Professor Roy Pounder is not perhaps quite accurate in stating that
[none of the workforce] not even consultants now work continuously. When
first appointed as full time NHS consultant neurologist in 1981 I worked
a 1 in 2 on call rota, sharing the services of two neurology SHOs with my
consultant colleague. Although additional consultants appeared from 1995
and registrars from 1998, in practice I found it easier to remain on call
for my own patients on a continuous basis with occasional exceptions, at
the same time taking part in the routine on call rota for colleagues'
patients. From February 1998 until partial retirement at the end of April
2009 I spent an average 80 hours per week working at, or travelling
between three main hospital centres. I now carry out fewer clinics but
continue to be on call for my own patients.
It has always seemed easier to get to know individual patients in as
much detail as possible when seeing them for the first time, following
them personally thereafter as necessary, thus enabling small changes in
their condition to be recognised promptly whether as a result of their
illness or treatment, rather than to expend the same time and energy
becoming familiar with more patients in less detail with much less chance
of appreciating any change in their condition.
Carrying out more clinics per week than average and providing longer
clinic slots per patient than average has been a matter of personal choice
attempting to follow the example of predecessors who had learned most from
their clinical experience. Spending more time on the ward has provided
similar rewarding experience and allowed the majority of problems to be
dealt with more quickly, reducing the need to return at night.
Physicians need considerable time to follow the course of each
patient's illness, reflect on difficult diagnoses and management and
discuss their conclusions with colleagues, acquire cognitive, visual and
manual skills and techniques and sufficient experience to recognise rarer
presentations of common disorders and drug side effects and supplement
knowledge to recognise rare disorders not only within a narrow
subspecialty, to become able to provide safe and effective treatment and
to recognise the current limitations of this.
Accepting a need to be available to continue care of their patients
when necessary [i.e. for at least somewhat longer than an average 56 hours
per week] would hasten the above process, strengthen the bond between
patient [reassured that they are looked after for most of the time by
someone already familiar with their details and willing to spend more time
at work, "putting the patient first"] and doctor who may gain greater job
satisfaction. A small increase in the number of staff on call, working a
little longer, would reduce work intensity, allow more time per patient,
with less time spent in hand-over and cross-cover, with potential to
improve efficiency and safety, increase capacity to meet average and peak
demands without delay and potentially reduce staffing costs to allow a
greater proportion of the budget to be spent on diagnosis and treatment.
Rapid Response:
Working Time Regulations BMJ 2009;339;b4488
Professor Roy Pounder is not perhaps quite accurate in stating that
[none of the workforce] not even consultants now work continuously. When
first appointed as full time NHS consultant neurologist in 1981 I worked
a 1 in 2 on call rota, sharing the services of two neurology SHOs with my
consultant colleague. Although additional consultants appeared from 1995
and registrars from 1998, in practice I found it easier to remain on call
for my own patients on a continuous basis with occasional exceptions, at
the same time taking part in the routine on call rota for colleagues'
patients. From February 1998 until partial retirement at the end of April
2009 I spent an average 80 hours per week working at, or travelling
between three main hospital centres. I now carry out fewer clinics but
continue to be on call for my own patients.
It has always seemed easier to get to know individual patients in as
much detail as possible when seeing them for the first time, following
them personally thereafter as necessary, thus enabling small changes in
their condition to be recognised promptly whether as a result of their
illness or treatment, rather than to expend the same time and energy
becoming familiar with more patients in less detail with much less chance
of appreciating any change in their condition.
Carrying out more clinics per week than average and providing longer
clinic slots per patient than average has been a matter of personal choice
attempting to follow the example of predecessors who had learned most from
their clinical experience. Spending more time on the ward has provided
similar rewarding experience and allowed the majority of problems to be
dealt with more quickly, reducing the need to return at night.
Physicians need considerable time to follow the course of each
patient's illness, reflect on difficult diagnoses and management and
discuss their conclusions with colleagues, acquire cognitive, visual and
manual skills and techniques and sufficient experience to recognise rarer
presentations of common disorders and drug side effects and supplement
knowledge to recognise rare disorders not only within a narrow
subspecialty, to become able to provide safe and effective treatment and
to recognise the current limitations of this.
Accepting a need to be available to continue care of their patients
when necessary [i.e. for at least somewhat longer than an average 56 hours
per week] would hasten the above process, strengthen the bond between
patient [reassured that they are looked after for most of the time by
someone already familiar with their details and willing to spend more time
at work, "putting the patient first"] and doctor who may gain greater job
satisfaction. A small increase in the number of staff on call, working a
little longer, would reduce work intensity, allow more time per patient,
with less time spent in hand-over and cross-cover, with potential to
improve efficiency and safety, increase capacity to meet average and peak
demands without delay and potentially reduce staffing costs to allow a
greater proportion of the budget to be spent on diagnosis and treatment.
Competing interests:
None declared
Competing interests: No competing interests