More on doctors and pilots

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7368.839/a (Published 12 October 2002) Cite this as: BMJ 2002;325:839

Monitoring by Big Brother may not be a Bad Thing

  1. Peter A West, director (paw11{at}york.ac.uk)
  1. York Health Economics Consortium, University of York, York YO10 5NH
  2. Beaumont Hospital, Dublin 9, Republic of Ireland

    EDITOR—I endorse the concerns of Macdonald about the work of his doctor son compared with that of his pilot son.1 But aside from the reasons given for their very different conditions, I believe that history plays a part.

    Air flight is a modern trade, born into a modern age with sophisticated citizens and a strong legislative framework, even at the start and more so today. Doctors share this environment now, but medicine developed as a profession with unsophisticated citizens, a much weaker framework of government and legislation, and much greater emphasis on self employment.

    I believe that this has contributed to a culture in medicine that resists the kinds of monitoring that airline pilots take for granted. Airline pilots cannot fly privately for other airlines at weekends (I assume) within their contracts, and they are expected to arrive for work suitably rested. Without denying doctors their rights to earn their income where they can, I see no enthusiasm from doctors for close monitoring of how they spend their time, even in the NHS. Yet without this monitoring, those who fund or analyse the NHS can continue to believe that low productivity, not necessarily low staffing, is a root cause of the problems.

    To a considerable degree, airline pilots may have Big Brother watching them, but partly to protect them and the public. If a pilot were working outside his or her hours, the plane would not take off. Perhaps we should be prepared to face this in the NHS too, with operations stopping when a surgeon is working outside of hours. But for this to happen, the profession would need to accept that monitoring by Big Brother has something to offer rather than tending to see it as a threat.


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    Doctors have only themselves to blame

    1. Ian Callanan, patient services manager (ian.callanan{at}beaumont.ie)
    1. York Health Economics Consortium, University of York, York YO10 5NH
    2. Beaumont Hospital, Dublin 9, Republic of Ireland

      EDITOR—Much of the sentiment in Macdonald's opinion piece comparing doctors and pilots is entirely accurate.1 Doctors, however, should carry the blame for the way things are.

      For too long we as doctors have whinged about overworking; yet when working times were reduced, we whinged about the reduced training options, the lack of experience, the advent of shiftwork (very much an issue here in the Republic of Ireland). We cannot have it all ways.

      Pilots are subjected to exemplary training requirements and supervision. As an orthopaedic senior registrar I was often supervised and often not. Teaching was of the “stand at the front of the class” type. Training sessions were scheduled at 7.30 am on a Saturday so that “other work” in other hospitals could be done.

      Who decided this? The profession and its members.

      Now that I have moved into medical management, I am continually surprised at the major obstruction to reforms of working hours from inside the profession. I also recognise that much of this results from doctors, with the highest altruistic dedication, taking on huge workloads, trying to be all things to all people, and getting a kick out of being busy, helping people, curing patients, and saving lives. We have but ourselves to blame.

      Rather than bemoaning our plight, we could look at the work that was done in the airline industry to enhance teamwork, improve safety, and open up communication between staff of all levels of experience. Then we might have fewer problems with medical negligence, near miss incidents, and clinical notes that are illegible, deficient, inaccurate, or obtuse (startling evidence of current practice).

      We must either grow up and face reality or be enslaved by others who will impose it on us.


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