Knitting the Ravelled Sleeve of Care - Junior Doctors Still Need Safe Working Hours

25/07/2016 11:17 | Updated 25 July 2016

On July 5th 2016,over two thirds of the 54,000 junior doctors, final and penultimate-year medical students voted against accepting the new junior doctor contract. The majority of these doctors clearly still consider the new offer to be unfair and unsafe. This voting pattern was considerably less marginal than the EU Referendum vote, yet like it or not, this re-negotiated contract is still set to be imposed on all junior doctors in England.

I still reminisce about what was far from a golden era of working straight from 9am on a Friday to 5pm on a Monday. I can recall vividly spending most of the day running up and down flights of stairs at Charing Cross Hospital as houseman in the baking summer of 1989, often only having time to drink less than half a litre of fluid a day. One night on call, I felt so hungry that I ate a whole large pizza, not having eaten for 18 hours straight. The broken sleep that I did get was filled with vivid dreams that were frightening and a true sign of chronic sleep deprivation. You don't easily forget those days.

A recent GMC survey found that 25 per cent of junior doctors reported that their working pattern left them feeling short of sleep on a daily basis. In spite of this, there is little provision for ensuring adequate sleep at a time when our brains are programmed not to be awake but we have still not tackled these problems as a profession. A survey by the London junior doctors in paediatrics found that nearly a third of doctors were actively discouraged from taking naps during night shifts. That doesn't bode well for clinical decision-making.

There may now be some hope for the future. The new junior contract incorporates what could act as a safety valve that helps to spot, regulate and report unsafe working hours. The doctors responsible for this are called Guardians of Safe Working Hours. Many junior doctors remain sceptical about the role of these senior doctors, even though they are recruited from a pool of consultants who are independent of Trust management. Here, I have to disagree. I have high hopes for the consultants filling these Guardian positions. They will be those who have to show a commitment to the training of junior doctors. Not afraid to speak out for doctors. Not afraid to provide evidence for unsafe working hours. Not afraid to raise concerns and see these addressed in a timely way.

No sooner have junior doctors move from the sleep-deprived world of frontline on-call work, they are thrust into the world of taking decisions about patients' lives as a consultant or GP. These are roles that are in themselves inherently stressful. A retired consultant was once asked "So, how is retirement?" to be met with the answer "Better. After 40 years, I can sleep through the night". Some specialties have added layers of stress, such as general practice, emergency medicine and psychiatry to name but three, where there may be professional isolation and a lack of positive feedback.

We have known for many years that tired doctors make mistakes. Sleep loss in doctors is associated with both changes in mood and work performance. It will up to Guardians to protect junior doctors from excessive fatigue through safeguarding their working hours. These doctors will also have families, many will commute long distances and to cap it all, they will also be studying for exams. They are not super-humans but conscientious individuals who are dedicated to providing the best possible patient care. Exploiting their working hours will inevitably push them out of medicine completely. Most will now be set to retire at the age of 68 or perhaps even older. That is if they survive until that age, given the culmination of years of tireless (or perhaps I should say tiring) dedication to their vocation.

In the end, junior doctors will look after you day and night. Now someone needs to look after them. Safe doctors will mean and always has meant safer patient care. It is time for the new Guardians of Safe Working Hours to step up to the plate.