What are the consequences when doctors strike?
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6231 (Published 25 November 2015) Cite this as: BMJ 2015;351:h6231
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In our province (Chubut, Argentina) we suffered a strike by surgeons for a period of a year in which they only attended the emergency room. We learned several things:
.- Necessary legislation to regulate and provide mechanisms to streamline the right to strike in the health service, since the International Labour Organization reports that this right should not be opposed to the right to life and health (essential services).
.- One of the aspects to consider in this line is to establish whether emergency services are only essential. The same International Labour Organisation recognizes that when there is a strike and its duration can have negative social consequences they should be seen as not discontinuing services (eg in the case of education and in our case care of elderly patients)
.-In our case, this group of professionals made use of a dominant position, which unbalanced any collective bargaining in which the parties must recognize the willingness to reach an agreement.
.-The prolonged stoppages generate institutional dynamics that cost; then a return to the previous institutional rhythm creates a climate of distrust among the actors in health.
Excellent discussion and necessary.
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Just as in the 'popular' press, selection of words for journal article titles, subtitles and conspicuous 'take home' messages can quietly nudge us in pre-determined directions. "What are the consequences when doctors strike? Doctors considering strike action may worry about the effect on patients", this article headline asks and says. And for the vast majority who glance at the quick take home message separately placed for easy access, the message is, "A recent systematic review reported mortality data from five doctors strikes, all of which saw patient mortality remain the same or fall during industrial action". Rest your conscience, you can go ahead and strike with no qualms.
When unofficial trade union action by police in New York city (angry that the mayor Bill Blasio's comments about two policemen being murdered were not gung-ho enough) cut arrests and citations by two thirds, newspapers reported a 'surreal' calm in the city, not increased crime. The logic and evidence in this article are not that different to quietly implying that the police may close shop and the world would go on well enough. The many qualifications do not have space to figure in the take-home.
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The cases studied here are effectively each an instance of 'strike sans strike ' and so the neutral impact on mortality is neither surprising nor instructive.
Were each to have been a complete downing of tools ie a strike in the true sense, the catastrophe to follow might be unimaginable.
These cases of not downing tools but passing them on to more senior colleagues (during a 'strike ') who had to jump into the rescue might create an illusion of paradox : yet it is not because there really was no strike.
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In response to this article ("What are the consequences when doctors strike?" 25/11/15) we three young medical cousins (one FY2 and two medical students) had a discussion with our Grandfather, Gerald Sandler, and Emeritus Consultant Cardiologist who recalled the last doctor’s strike in 1975.
At the time, Grandad was at Barnsley District General Hospital and, alongside fellow consultant colleagues, was responsible for performing the duties of the striking junior doctors, including the weekend on call for admissions, being resident on-call in the hospital from Friday night to Monday evening. Of course, he considers this the “good, old days” before the EWTD had even been considered. On Saturday afternoon, a young person was admitted in a moribund state. He recounts that the patient was peripherally cold, mottled, obtunded, hypotensive and peri-arrest.
Grandad has always prided himself on clinical knowledge and accurate diagnostics, obtaining the University Gold Medal in his undergraduate finals at the University of London in 1952, alongside an impressive 3 distinctions. He can’t remember exactly what clinical features drew him to this conclusion, but he was suspicious of Waterhouse-Friedrichsen syndrome. Treatment with intravenous fluids, hydrocortisone and penicillin was initiated swiftly and the patient went on to make a complete recovery.
Whilst we would not question the capabilities of the modern day frontline medical teams, we do wonder if such an uncommon and critical diagnosis may not have been reached as quickly should the clerking doctor have been a house officer rather than an Consultant and consider if, on this occasion, the junior doctor’s strike may have saved this life.
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This is a truly terrific discovery. So long as the UK doctors strike no harm will come to their patients. Then the case for an indefinite strike is indisputable. The money thus saved could be directed towards those EU doctors that work for a fraction of their UK counterparts salaries.
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Of course patients will suffer if the proposed NHS strike goes ahead. The analysis published may show that measurable extreme harms such as death may be unaffected. But it all depends on your definition of harm. The elderly patient with poorly controlled pain and disability awaiting a hip replacement will not die if the elective procedure is cancelled but by any common sense definition will suffer harm. We delude ourselves otherwise.
It saddens me that the UK print version chose to highlight this article with a headline on its front cover stating "Doctors' strikes don't harm patients". I don't think my postman was convinced!
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It is strange that much if not most of the Media concentrate on the effects of the actions of 'striking' employers rather than the actions of irresponsible employers. At the very least blame should be impartially allocated between employers and employees. Just as a problem may cause a road to be closed forcing a time-consuming diversion it is very likely that it is the problems caused by the intransigence of employers that lead to withdrawal of labour in order to resolve the difficulty. Any inconvenience of such a withdrawal is an unavoidable side effect of the employees' necessary actions to repair that damage.
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Just as an amendment: My late Grandfather who was a physician in Vienna told me years ago that the only day he remembered without a single dead patient at the University Clinics in Vienna was the day of the doctors strike in December 1923.
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Re: What are the consequences when doctors strike?
The National Health Service (NHS) is the fifth biggest employer in the world – yes, out of 196 countries, it is the fifth biggest, something to be proud of. However, being such a large health organisation it is pivotal that consequences of doctors striking are discussed and evaluated. The article “What are the consequences when doctors strike” (25/11/2015) raises a valid point that unlike other employers such as Transport for London (TfL), which have three upcoming strikes and will not necessarily affect patient care, when NHS doctors strike, patient care can be affected.
We assessed the disruption caused in our hospital (a district general hospital in the West Midlands with a 500 bed capacity). 2 inpatient procedures were postponed, 2 day-case procedures were postponed, 10 outpatient appointments were postponed and at 8 a.m. on 12/01/2016 (1st junior doctors strike) 100 beds were available.
The disruption was in fact minimal. The hospital service ran smoothly for 24 hours and importantly junior doctors had the opportunity to raise their concerns towards the government from the hospital picket line. So how did the strike day run so smoothly? Two reasons: planning ahead and the ethos of our hospital.
Crucial meetings that were held in December between the hospital management, BMA representatives and the LNC representative enabled forward planning where we adopted an emergency care model. However, it is the ethos of our hospital and the staff working here which we truly believe prevented any major disruption. It all stems from regular meetings we have in the year between junior doctors and the medical director. Junior doctors can openly voice their concerns, suggest improvements and point out strengths and weaknesses of the hospital without any backlash. Ultimately this allows enhanced patient care and when improvements are made (which are normally swift), junior doctors feel satisfied and their daily tasks can run more smoothly. Our corridor walls are scattered with small reminders that any concerns or improvements are welcomed by the trust and because junior doctors as well as other staff are all listened to this creates a very pleasant personality amongst the trust and its staff. It motivates the staff to work hard and to enjoy their job which prevents panic and so prior to industrial action day (12/01/2016) patient care for the following day such as bloods, imaging requests and procedures were all delegated in time to those doctors not partaking in the strike including consultants. Providing 20% free bed capacity on the morning of strike day created confidence in the emergency units that if an admission was needed space was available.
Planning ahead and having an ethos in the hospital where everyone feels part of the team creates understanding and co-operation for circumstances such as a strike without dramatically compromising patient care. And of course an encouraging email from the medical director that praised all staff at the hospital for their hard work to enable a smooth service on strike day goes a long way.
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