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LETTERS: Andrew Short Junior doctors' shifts and sleep deprivation: Pendulum is still swinging BMJ 2005; 331: 514-c [Full text]

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Junior doctors and moral imperatives.

Adrian R. Leahy   (7 September 2005)

Junior doctors and moral imperatives. 7 September 2005
Adrian R. Leahy, Staff Grade Psychiatrist Guild Lodge, Preston PR3 2AZ Send response to journal: Re: Junior doctors and moral imperatives.	Dr. Short misses a number of important issues when comparing stoical nursing staff and industrial labourers to junior doctors working on night shifts. The most important is obviously that nurses are only contracted to work 37 and a half hours a week and no more. In my experience most nurses rarely work more than four nights consecutively and only volunteer to do more because of a personal interest in the time off accrued at the end of it or the enhanced pay rate. Few junior doctors I know have ever volunteered to work like this because there is no reward comparable. On the matter of being paid to sleep, a partial shift is not a full working shift and I should be most surprised to hear that the industrious labour force to whom Dr Short alludes would be happy to work in excess of their forty hour week and perform a seven day night shift without some form of impressive overtime rate. I just wonder if some Health and Safety objection might not be raised if it were suggested that they work for seven consecutive twelve hour shifts,eighty four hours in a week, without some break, most especially if the potential for danger existed in the event of an error. As a general management rule, if not enough staff are available to complete a task, it is only sensible to hire some more. If not enough money is available, then it is clear that an error has occurred at the planning stage. There are many doctors available to work at the present and the planning which caused the present difficulties was never under the purview of any junior doctors. Criticism of junior colleagues, even indirectly, will only serve to reinforce the culture of blame that is now metastasing throughout the Health Service. Let us put an end to this anachronisnistic and wilful ill-usage of our colleagues and the narcissistic defence of this abuse by the insistence that as doctors, we are exceptional people and that this is the tariff due that we might maintain our status. Nobody else would do this and nobody else is impressed. In my view, the only sensible way forward is to start afresh and plan a correctly staffed service. It will be more expensive, but to try and keep the ideal of self-sacrifice alive as a model for planning a professional service in the 21st century is not realistic. Inhumanity is always a cheaper option, consider Industrial Revolution factory conditions or indeed slavery. What loving parent would insist that their child worked seven night shifts, 84 hours in a week ? Or does stuffing their mouth with gold coins to suppress the sound of their crying make it all alright? Competing interests: Long history of unreasonable hours worked as a junior doctor