Systems in crisis

“My pilot son will continue to have regular health checks, strictly regulated working hours, and rest periods. He will receive planned retraining and routine evaluation of performance and will work in a supportive psychosocial environment. My medical son will continue to work in an environment that is demonstrably psychotoxic.” Thus writes Ewan Macdonald, an occupational physician, about the working lives of his two sons (p 1105).

Some readers are fed up with analogies between doctors and pilots, but there are enough similarities (high demands, grave responsibility, professionalism) for the comparisons to be telling—and the differences to be worrying. Margaret Cupples and …