I should declare an interest. As many people know I am married to a doctor.
Like every other doctor she is human and suffers from fatigue and stress. Like every doctor she stays awake all night worrying about patients. And she takes patients deaths badly, especially when she has got to know them well.
That's because she is also very much a human being.
So why is anyone surprised that doctors working at weekends don't produce results as good as those working in the week?
And why does anyone think doctors can work 13 plus hours a day ( her norm) and then cover the night, and still be safe?
Yes doctors are well paid. But very, very many of them wonder whether it is worth it as they get older. One reason their pension fund is so over-funded is their low life expectancy.
If we want care then we have to accept humans must provide it, at all levels of the caring professions. And treating those who work in them with contempt and derision whenever possible is a recipe for a health disaster that the private sector could never solve - because it hasn't got the compassion to do so.
And that word 'compassion' is the key.
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Richard,
I too should declare an interest. I was a hospital doctor and my husband still is, a surgeon.
You make a significant point. Most people seem to think that all doctors work a shift system and that when they are not working they are off duty. In reality it is only in the more junior hospital posts that this is case. In the more senior training posts and, as far as I know, all GP and consultant posts, the doctor does his or her routine 12-13 hours per day, as your wife does, and is in a rota, often as high as 1 in 2 or 1 in 3, for covering the nights and weekends on top of that. Depending on the intensity of the work, they may be up all night or may, if they are lucky, get a good night’s sleep before their next day’s work. You are aware of this, no doubt, being married to one.
Can you tell me, though, about the low life expectancy? It’s contrary to what I would have expected.
The stats show doctors have a horrible habit of dying soon after retirement
are there stats for bankers? !
Can you supply a link to those stats, please, Richard.
Thanks
No -I have to say I know them from reading them – I have not got a link right now
I sympathise completely with the strain doctors are put under but I don’t see the reasoning with regard to working at weekends or evenings. Yes, if doctors are expected to do these things *on top* of their existing responsibilities then that’s unfair and unreasonable. But if they organise themselves so as to cover more hours as teams then what’s the problem? Plenty of other professions have to work in shifts over weekends, why not doctors?
It’s not much fun working all weekend then having a couple of days off during the week instead but that’s something pretty much everyone in the service sector has to put up with. Human beings eat, breathe and get sick 7 days a week. Human life doesn’t map onto a working week.
From a patient point of view, it is very annoying to come down on a Friday evening with some illness or problem that isn’t serious enough to go to A&E but serious enough that you don’t want to wait until Monday to go the the GP’s – or, more realistically, wait until Monday to call up to book an appointment, probably for the following week unless you complain enough to make them slot you in sooner. Ten days later and you’ve suffered through your ailment and the appointment is pointless.
Doctors have a tough job that’s only getting tougher, I don’t doubt it, but levels of service at GP surgeries in terms of opening hours and appointment waiting times are rather poor in my experience. The government’s reforms are deplorable but if doctors were more proactive in adjusting their working practices to suit people’s needs then maybe they’d have more public sympathy.
Most doctors do a wonderful job but there is at least a little blame on both sides.
Sure t’s possible to demand that
But you just won’t have GPs
Because no one will chose to do what is already compared to most other medicine and most other professions a nigh on impossible job
I just saw the previous post vis-a-vis most doctors not working in shifts. My previous post assumed that they did. So I proved Helen’s point! But then my follow up question must be: why the hell don’t more doctors work in shifts? I mentioned GPs in particular since an absence of shift working presumably accounts for surgeries rarely opening at weekends for more than a couple of hours. It’s not a complicated thing to organise so it seems pretty strange to me that it’s not more common.
How about three things?
1) People work safely in the day and not at night
2) When GPs worked shifts it was impossible to recruit any
3) There is insufficient real demand to require it
“1) People work safely in the day and not at night”
That will be news to the process and major industries that work 24/7. What the doctors mean is “I don’t want to work shifts and have my days off during the week like lots of other plebs – we’re doctors, not working class people”.
Shift work and staff ‘on station’ were issues that were actually covered in a R4 documentary and it is do-able to bring down the ‘weekend spike’ but it means proper shift work and doctors actually being at the hospital and not ‘on call’ at home.
Not something the medical profession are that keen on at the moment.
That, respectfully is absurd
Doctors know their judgement is impaired at night
In emergency they exercise it but the risk is high
Do you want that to be made commonplace?
If so, you are reckless. Doctors aren’t
But in the absence of such reasoning you resort to abuse
One assumes you are referring to the weekend deaths stats ?
Having had personal experience of that problem I have myself noted, years ago, that patients operated-on at the end of week had poorer care than those who had procedures at the start of the week.
My father had a hip-replacement on a Friday, and never recovered.
The reason was, and is, simple. The orthopaedic team were not in at weekends. Any problems fell to an import from general medical, which itself is under strain at weekends.
In short, another management failure.
