Questions for doctors - I've just read This Will Hurt

[banoffipies]

I am seriously shocked by the hours that the author had to work, as well as by the working conditions in general: understaffing, inadequate support, having to arrange cover for his own sick leave, having to cancel holidays, not getting time to eat at work etc.

If you are, or have been, a junior doctor, I'd be interested to know - has your experience of it been the same as his? I realize the NHS is under particularly high pressure at the moment, so would be interested to hear your experiences of what it was like before the pandemic as well as now.

I'm puzzled by the hours. I don't doubt that the author is telling the truth, but friends who are doctors don't seem to work, or to have worked, such insane hours. I wonder whether the author was particularly unlucky with the hospitals where he worked, or whether obs and gynae is especially bad for hours?

Also: thank you so much for the work you do!!

I was a junior doctor before Adam’s time and the book really resonated with me, the hours, the stress, all of it.

In my era (qualified in 1991) the hours were bad in all specialities unless we worked shifts, which we did in A and E. In those days I sometimes worked 120 hour weeks- you were dead on your feet and I’m sure mistakes were made. Being on call for obstetrics was particularly stressful and busy but they all had their moments.

The ridiculous hours for junior doctors have stopped, but obviously there are other stresses now.

The EU working conditions law mean that no member of staff should work more than 48 hours a week on average but on my rota some weeks are 70 hours. My last hospital pressured/tricked mostly foreign junior doctors to opt out of the EU regulations so many of those members of staff work beyond 48 hours a week.

The book completely resonates with me though. On my current post there is not enough cover to book annual leave for the doctors so we are being assigned random days off over the next few months which doesn't even amount to our total annual leave. Last week I called in sick with a migraine and was told to come in to prove I was unwell. I requested to come off the rota during my first trimester of pregnancy and was told it was too early in pregnancy to make changes though I suffer from HG and knew I couldn't cope without a lunch break or food/water. Ended up fainting and falling down the stairs .... The list goes on and on and on. All doctors have had these experiences, we just get used to the toxic culture.

Also the NHS was broken before the pandemic.

Not a doctor but staff wouldnt be striking for no reason! Also worked in the NHS in emergency care and 100% agree its a toxic and frankly unsafe workplace

We went to A&E twice in about 15 hours 7 years ago and saw the same doctor - he looked way more tired the 2nd time, I'm sure he hadn't been home!

Adam was in the year above me at medical school and it seemed pretty accurate when I read it. We had to sign something in our contract to opt out of he European working time directive.

The thing is that managers know they shouldn’t be expecting people to work over 48 hrs or expect a pregnant woman to work through HG. They know that and to do otherwise is negligent. In the 90’s they was a change from the 80’s where doctors were on call but had sleep and just got beeped for emergencies. In the 90’s doctors were pressured just to work through, didn’t have a bed to get a few winks in, didn’t have subsidised meals, accommodation or on-site social clubs so the whole job got harder and less fun.

I left med school in my penultimate year. I couldn't actually finish the book as I found it really triggering.

Just to clarify I meant to come off the on-call rota* as the 13hr shifts were too much of a struggle with HG and those shifts were known to be busy with no/inadequate tims for a break.

I was a junior doctor in the 90's, the working hours were insane. Looking back I really don't know how I managed.
When I was a registrar ( training to become a consultant in a certain speciality ) I routinely carried chocolate bars to give my juniors as most often we did not get time to eat.
When I was pregnant with my eldest with severe HG, the only way I could go to job was to not eat or drink anything in the morning. The nurses took pity on me and used to call me into their room to give some ginger biscuits at around 11:00 am as I had almost fainted on few occasions. Did on call till the beginning of third trimester as could not come out of the on call rota.,
I distinctly remember on one occasion, I was so hungry at around midday ( pregnant with my eldest ) and asked if I could go for lunch for 15 mins. Was refused permission and asked to finish certain non urgent jobs on the ward. I am a strong person but it broke me.. I cried. My boss was not a nice man.
We were asked to come to the wards at 7:30 am although we did not officially start till 9:00am. I did not have immediately family and it was a nightmare sorting childcare starting that early.
I could go on and on..

Exactly the same experience. If anything he underplayed it in the book. Doctors are killing themselves every week.

Yes, late 90’s early 2000’s. I used to start a weekend (1 in 3) at 8am on Saturday morning & finish at 6pm on Monday evening. 58 hours straight, it was brutal. Some weeks I only went home for 3 nights, the rest of the time I was at work, > 100 hours/week regularly.

My first day as a doctor:

I turned up to the ward for induction but when I arrived no senior doctor was there. The nurse came and said, "we are so sorry but we don't have any doctors on the ward can you please help out." I asked her to call the consultant but he was in clinic covering it for another consultant.

I had no computer login, no ID card, didn't know where anything was and didn't know any of the patients. Another foreign doctor was with me and although we were at the same level he was very experienced in his county. He covered the ward with the "support" of a senior registrar in charge of another ward but who was covering what seemed like the whole hospital.

How could I forget 1:3 weekends, if you are married to another doctor doing 1:3/4 weekends. You hardly get to spend time with each other !

Reading this made me cry. I genuinely hoped I was the only person to have experienced something like this because it is just so awful and dehumanising. There must be so many pregnant doctors who get treated this way. I actually believed that maybe my experience was exceptional but ofcourse not.

Some of the consultants had to fight to make the management take into account of the extra hours junior doctors worked during covid. It was a disgrace.. Most of the junior doctors were fab and were flexible to accommodate the ever changing demand during covid.

Even now, the junior doctors don't get paid for all the hours they work. They are put in a difficult position - they can never finish their job before their finish time and they over stay most days of the week but this is not recognised and paid. They know if they don't do their job, treatment / investigation/ discharges gets delayed !

I read the book and it rang true to life.

I watched about 30 minutes of the TV programme and it gave me such vivid flashbacks to some of the worst moments of my career I cried.

I've been qualified for 20 years.

The juniors now work fewer hours on paper but often stay late, there seem to be fewer of them around at any one time which makes their jobs harder and the "firm" set up that was still vaguely functional when I was doing junior ward level jobs so you had continuity with registrars/ consultants who looked out for you has now well and truly gone.

It is really common to hear people having huge wrangles to get annual leave for their weddings etc. Even now my colleagues and I swap on calls if we are sick.

And our pay is terrible now due to stagnation. Someone on social media looked out one of their pay slips from the early 2000s they were getting the same then as their junior doctors gets now. Think how much house prices, petrol and food have increased since then and also how much extra debt medical students graduate with. £2400 after tax went a hell of a lot further in 2005 than it does in 2023.

I qualified after the European working time directive, so didn't do the 100 plus hour weeks.

However I remember living on the chocolates patients brought for the wards as I didn't have time to get anything else.

Having worse observations than some of the patients due to dehydration.

Working 10/11hr days on 'normal' days on top of a 100 mile round trip commute because you don't get much choice about where you're sent to work within your area (which are massive, e.g the whole of Yorkshire, or the whole of Wales).

Being told I can't request to not be on call for my wedding (not asking for time off, just not being on call in a rota that hadn't even been written) and I'd just have to swap it when I rotated to that hospital (4 weeks before my wedding)

Needing 7(!) people's signatures on an annual leave request form (when you can even take it)

No continuity as you're constantly on call so don't get to know your ward's patients for more than a couple of days.

Being told our long days are due to poor time management not sheer workload. Looking after three wards on my own some days.

I'm out the other side of the crap ward days, and senior roles have their own stresses. I'm glad I love the medicine otherwise I might have bailed a long time ago.

It's not just pay, it's being treated like a human that's needed too!

