Current Affairs, Real Medicine, Studying Medicine

Humane Hours for Junior Doctors is a Matter of National Importance

There is a petition on Change.org for better working hours for junior doctors in South Africa. Despite the fact that there are far more than 1 000 doctors in South Africa, only 831 people have signed it so far.

Because I got some interesting responses to previous posts about working conditions, a quick low-down on the status-quo: junior doctors (freshly qualified up to three years after graduation) work insane hours in South African public hospitals. Calls are as a rule 24 hours long, but the doctor does not get to leave afterwards: they have to stay for the next working day. The State will not pay a junior doctor for more than 80 hours overtime per month, and yet junior doctors work on average 150-200 hours overtime per month. 

Although nobody likes working 36-hour shifts, there seems to be an element of stoicism and tradition permeating discussions regarding this petition. It has always been like this in our profession, they say. Working insane hours is part of what makes us doctors.

Well, no. What makes us doctors is the desire to save lives. An intense love of the way the human body works. Pick any of those. NOT working hours that amount to slavery and poor service delivery.

It is not good for anybody to work insanely long hours. As a doctor, would we EVER recommend to our patients that they stay up for 36 hours? No. We would suggest that they get at least six hours of sleep a night, that they maintain good sleep hygiene, and that they avoid being awake for longer than 18 hours a day.

Yet, we have this incredibly unhealthy life(sleep)style. Do we think we are untouchable? That our being doctors precludes us from burnout? From loss of concentration? From errors? (Sounds like the habit South African doctors have of not wearing their TB masks, as if they are exempt from infection, which is clearly not the case.)

Would you ever suggest to your CHILD (even if they are no longer a child) that they follow this lifestyle?

The past while I have heard overwhelmingly from people (especially older healthcare practitioners as well as laypeople) that one must simply “push through”. It gets better, they say. It’s the way it is and you will get used to it. You will learn to survive. And it is “only” three years of our lives.

Well, I say NO.

Not only is a lifestyle where one routinely works 36 hours at a go bad for our OWN health, but it is bad for our patients. It is unacceptable for our patients.

A drunk doctor would not be able to treat patients. So why should a doctor who may as well be drunk?

“…after 24 hours of sustained wakefulness cognitive psychomotor performance decreased to a level equivalent to the performance deficit observed at a blood alcohol concentration of roughly 0.10 %[double the South African legal driving limit] .

-D. Dawson and K. Reid, Nature 388: 235, 1997.

This year I have worked crazy hours, being on call routinely for longer than twenty-four hours. I have been abused by interns and complained about it – but given their level of exhaustion, I can understand why they would try everything they can to get some help.

I am not going to go into why the “everyone-has-done-it-and-it-has-always-been-like-this” argument is moot. It is NOT an intelligent argument and not befitting of a profession that is meant to be progressive and cutting-edge.

As for “just pushing through”? That is the very reason why a broken system is allowed to continue as it does. Young doctors work themselves to near-death in an effort to correct for the multiple errors and holes in the system, and so the system gets away with being inefficient and poorly-run.

I was once told that my insistence on better working conditions causes me to appear lazy and indifferent to the needs of patients. I disagree. I am not lazy, but I believe in working hard, not long. I would rather work at high efficiency for shorter shifts than zombie-walk through 36 hours, doing the bare minimum not to get sued.

Speaking of which, the prevailing opinion is that the problem cannot be solved because there are too few doctors in South Africa, and therefore the problem will simply continue as long as the doctor-shortage prevails. But this is an example of lack of creative problem solving. What if we instituted twelve-hour call-shifts, with a mandatory limit on 18 hours on consecutive duty? That gives the doctor six hours to do handover, see patients, and do outstanding tasks. Essentially the doctor will probably still have the same total amount of hours per week, but in shorter bursts. It may not be a perfect solution but it is a suggestion.

The USA and the EU have regulations that protect doctors and patients in this regard. It is high time that our country step up to the plate.

And so my plea is: sign the petition. Even if you are not a healthcare worker, because you would not want a doctor who has been awake for 18 hours straight to operate on your acute abdomen.

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18 thoughts on “Humane Hours for Junior Doctors is a Matter of National Importance”

  1. Interesting…I know there has been a movement recently in the US for medical students although there is not currently one for veterinarians. I hope this does push forward! As a DVM I am often on-call for 3+ days at a time including having to be in the clinic performing regular appointments and surgery. It is exhausting and in reality alters my ability to provide the best of care. Good luck!

  2. I went through med school and residency in the States as the work hour rules were changing. Third year I did overnights then stay the next day. Fourth year I did signouts at midnight to have a few hours of protected sleep before getting back to the hospital at 6 am.
    Guess which year I liked better? The second one, even though I was still sleep deprived . Sleep is good. It resets the brain. I no longer fell asleep in the middle of writing a note, scribbling nonsense in black ink into the permanent medical record.

  3. Agreed! Doctors (especially junior doctors) often get exploited at the expense of the patients because of a damaged system. But until someone with the power to change things is convinced that they need to be changed, things will probably stay the same.

    In response to the same issue you’re having, the junior doctors in my country all stayed home sick for an entire day. They had been working too hard for much too long.

    1. Wow! That’s quite a strong move. Striking is illegal for essential services in South Africa, so I don’t know if that would ever happen here… but it’s a bold move. I’m impressed.

      1. It was in the midst of a lot of political crap at the time surrounding wages and working hours, so I think people were just fed up.

  4. Wow, that is crazy! Even as a med student we get to go home after 24 hours. It is written in our residency contracts that we can’t work into the 28th hour, we get paid call stipends for each call shift, and where I’m going for residency, we only have 12 hour call on the weekends. Can I sign this petition even if I’m not a SA doctor???

      1. Thank you for your support! I think international support it good 🙂
        Have you read the EU regulations for doctors working hours? Sounds like heaven. They must have tonnes of doctors there, or something.

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