Intended for healthcare professionals

Rapid response to:


Is it my moral duty to cover shifts in the absence of staff?

BMJ 2021; 375 doi: (Published 11 October 2021) Cite this as: BMJ 2021;375:n2443

Rapid Response:

Talking about moral duty is simplistic and idealistic; where is our legal and practical protection when we say "no"?

Dear Editor

I agree that the the title of the article allows discussion of what the moral argument should be as offered by 3 different clinicians: one a clinician caring for other clinicians, one a senior clinican, and one a junior clinician under training.

None of the advice or comments were from those wearing the hats that make decisions within the hierarchy regarding the rotas, particularly the NHS managers or clinical leaders.

And frankly all these "desirables" and "moral duties to oneself" do not offer practical advice for one to deal with that unexpected and unsolicited phone call out of the blue that "you are now needed to cover this shift because someone else can't do it".

This might come from a hospital manager, a clinical unit head, a departmental secretary or even the switchboard operator.

I am not sure that other healthcare professionals (for example, nurses) have this experience, but I do think that doctors often get phone calls to be "told" you are now filling a particular rota gap.

Even when this is phrased as a polite question, if you decline you are likely to be asked "why not" and hence expected to justify why you can't help out as if there needed to be a good reason to say no.

Junior doctors and trainees are especially vulnerable to this dual emotional blackmail, in which something bad might happen when they say yes or no to covering shifts.

Say no to these extra shifts and they would be labelled "not a team player" or get less enthusiastic feedback from their training supervisors. Of course this doesn't happen..... officially.

Say yes to working in understaffed medical cover and maybe you get away with it often enough. But remember we are all Bawa-Garba in waiting. And judging by the recent GMC posturing, they have not appeared to change from their approach, in my opinion.

You may think that saying yes staying on for a double shift is to adhere to Good medical practice "guidance" number 38:
"Patient safety may be affected if there is not enough medical cover. So you must take up any post you have formally accepted, and work your contractual notice period before leaving a job, unless the employer has reasonable time to make other arrangements".

But I do not think the GMC will be more forgiving despite your working circumstance.

Being a consultant does not mean you do not get these kinds of phone calls either. For example, I have been called early in the morning of my day off telling me to be on take for the day.

A more helpful followup article would be comments from hospital managers and departmental heads, or even the director of medical services. How about the legal services from the defence union? If they all offer practical constructive advice on how to deal with this dilemma, I might sit up and listen.

Otherwise all these discussions are pretty much utopian idealistic talk in my opinion.

Competing interests: No competing interests

13 October 2021
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia