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!!

Prestige, I think.
Also, people are genuinely keen to look after patients and do not realize until halfway through med school how awful the conditions and pay really are.
I am a retired midwife and I wouldn't want to be a doctor for any money. The responsibilities are so enormous and the rewards so paltry.

I haven't looked at the figures closely recently but remember reading that the junior doctors basic pay is 13.50 pounds per hour!
Less than a supermarket worker..
their monthly pay goes up
As they do lot of hours in a week

Why don’t people say no.

@4thtimeunlucky

A) I thought I would be able to help those in need and would be able to take pride in caring for the sick. I'm very empathetic and I've always cared for people regardless of their circumstances. I also thought doctors were respected members of society who got a decent wage. Pay for doctors wasn't bad 15 years ago.

B) The lack of doctors being trained is an intentional move by the government. There are or can be enough doctors. Even if you don't want to train UK doctors there are plenty of oversea medics who would come to the UK.

This thread brings back some pretty stressful memories. I qualified as a doctor in 1980, and we worked alternate 72 hour and 120 hour weeks. A single continuous shift at the weekend was 80 hours - Friday 8am til Monday 5pm. And you came back on Tuesday morning to do another 32 hour shift, til Wednesday evening.
You didn’t dare pester the consultant at night - they were at home, 12 miles away, asleep. While you, newly qualified, were responsible for 90 adult surgical beds and 10 paediatric surgical beds, plus emergency admissions.
In those days, you worked at high speed. One operating theatre would do up to 23 cases a day, including major surgery, then start on the emergencies at 5pm. I used to put three Yorkie bars on my anaesthetic machine and live off them all day. You didn’t get a lunch break to go and eat an actual meal.
My worst stint was as a house officer in geriatrics, covering two hospitals five miles apart. I was on for 17 days and nights continuously- as we had to cover our colleagues’ annual leave, and the hospital wouldn’t pay for a locum.
If anything, Kay’s book understates it, but he is a lot younger than me, so things had improved a bit by his time.

You will have to complain about your boss and his/ her reference is generally needed for your next job.,
You do need your seniors help to do your job and your life can be difficult.
Culture is that you don't complain- if you complain then you are branded a trouble maker.

That’s truly horrifying. During labour I was awake for about 54 hours straight. By the time the doctor came to consent me for an EMCS, I was so tired I was seeing double, struggled to sign the consent form and was so confused, I told the doctor it was good I was having a planned CS and not an emergency one.

The idea that the doctor might have been as tired as me is something I don’t want to think about. I hope she wasn’t seeing double as she cut into my abdomen.

DH is retired now. For the first 10 years of our relationship (first 6 married) he worked 120 hours a week. His take home pay was around £3 per hour. Team work was generally good, the juniors on call at least had a doctors' mess with tea and coffee, a fridge and sofas. They had an on call room with a bed in it, even if they never actually got to lie on it. Weekends on call started on Friday morning and finished on Monday evening. Time on call was paid at a much lower rate as it was assumed they would be asleep for some of the time...
Some bosses were nice and others were awful.
When he eventually made consultant in the early 90s after lots of very expensive exams, we thought things would get better. But everything changed and I reckon he worked at least 30% more than his contracted hours consistently for the next 30 years.
That book is very accurate. Things have changed in many ways since then, but not for the better.
I think he would do the same again. I love him dearly and am proud of him, but I do wonder if I would have made a different choice, given how hard it was bringing up children with someone who was either absent or exhausted.

Pretty accurate account. My husband couldn’t get annual leave approved for his own wedding!!

I imagine it's physically demanding as well as you are on your feet all day. And then the mental exhaustion must be devastating. I know there are people working in long hours jobs but I think it must be unique to have such a physically AND mentally demanding job.

Are other countries as bad in the way they treat junior doctor?

Can it change if there was the will?

Pretty accurate for the time. At the end of my first year as a junior doctor, in the 90s, I calculated that I had already done the equivalent of 120 9-5 days of unpaid overtime. I was probably one of the last people to do old fashioned weekends: start Friday am, and finish Monday teatime. Thank god the doctors in training are no longer allowed to work that. But as a consultant I am still expected to work the day, be oncall the night, and still work the next day. Weekends are still 52 hours.

Yep, it’s accurate. I remember presenting a patient on the post take round that I had hallucinated from lack of sleep. Didn’t exist at all. Having little microsleeps whenever anyone else was speaking on the post take round, which often went on until mid afternoon and you weren’t allowed to leave, even though you were due back in again that night. And then having to get in my car and drive 60 miles home. I had a favourite petrol station on the A22 that I used to stop at for a coffee and a quick nap.

It stood me in very good stead for having a newborn! And it doesn’t change that much as a consultant - I’m typing this in between signing off some clinic letters, at midnight, due in work at 8am tomorrow. I probably do 50-55 hours in a normal week, obviously much more when I am on call (when I am basically resident in the hospital for a week).

Why does anyone sign up to do it? It is a great job. Very rewarding, lots of variety, mentally stimulating. I actually absolutely loved being a junior doctor. It takes over your whole life, basically becomes your identity, but medicine, my branch anyway, is very much a family and you get Stockholm syndrome, I think.

I’d rather do it part time. But my experience of being part time in the past is that your workload is the same, you are just expected to do it in fewer days and for less money.

I remember around the time DH qualified, a junior doctor was found dead in the hospital grounds having collapsed in the snow on his way home. I think the cause was put down to exhaustion. I used to worry about DH driving home after a weekend on call.

You have to understand the culture of NHS, its such a monopoly that you can't just say nah I'm out if you don't agree to the crappy terms because it's the only place to be in training in the UK. So junior doctors are expected to come in early before their shift and complete their (usuaully understaffed) jobs list which takes them well over 2 hours extra a night. There's no Dr's room in a lot of wards so they'll be doing that at the nurses station and the nurse will say oh can you please come to room 2, he's desaturating and tachycardic I'm really worried about him, and of course they go because its life or death and then end up staying even later. And if you speak up (on the fact that you are scraping minimum wage for the hours you actually do) you get a name for yourself as difficult and get "in my day we did .......".
They have to rotate and move hospital every few months and often aren't seen as part of the team as them being there is so transient and its very difficult to work in such a high stress environment where one decision can be the difference between life and death without knowing the team you have around you really well. They need to have no more than x amount of sick days (which led to a close friend going back 4 days after a miscarriage at 20 weeks) and provide multiple sources of feedback for their competency review.

I genuinely don't know how they do it, will always make a cup of tea and toast at 0300 for my colleagues and try not to bleep them for stupid reasons.

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

Combination of artificially keeping numbers down (government choice, assume cost-related - they don’t want to have to pay for more doctors).

And practically, there is a limit to how many doctor we can train per year. Medical students need placements, teaching, practical experience - all of which is done for free, in consultants’ own time (I was examining medical student finals today, unpaid, which is why I am working late tonight doing my admin). I’m doing classroom teaching on Friday, which again is not in my job plan, so will be doing more work over the weekend. There is a limit to how much teaching I can offer for free without impacting service provision. Multiply that by the rest of the NHS - you can’t double the number of medical students overnight, there is nowhere to put them. We could train more than we do, but not that many more. The students already complain it is like a conveyor belt.

I qualified in 1997. I would often work 100hr+ weeks. I remember many nights dashing from ward to ward at around 3am and being so thirsty/hungry as it was many many hours since I'd last ate or drank anything. I remember having to be on the on call rota throughout all of my first pregnancy. I still vividly recall one night , I was pregnant with my first baby, in my third trimester, walking across the hospital car park at around 4 am when I'd been working for more than 36 hours striaght, sitting down on the car park floor, leaning against a wall and crying cause I honestly didnt think I had the enegy to keep walking across to the ward I needed to go to. We were regularly shouted at/berated/publically humiliated by the older consultants. I even had many comments about how I shouldnt be working if I was going to have children when I was pregnant from my particularly unpleasant consultant at the time.Thinking about it now it is all really shocking. The thing is everyone just sort of accepted it was how it was back then.

Whilst nowhere near as brutal as the NHS, DH is a police officer and does six shifts in a row (two early, two late and two nights), usually 10-12hrs on paper (longer in reality) so between a 60 and 72hr week minimum. No breaks, poor support and a toxic acceptance of treating staff this way. No annual leave in summer holidays, had one Christmas day off in 2 decades, called in at short notice even when on leave. It's killing him.

The public perception of public sector cushty jobs with wonderful pay and pensions is so far from the mark.

We were in call in the 80s but rarely slept as we were up and down all night. In my first job I had to sleep in a camp bed in the consultants office so I was near CCU. One Saturday morning I went back to my bed at 6.30 and found the cleaner folding it up and putting it away. As she was getting paid more per hour than I was at this time of the day I persuaded her to put it back so I could collapse on it to get some sleep. The 48hr directive now is a laugh as they average it out over several weeks so some weeks you will work 20 hours and some 76!!

The advice for car/truck drives is don't drive tired so I don't see why hospitals should (note I said should I know they have too) be able to have long shifts

I don't think it is safe to work with lack of sleep, it should be a health an safety issue

The nhs and schools are ran on the good will of people who are completely taken advantage of. Massively underpaid and overworked.

I'm not a doctor but surely the shit conditions and crazy working hours for junior doctors are a sort of trial by fire which if you succeed you can then end up as a consultant, treated like God, earning ££££ and then play golf on your shifts whilst taking the odd phone call. I'm having some private medical treatment next month; my consultant (lovely man) will waft in in his designer suit, being salaamed to by nurses, do a procedure that will take about 20 mins and then charge me £5k.

There are many people in this world that I feel sorry for but believe me, doctors are not on that list.

We ask for basic amenities as doctors but these are not met at all. In fact I have seen these amenities deteriorate over the last 10 years.
I was so fed up last week and thought that I should start private work. I strongly believe in nhs and haven't done any private work so far. I was thinking about starting a private practice- not for money but thought at least I will have control of my time and will be treated better!

I think you have missed the point of this thread entirely . The level of exhaustion that people are describing means that the patients that they treated were receiving poor care at best and care which was a risk to life at worst. Would you be happy for someone you loved to receive this standard of care? Its not about money for junior doctors, its about being able to look after patients in the way that they have been taught, to preserve life and health .

Have you read any of the messages on the thread?!

There are a small number of doctors who only work in the private sector, usually in a speciality that earns big bucks. DH trained with one who was a very talented plastic surgeon who got out of the NHS as soon as he could.

You clearly have no clue what consultants working in the NHS actually do. You are very fortunate to be able to afford private care.