We should get use to such things. The proposal to charge patients who exceed a number of visits to a doctor will certainly lead to chronically-ill patients having a shorter lifespan. Normally I would consider such a proposal to be the product of a small mind being overtaxed, but this is a conservative government, so it is more likely to be the product of a small mind, living off a foreign-based trust fund and not taxed at all.
‘Like every doctor she stays awake all night worrying about patients.’
I hope her colleagues and patients are aware of this; if she’s staying awake all night worrying she may not be fit to carry out her duties, and should probably recuse herself.
All doctors I know worry about patients all night
Well I do remember when I was a boy Mum only had to find a phone and the Doctor was there within minutes.And without todays NHS many poor folk are going to suffer!I believe Dentists have the same tendancy!
And in those days I suspect doctors could do almost nothing when they arrived
This low life expectancy is also true of the teaching profession I was in which has some of the highest levels of stress and the lowest levels of morale. Moreover, it is a profession that has been maligned since Thatcher’s initial assault.
The issue with doctors is, perhaps, that we expect too much from them in our highly litigative culture and we expect medicine to have defeated death. On the other hand, it is a job with high pay and reasonable social status where austerity will not be snapping at your heals too vigorously. I think research shows that unemployment and jobs that involve little latitude for decision making can be connected with low life expectancy. So my sympathy is limited here, Richard – an accountant married to a doctor will be doing quite nicely in monetary terms. Perhaps your wife could work part time – or would a cut in the £110,000 a year mean an unbearable drop in living standard? Perhaps doctors could show a bit of compassion and voluntarily take a little pay cut so that money could go BACK into the NHS. I wrote to Hamish Meldrum in this manner( former chair of BMA) when there was a doctors’ ‘strike’ – he never replied (quelle surprise).
My wife does work part time
And I wasn’t asking for personal sympathy
I was asking for understanding
And you offered abuse
Try that next time you’re in A & E
And those wonderful people in A & E are often probably very tired through the work load AND a shift pattern I`d say.
Precisely why A & E is not good enough
And in crisis
Haven’t you noticed?
Simon, it sounds as though you’ve allowed your anger to get the better of you. Please don’t fall into the government’s desire to monetise everything or belief that anything can be bought if the required price is met. Being well paid doesn’t exempt anyone from stress, nor does it buy their compassion and commitment.
Your last paragraph makes it sound as though you believe that high pay and reasonable social status carry an obligation to be compassionate and committed to what you do. That’s an apple and pears argument that comes across as little more than envy which, in my humble opinion, is a hopeless starting point for rational thought. Snide doesn’t help much either.
I take the point Nick, i think i did allow some resentment to get the ‘better’ of me. I certainly don’t think that High pay mitigates stress but i DO think we need to create a culture of service rather than the ‘grab what you can’ approach we have. Research does seem to show that those on low pay/unemployed have the worse health outcomes. I don’t agree that asking these questions is a hopeless starting point for rational thought. If you think about what I said I was trying to ‘de-monetise’ it by factoring in voluntary acts of generosity. As a teacher I often got out of pocket helping students and didn’t claim back every penny – I never resented this. When I look at my wealthy M.P.’s expense claims I see him claiming £3 here £4.50 there for bar snacks or a short taxi ride – where is the ‘give’ here?
Simon, the ability to own up to a mistake is an all too rare commodity so you have my admiration for demonstrating it.
I agree that the prevailing grab what you can culture we currently have desperately needs to change. That’s what prompted my comment because it seems to me that Richard fights for that very thing and was undeserving of what you wrote.
My main point however was that I believe it unhelpful to conflate reward with attitude unless the specific example makes it appropriate. Your example of MPs claiming excessive expenses is a good example, as would have been those doctors who take all they can but are unprepared to go the extra mile for their patients or teachers who, unlike you, and for which more congratulations are due, do not give their students practical care as well as teaching.
We’re on the same side.
Sorry Richard, I really didn’t mean it to sound like abuse (honestly)I was simply making a contrast between the research that shows that poor pay and unsatisfying work might bear down upon an individual more significantly – if you’d have focused on my preceding words rather than the critique at the end (which i personally think is justified). I certainly could not be a doctor as I would worry too much and indeed worried that I was not doing enough for pupils when I was a Teacher. The issue of pushing people beyond their limits is a real one and a broader cultural issue. Shorter hours and job-sharing would help but that would mean accepting less money.
I don’t deny there is GP greed – a major issue
And that sensible doctors do work part time
But to think doctors can take on more in that case is absurd
That was my point
Doctors dying early is probably a myth. The ONS doesn’t keep the data by profession and I don’t think that the Institute of Actuaries does either. Life insurers will have data, but it’s commercially sensitive so they don’t share!
Looking for other evidence, here’s a link to a study in the British Journal of Cardiology: http://bjcardio.co.uk/2009/11/lifespan-and-cardiology/
They were trying to get data on lifespan by medical specialism based on obituaries(so over-reports men probably, which typically would pull down the average age of death). Have a look at Table 4 – average age of death in 2004 was 78.4 years and had been increasing over the years in the study in line with what you’d expect for the general population.
By all means be sympathetic to your doctor, but if you want to worry about work that kills look further down the socioeconomic spectrum.