Yep.
I'm a junior doctor. In theory our hours are supposed to average 48 hours a week, but that's an average - every rota I've worked has individual weeks that are around 68 hours or so e.g. 5 x 13 hour shifts in 7 days. And unpaid overtime due to workload, or rota tricks like not being paid for handover, etc are on top of that. Exam study, CV building, compulsory audits and time-consuming 'eportfolio' documentation (compulsory to complete each year of training) is done in our own time.
Although consultants love to tell you the hours we work aren't a patch on what they did (you can see it on this thread), I don't think they have all grasped the intensity and patient acuity of modern shifts. I regularly work 13 hour day shifts with no more than 10 minutes break, and many equally busy night shifts. It used to be that the medical "take" of new patients from A&E wound down at some point overnight, but nowadays there are always patients waiting. Even if we did get time to take breaks, there are no on call rooms, so limited places to get proper sleep. I've lain down on the hard floor of the A&E plaster room in desperation before.
Even when working normal daytime hours on my base ward, it's typically too frantic for lunch and we finish late every day.
I have worked 1 in approx 3.5 weekends for most of my rotations. These don't have to be evenly distributed, so I've had rotas that make you work a weekend (that means 13 hour shifts Fri, Sat, Sun), then one off, then work the weekend after. 1 in 3 weekend rotas are still perfectly legal and common.
A quick search of the Reddit junior doctor forum will show you how much misery trying to get leave causes, including for e.g. one's own wedding etc etc.
Like lots of others, I'm planning to leave.
Thanks for your thanks, OP!

Oh and I'm a consultant anaesthetist. I regularly don't get lunch.

Our hospital thinks it doesn't need to follow the RCoA recommendation to have a spare consultant to provide breaks/ clinical assistance in an emergency.

Result loads of lists scheduled for all day operating being done by solo consultant anaesthetists who don't get lunch. Sometimes it's hard to even get to the loo catastrophic as I approach the menopause and have unpredictable periods.

(Depending on the list the surgeons usually manage to grab some lunch while we are either waking up or inducing patients). The theatre staff get lunch because they are funded to have spares so they rotate out.

I'm not a Dr but a nurse and I can tell you Adam Kays book is pretty spot on with the state of the NHS. I wouldn't be a Dr if you paid me a million pounds a day, crap pay, massive debt, moved from pillar to post every few months with very little appreciation.

I started a job in 2005 in June and had a family holiday planned to take my elderly grandparents to somewhere significant to them.
I needed to go to help with the driving/ care.

The rota person had two slots on a rolling rota to allocate. One would have given me my holiday easily. The other didn't.

Rota person deliberately didn't give me the rota slot that would facilitate my holiday as I had been so demanding as to contact him in February knowing I was starting there to request annual leave.

I posted on another thread about that workplace - there were lots of issues. I eventually raised a formal grievance about something else and the boss threatened me with never working in this city again if I persisted. I refused to back down.

I still work in the city but all of my more docile colleagues who were also affected backed down because of his bullying and didn't get the back pay they deserved when the grievance was upheld. It still makes me angry.

To the consultants .... If you could go back and leave the profession would you?

I gather it might be hard to say yes but in all honesty ...?

I'm obviously very very naive about all this but why is medical school so competitive to get into....as in
a) why do so many people actually want to sign up to be in debt, highly stressed , underpaid, overworked and unable to have any free time

b) why are there so few spaces available if enough people are mad enough to want to do it??

Absolutely agree with the previous posters, team working is gone, nature of junior doctor job is changed from my time, rotas are cleverly designed to meet EWTD but not good for doctors. I did EWTD working during my last year of reg training - preferred to do the longer hours with my own team with a place to rest.
How about a shift starting at 12:00 noon and ending at 12:00 night ( you could not hand over at 12:00 as invariably there were sick patients you were managing) so ended up sorting them out till 1:00 or 2:00 am ( you don't have car park space so you parked two street away and had rape alarm waking you your car or waited for others to finish so you walked as a group ) and drove home which was sometimes an hour away due to your job constantly changing every 6 min the to a year,
My daughter went to three different nursery before starting school. You were told a month or so before which hospital you are being sent next for training - beg for a nursery place nearer the hospital.
Appeal to the deanery so you can at least stay commutable distance to your partner.

I work in paediatrics and all I will say is that a couple of weeks ago, one doctor was on call over 3 days where she had to physically be in the hospital. On her next shift she was the only paediatric consultant on duty and she was doing the ward rounds but had to come down for an emergency NAI medical (a family of siblings) that NO ONE knew about, because she was the only paediatric doctor on duty. She ended up making one mistake that end up causing a catastrophic incident because she had to rush through the medicals due to the social worker pressuring her to do everything in a timely manner as they said they had to file paperwork before the weekend began (it was a Friday). She also felt pressured into going back to the ward to finish her round because she was the only doctor on duty that day.

I later found her in the kitchen crying, panicking and saying how tired she was and all I could do was give her a hug and offer to make her a cup of tea 😔