Pregnant doctors: health and safety risks in the real world
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7446.s168 (Published 24 April 2004) Cite this as: BMJ 2004;328:s168
- Joanna Smith, medical practitioner
Abstract
Although there are guidelines about assessing the risk of pregnant doctors working, Joanna Smith finds that they are not being adhered to
“I can't believe I'm 25 weeks and this is still a problem,” confided one distressed pregnant junior doctor. As part of her psychiatry rotation she was expected to continue on-call duties, covering forensic and challenging behaviour units, well into her pregnancy, not only during normal working hours but overnight and at weekends. When she challenged the trust on the safety issue of a pregnant woman attending potentially violent patients, she met with resistance, delay, and little support. It seems she may not be the only one. BMJ Careers found out that some UK trusts are exploiting pregnant junior doctors at the expense of health and safety.
What are the guidelines?
Guidelines exist to protect the rights of pregnant women in the workplace. It is widely accepted that pregnancy is not an illness and doctors can continue working in their jobs until a late stage. However, considerations need to be made about the individual doctor's post and the inherent health and safety issues that the job entails.
Under the Management of Health and Safety at Work regulations (1999) “employers must identify hazards in their workplace that could pose a health or safety risk to new and expectant mothers and take appropriate action to remove or reduce the risk.”1 “If a risk remains which could damage the health or safety of a new or expectant mother or her baby, employers must take steps to make sure she is not exposed to that risk.”2
Inconsistencies
Guidelines are being applied inconsistently both on a local and an NHS wide level. The above junior's trust policy states that violence and aggression “must be avoided,” advises avoidance of exposure to bodily fluids, and, to minimise fatigue, says that pregnant women should “avoid excessive hours and workloads.” So why are pregnant junior doctors expected to cover forensic services, take bloods, and work extended nights on-call? At the same trust, nurses working in the same areas are removed from clinical duties and night shifts as soon as they inform the trust of their pregnancy.
The discrepancy does not end there. Psychiatry trainees in a southern trust are removed from on-call duties as soon as they notify their employers. Trainees in a northern trust continue, unchanged, in their on-call commitments, including intensive care and challenging behaviour wards. Nurses in the same northern trust are placed in a safer work environment.
Why are discrepancies occurring?
Risk assessments
Risk identification can vary, depending on who performs the assessment. Junior doctors often work on several wards, especially when on-call. If the person who performs the risk assessment is not familiar with the entire remit of the doctor then risks can be missed. For this reason employees should be present at their risk assessment. The junior doctor mentioned above found that a second risk assessment had been performed in her absence after her trust had rejected the recommendation, on her initial assessment, that she be taken off all on-calls.
Attitudes to perceived risks
The above junior doctor was told by her senior that pregnant juniors are at no greater risk of harm than their non-pregnant colleagues, and that if she is at risk then all juniors are at risk. Her local junior doctors' representative disagrees: “It's okay for me, I've only myself to worry about and have a much better chance of removing myself safely and quickly from a situation than someone who is pregnant.”
I don't care if you're pregnant... just get here now
Staffing shortages and resources
“If a risk remains which could damage the health or safety of a new or expectant mother or her baby, employers must follow a series of steps to make sure she is not exposed to the risk.”2 The ultimate course of action is suspension on full pay if suitable alternative work is not available. Removing pregnant juniors from on-call rotas may create staffing and funding problems, especially when locum services are required to fill the gap. One junior was told, after being signed off on-calls by her general practitioner for health reasons, that she would have to continue doing the on-calls for another four weeks until the next rota was arranged.
Misinformation
With regard to risks and hazards, employers “must make this information known to all their female employees of childbearing age, not just those who have informed them they are pregnant.”1 Few juniors I interviewed were aware of the existence or availability of such information. In some instances, pregnant juniors had been misinformed by their trust. One junior was told that if she was signed off on-calls the Royal College of Psychiatrists would not accredit her job. However, the college informed her that trainees are “not necessarily required to undertake on-call in every one of their clinical placements.”
What to do if you feel your health or safety is being compromised
Know your rights. Get a copy of your trust's new and expectant mothers policy. Maternity rights: a guide for employers and employees (www.dti.gov.uk/er/individual/maternity.pdf), New and expectant mothers at work: a guide for health professional, and A guide for new and expectant mothers who work (www.hse.gov.uk/mothers) spell out health and safety regulations
If in training, find out what your college's position is on the specific health and safety aspects of your post and their policy on continuing on-calls during pregnancy
If you feel there is a risk to you or your baby's health or safety that your employer has not addressed, bring it to their attention. If your employer discounts the risk, and you remain concerned, consider discussing it with your general practitioner or occupational health physician (if it is a health issue) or get in touch with you local health and safety executive office (information line 0870 154 5500). They will provide advice and may be able to arrange their own risk assessment if the employer will not take the necessary preventive action
The Advisory, Conciliation, and Arbitration Service (ACAS) has regional offices. They offer practical help and support to tackle workplace issues including dispute resolution services. Helpline 0845 747 4747 (www.acas.org.uk)
If you are a BMA member, contact your local BMA office for advice on your rights and further help.
How does this translate?
This situation has resulted in several alarming incidents concerning pregnant junior doctors. One junior was attacked while attending a patient on a locked ward. Fortunately, no harm came to her or her baby. Another junior recounted an interview with a disturbed patient. She specifically asked security guards to remain just outside the door so that she could call for help if necessary. When things escalated and she called for help, the security guards had disappeared.
Yet another junior was called during the day to attend a patient who was being violent. After suggesting other, appropriate, courses of action she was told: “I don't care if you're pregnant. You are the duty doctor and I want you to see this patient. Just get here now.” With experiences like this occurring it may be only a matter of time before someone, or her baby, is seriously hurt.
So what are the main health and safety issues?
The pregnant juniors I met expressed a feeling of lack of control over their work conditions and environment. They felt distressed and frustrated at having to fight for health and safety rights while their trust employed delaying tactics, all at a time when other life events are pressing.
Safety
These issues are not confined to psychiatry. After police officers, health professionals are included in the next group most likely to experience violence at work.3 Doctors working in other areas, such as accident and emergency and general practice, may have similar exposure.
Health
Avoiding exposure to bodily fluids can be difficult for junior doctors, especially when they are the only person trained to take bloods available during overnight or weekend shifts on a psychiatry unit. Fatigue and physically demanding work contribute to negative outcomes in pregnancy.45 Some pregnant juniors find working extended hours and night shifts intolerable. To be relieved of these duties, a medical certificate is needed stating that night work could affect the employee's health or safety.
Where do we go from here?
With more women entering the medical profession, pregnant doctors will become more common. Guidelines are in place that address the health and safety of pregnant workers, but they are being inconsistently applied across the health professions. Information needs to be better distributed, and trusts must prepare alternative work arrangements to accommodate the health and safety needs of their staff. Pregnancy is a foreseeable event and lasts for a set time. We should all ask ourselves, “Would we want the health and safety of our wife, sister, or daughter, and her unborn child, compromised?” Unlikely.
Footnotes
Go to web extra on bmjcareers.com/careerfocus fo a full list on further information and readingEditor's note: Owing to the current negative climate against whistleblowers, the author's name is a pseudonym and the doctors interviewed requested that they be kept anonymous. I have independently verified with them all that has been said in this article.