It sure doesn’t seem like a myth to me
I’m sure it does! But, respectfully, there’s probably a lack of randomness in your data set. The good news is we’re all living longer and the bad news is that our pensions are underprovided.
The trouble with things like this is that the reasoning is a bit..bleak.
Statistics tend to prove what the compiler wants them to prove.
Doctors suffer more ill-health through their working lives, physical as well as mental.
And you cannot draw comparisons between a factory worker and, say, a solicitor.
Other than to say a factory worker has a shorter life. People, of differing occupations, live various lengths of time after retirement. But why ?
Could the varying pension amounts cause it ?
A look at life insurance data suggests that professional people are expected to live longer.
Hardly surprising, given that many people work their lives in bad employment conditions.
Then again…the commonest reason for medical retirement would seem to be failing mental abilities. Something that a builders labourer would work through…after all, you cannot have doctors prescribing the wrong drug/coming to a wrong diagnosis etc.
Given that the majority of doctors have only a vague idea what is going-on in the health service now, I expect stress levels to be going through the roof….my own GP has resigned and is departing for pastures new.
Sorry, but your post is so gloriously wrong-headed thatI had to reply. My comments are inserted in your text.
The trouble with things like this is that the reasoning is a bit..bleak.
Why is that a problem? It might be right or wrong. Whatever. But bleak is a problem! Presumably you only line sunny?
Statistics tend to prove what the compiler wants them to prove.
Gosh. All that maths and science. Bit dificult to get you head round?
Doctors suffer more ill-health through their working lives, physical as well as mental.
More than what? Lion gamers? Lumberjacks?
And you cannot draw comparisons between a factory worker and, say, a solicitor.
Why not? Oh sorry! You don’t believe in stats.
Other than to say a factory worker has a shorter life. People, of differing occupations, live various lengths of time after retirement. But why ?
So you can compare them!
Could the varying pension amounts cause it ?
Good question. I suspect that’s not the direction of the causality but I can’t dismiss it out of hand.
A look at life insurance data suggests that professional people are expected to live longer.
No shit Sherlock.
Hardly surprising, given that many people work their lives in bad employment conditions.
So it’s not the size of the pension? I guess you’d forgotten your good point!
Then again…the commonest reason for medical retirement would seem to be failing mental abilities.
Where on Earth did you get this from?
Something that a builders labourer would work through…
Because they are just stupid working class people without your delicate sensibilities?
after all, you cannot have doctors prescribing the wrong drug/coming to a wrong diagnosis etc.
OK this sounds like English but doesn’t really make sense.
Given that the majority of doctors have only a vague idea what is going-on in the health service now,
Based on what? Unlike you obviously!
I expect stress levels to be going through the roof….my own GP has resigned and is departing for pastures new.
Probably just told you that to avoid you in future.
Apologies for my typing. Formatting doesn’t come through. Comments still stand though.
You might think so…..
I think more research needs to be done into unhappiness at work. Like teaching, the NHS goes through massive levels of change fatigue as these professions become political footballs. I remember, early on in the existence of the Coalition, Cameron, Landsey and Clegg, all visiting a hospital with shirt sleeves rolled up, were shouted at by an irate doctor who ordered them off his ward and clearly saw them as time wasting irritants – I thought this doctor very courageous, he wanted to get on with his job and do it well, like most of us:
http://cameron-cloggysmoralcompass.blogspot.co.uk/2011/06/surgeon-chucks-cameron-out-of-hospital.html
It seems to me that there is a conspiracy to make all work horrible so that eventually all of it can be carried out by robots. Teaching, especially, should be the best job in the world, but at least it is reasonably well paid. Most horrible jobs are also badly paid. My daughter has recently started her own one-woman business and is enjoying it, despite the extreme financial and other stress (much relieved by mother slave/bank). There’s something to be said for being your own boss, I guess, although many people have been forced into it rather than relishing it by choice.
my own experience of gps is mixed. at my current surgery, two gps are superb, two are OK, and one is poor.
i remain struck by how the bma handled debate about a decade ago over the fact that gp numbers in france were double that for the uk. the bma was quite happy to talk about this until it was pointed out that gps in france were paid half as much, when the bma promptly shut up.
the point about the existing changes, and those to come, is that they are definitely not intended to address poor staff or outcomes. rather, they are intended to divert a public service income stream to the private sector by reason of economic dogma and political self-interest.
those in charge couldn’t care less that these changes will probably worsen outcomes. from their perspective that may be helpful if it could be used to increase income for the private sector.
Personal experience can be a misleading way to assess risks. Table 2a of Health Statistics Quarterly 49 Spring 2011 includes GPs as higher professionals. It shows life epxectancy at birth increasing from 75.1 (1982-86) to 79.9 (2002-06). At age 65 Table 2b shows it rose from 16.2 to 18.9. http://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/spring-2011/deriving-trends-in-life-expectancy-by-the-national-statistics-socio-economic-classification-using-the-ons-longitudinal-study.pdf