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I agree that working longer hours as a team could be less tiring and more rewarding than working alone.<1> I have worked in hospitals in both Canada and Britain, and would like to make a comparison here.
In Canada, which obviously does not have the European Working Time Regulation (EWTR), junior doctors (called "residents" there) work a maximum of 60 hours/week,<2> compared to 48 hours in Britain. However, the Canadians have better work coverage. During my general surgery placement in Canada, we rounded early in the morning, but the seniors returned to the wards after their operations to ensure continuity of care. In contrast, during my time in a NHS hospital, the seniors rarely came back to the wards after their operations, possibly due to the EWTR. The juniors managed all the ward issues after the rounds. Often, they had to escalate to the on-call teams, which are usually over-stretched and did not know the patients beforehand.
By having more doctors working longer hours as a team in Canada, we have the capacity to cover each other during breaks. In our spare time, the seniors do impromptu teaching to enhance the juniors' learning. If we are lucky at nights, each of us has some sleep. When we request for vacation in advance, the rota coordinators ensure adequate work coverage. These are unlike the NHS in which juniors could be denied breaks.<3> There is almost no time to do teaching during unprotected time, or rest during on-call hours. It is the juniors' responsibilities to find their over-stretched co-workers to cover during their leaves.
Although the EWTR appears to take care of workers' well-being by restricting the maximum work hours, it does not specify the minimum doctor-to-patient coverage and maximum workload. Employers and politicians could use the EWTR as an excuse for inadequate work coverage that hampers patient care and quality of our work.
I support Black's suggestion on reducing number of handovers and improving continuity of care when the EWTR is replaced.<1> I would also suggest better work coverage to improve patient safety and doctors' learning.
References:
1. Black J. Loneliness and tiredness resulting from the European Working Time Regulations. BMJ. 2017;359:j5775.
2. Maximum duty hours. Toronto: Professional Association of Residents of Ontario; 2018; cited [Mar 26, 2018]. Available from: http://www.myparo.ca/your-contract/#maximum-duty-hours.
3. Dyer C. Junior doctors take trust to court for denying them breaks every four hours. BMJ. 2018;360:k852.
Competing interests:
I have received salaries from working as a medical doctor, but I am not paid to write this letter.
Post European Working Time Regulation
I agree that working longer hours as a team could be less tiring and more rewarding than working alone.<1> I have worked in hospitals in both Canada and Britain, and would like to make a comparison here.
In Canada, which obviously does not have the European Working Time Regulation (EWTR), junior doctors (called "residents" there) work a maximum of 60 hours/week,<2> compared to 48 hours in Britain. However, the Canadians have better work coverage. During my general surgery placement in Canada, we rounded early in the morning, but the seniors returned to the wards after their operations to ensure continuity of care. In contrast, during my time in a NHS hospital, the seniors rarely came back to the wards after their operations, possibly due to the EWTR. The juniors managed all the ward issues after the rounds. Often, they had to escalate to the on-call teams, which are usually over-stretched and did not know the patients beforehand.
By having more doctors working longer hours as a team in Canada, we have the capacity to cover each other during breaks. In our spare time, the seniors do impromptu teaching to enhance the juniors' learning. If we are lucky at nights, each of us has some sleep. When we request for vacation in advance, the rota coordinators ensure adequate work coverage. These are unlike the NHS in which juniors could be denied breaks.<3> There is almost no time to do teaching during unprotected time, or rest during on-call hours. It is the juniors' responsibilities to find their over-stretched co-workers to cover during their leaves.
Although the EWTR appears to take care of workers' well-being by restricting the maximum work hours, it does not specify the minimum doctor-to-patient coverage and maximum workload. Employers and politicians could use the EWTR as an excuse for inadequate work coverage that hampers patient care and quality of our work.
I support Black's suggestion on reducing number of handovers and improving continuity of care when the EWTR is replaced.<1> I would also suggest better work coverage to improve patient safety and doctors' learning.
References:
1. Black J. Loneliness and tiredness resulting from the European Working Time Regulations. BMJ. 2017;359:j5775.
2. Maximum duty hours. Toronto: Professional Association of Residents of Ontario; 2018; cited [Mar 26, 2018]. Available from: http://www.myparo.ca/your-contract/#maximum-duty-hours.
3. Dyer C. Junior doctors take trust to court for denying them breaks every four hours. BMJ. 2018;360:k852.
Competing interests: I have received salaries from working as a medical doctor, but I am not paid to write this letter.