BMJ  2004;329 (7 August), doi:10.1136/bmj.329.7461.0-g

Editor's choice

All doctors have a personal horror story

Most doctors have at some time borne the broken look of Marlon Brando's Colonel Kurtz in Apocalypse Now, dehumanised by the Vietnam War. For me, "the horror" was over 10 years ago as a preregistration doctor in surgery at St James's Hospital, Leeds, about the time the European Working Time Directive was conceived by people with time to think. I began a weekend shift at 8 am on Saturday morning, an endless ward round of patients I'd never seen before with illnesses I little understood. I finished at 9 pm on Monday after non-stop calls—mostly straightforward but many bewilderingly complex—a couple of cheese sandwiches, a few cans of soft drinks, and three hours of broken sleep on a two seater sofa.

At some point on Sunday evening my fellow junior doctors and I cracked. Overworked, sleepless in surgery, every incident and comment greeted with unstoppable mirth, professionalism replaced by inane amusement at our predicament. By Monday evening we were catatonic Brandos. Sharing this rite of passage with senior colleagues attracted little sympathy: "In my day we had it much worse; whole weeks on call without a break." "The experience will be good for you." But was the experience any good for patients? Was it really any good for any of the doctors who lived it then and live it now? Too much mistreatment of doctors and patients has been excused by what is deemed good for us.

This week, the working time directive should mean fewer doctors in training work more than 58 hours a week (p 310). Rhona MacDonald describes how organisers of health care have had to innovate by rethinking out of hours cover and switching to competency based training (p 301). New medical schools have opened in England to supply enough doctors to compensate some far off day for this reduction in working hours (p 327). What hope that doctors in training will see real benefit? MacDonald, a passionate Scot, argues that those already exploited—doctors from poorer countries and non career grades—will be further exploited for doctors in training to benefit. This well meaning legislation—legislation that doctors know to be inapplicable without major reform of the medical workforce and medical training—is proving hard to implement, as our European round up shows (p 310).

Richard Smith, another passionate Scot—by choice, not by birth—left the BMJ last week (p 309). He devoted 25 years of inexhaustible energy to this publication—13 years as one of its greatest editors—one eye on blue skies the other on fine detail, working at full tilt to the end as he promised, in defiance of any working time directive. He leaves behind a young team—plus some wise heads—dedicated to building on his considerable achievements. The BMJ will miss his genius and his gusto. But as he once told me: "Nobody is bigger than the BMJ, not even me."

Kamran Abbasi, acting editor

(kabbasi{at}bmj.com)

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How protective is the working time directive?
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Rapid Responses:

Read all Rapid Responses

Hopefully, doctors in future may not have horror stories! At least not of this kind!
Padmini Venkataramani
bmj.com, 5 Aug 2004 [Full text]
No one dies of over work
Ashish Goel
bmj.com, 5 Aug 2004 [Full text]
Death Of The '104-Hour' Working Week : Fiat Justicia Pereat Mundus
Joseph . C . Obi
bmj.com, 9 Aug 2004 [Full text]
Readying for lengthy working hours
Laxmi Vilas Ghimire
bmj.com, 7 Aug 2004 [Full text]
India needs to think differently
Abhijit M Bal
bmj.com, 7 Aug 2004 [Full text]
Stay hungry and feel the joy
Abhijit M Bal
bmj.com, 7 Aug 2004 [Full text]
Re: No one dies of over work
David Carvel
bmj.com, 7 Aug 2004 [Full text]
Doctor's Horror in Developed and Developing Countries
Matiram Pun
bmj.com, 7 Aug 2004 [Full text]
Mixed feeling
Halina M. Iwanowska
bmj.com, 7 Aug 2004 [Full text]
Re: No one dies of over work
mike green
bmj.com, 7 Aug 2004 [Full text]
TOO MUCH WORK IN BRAZIL
CELIO LEVYMAN,MD,ScM
bmj.com, 7 Aug 2004 [Full text]
Re: No one dies of over work
Alan E O'Connor
bmj.com, 8 Aug 2004 [Full text]
Where are the data to support our gut feeling?
Pinchas Halpern
bmj.com, 8 Aug 2004 [Full text]
Do a billion Indians think the same?
Jayaprakash Gosalakkal
bmj.com, 8 Aug 2004 [Full text]
To err is human , but...
Farheena N Mecci, et al.
bmj.com, 9 Aug 2004 [Full text]
Amazing debate
Ashish Goel
bmj.com, 9 Aug 2004 [Full text]
"He took eighty calls in one shift"
Phillip J. Colquitt
bmj.com, 10 Aug 2004 [Full text]
Re: Amazing debate
P.N Kiran
bmj.com, 11 Aug 2004 [Full text]
Ethical Working Time directive & junior doctors adaptation
Ruchir D Trivedi, et al.
bmj.com, 11 Aug 2004 [Full text]
Limited hours of working during training period?
Arun Bharthuar
bmj.com, 12 Aug 2004 [Full text]
Re: No one dies of over work
Matthew L Keating
bmj.com, 12 Aug 2004 [Full text]
Stop the torture...
Raha Shojai
bmj.com, 12 Aug 2004 [Full text]
Managing hours, stress, continuity of care and junior doctor training
Steven M Rudolphy
bmj.com, 6 Sep 2004 [Full text]
Re: No one dies of over work
shripada rao
bmj.com, 9 Sep 2004 [Full text]
Horror begins at home.
Abid Rashid, et al.
bmj.com, 6 Jan 2005 [Full text]
The real reason behind endless working hours
vineet gupta
bmj.com, 12 Jan 2005 [Full text]
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