next appointment).
We did not have computers, mobile phones, extra duty payments or ‘on call’ payments.
We wrote all the notes by hand and spent many hours chasing up blood test results and absent 'real' X-rays. We commonly took our own patients’ routine blood samples.
We did not leave the hospital at 5pm to go home to families, or even to our small bedrooms in the on-site hospital accommodation, where we slept.
We lived to work. We were young, fit and healthy, and eager to work and to learn.
We did not expect high pay, but hoped one day to achieve a good living, when we reached our 40s (we were paid £1,250 per year in our first year after qualifying, before tax). We revered our consultants and the ward sisters, for their dedication, knowledge and experience.
This was normal in 1970. While this level of work pressure seems extreme by today’s standards, it equipped us effectively to become useful and safe doctors, confident in our own ability, very early in our careers.
While no one would want to continue at such a pace for more than a few years, General Practice was also demanding in the 1970s and 80s: one in three night and weekend 'on call' rotas and home visiting lists of 10 to 12 per GP per day were the norm in many practices.
I once did 17 home visits and saw 40+ patients in surgeries during a normal working day, followed by a night on call and another normal working day, the next day.
In the interim, the night and weekend cover requirements have been reduced; locum services often take hours to attend ill patients at home and generations of hospital doctors have become used to fewer hours at work and on call. The European Working Time Directive has exacerbated their situation.
However, medicine is a profession and a calling, serving patients’ needs, not an ordinary 'job'.
As doctors, we make personal sacrifices but are privileged in many ways, in the community.
The requirement for the profession to adapt to and satisfy the increasing 24/7 needs of an ageing population, utilising all available skills and equipment most efficiently, is paramount (and obvious).
The NHS needs many more UK trained nurses and physiotherapists and the resurrection of the state-enrolled nurse role, to improve the provision of 'hands on' community and bedside care.
Patient safety is not the most important issue here, as suggested by some junior doctor representatives; high standards of training, commitment, dedication, competence and service are. If all these are a given, patients will be well safeguarded.
The truth is that today’s junior doctors have become used to working less hard for less hours and more remuneration than the junior doctors of their parents’ and grandparents’ generations did, through no fault of their own. And the pendulum must now swing back once again, to enable and require them to work longer (and smarter) into the future.
Ars longa, vita brevis (The Latin translation of Hippocrates’ Aphorismi) - "The art is long and life is short".
If today’s junior doctors are dissatisfied with their much improved lot, compared with 1970, then they would do better to submit undated resignation letters to the BMA, en masse, which would be a proper professional approach to the current situation.
Strikes (and threats of strikes) will inevitably result in increased patient suffering and, most probably, deaths and will diminish the profession’s reputation still further, with the public. This will be bad for both doctors and their patients.
These are the personal views of Dr Henry Goodall.
Read more: Junior doctor: The prospect of more strikes is daunting