Intended for healthcare professionals


Inexperienced doctors may fail to spot warning signs

BMJ 2009; 338 doi: (Published 25 June 2009) Cite this as: BMJ 2009;338:b2520

The latest report from the National Confidential Enquiry into Patient Outcome and Death highlights the problems in having inexperienced junior doctors treat acutely ill patients, says the Royal College of Surgeons.

The report, Acute Kidney Injury: Adding Insult to Injury, shows that being treated by a junior doctor was a key factor in over half of acute kidney failure deaths in England, Wales, and Northern Ireland between the beginning of January and the end of March 2007.

The college says that this finding should serve as a wake up call to those wishing to further reduce training time and opportunities within NHS hospitals.

“The cut backs in hours, the punishing full shift rota systems, and the cross cover of other specialties forced on trainee doctors are destroying medical training in this country,” said John Black, president of the college.

“This report provides a clear example of how patients suffer as a direct result. NHS trusts are being placed under intolerable pressure to keep services running with less doctor time, and inevitably it is training time that suffers. No amount of calls for ‘innovative solutions’ from the Department of Health can change this—the arithmetic simply does not add up. Fewer hours equals fewer doctors on duty equals less training, and poor patient care is the result.”

Today’s medical graduates are well equipped with the knowledge to manage conditions that may set in after an operation, such as sepsis, but they lack the day to day exposure to such conditions as a direct result of reduced working hours and shift systems, he said.

The college says it has worked hard to educate doctors about recognising the earliest signs of acute kidney failure and failure of other vital organ systems. However, it says participation in its training course, Care of the Critically Ill Surgical Patient, has decreased dramatically since trainee study leave budgets were cut drastically two years ago.