Intended for healthcare professionals

Rapid response to:


“Going the extra mile” endangers doctors, patients, and NHS

BMJ 2017; 358 doi: (Published 26 July 2017) Cite this as: BMJ 2017;358:j3547

Rapid Response:

Re: “Going the extra mile” endangers doctors, patients, and NHS

The system of healthcare in the province of Nova Scotia, Canada, is in crisis ,as evidenced by patients frontline medical & healthcare providers. Family doctors like myself have expressed our observations that , it has felt like a crisis to us for the last ten years. We were ten years younger then and believed it was our duty and obligation to take more on in the name of patient centered care and advocacy.
Our system of care has not valued the unseen, relationship building and continuity of care that inherently is our domain. The unsexy tenets of long term care, the cold realities of incurable, relapsing conditions, and the stark underpinnings of end of life decisions are our 'bread and butter'. Our work is dogged, with no fanfare and is never-ending. We willingly turned into hamsters and ran faster, harder, to prove our shoulders were wide enough to carry the burdens heaped upon us.
Many of us are not only burning out, but are tasting the bitter disappointment of now being cast aside by administrators, politicians, lawyers, accountants and bureaucrats who believery they know what primary care reformation is all about. None of them have earned the right or meritocracy to achieve this. They have little knowledge and even less competency for this work. It appears that our silence and steadfast patient centered sacrifices, done with compassion to uphold what it is to be a doctor has been seen to cost nothing, is replaceable and has no value.
As I feel my hope run out, like sand in an hour glass, despair fills that space, and the futility of it all steals whatever is left.

Competing interests: No competing interests

12 August 2017
Ajantha Jayabarathan
Family Physician
Coral Shared-Care Health Center
Unit #4, 2751 Gladstone street