A patient came to see me at my GP practice the other day. “I know you from the hospital,” he said. “It was you I saw on the night I went to A&E.” He paused, and then added: “You seemed tired”.
I couldn’t recall the event – it occurred during the A&E rotation of my GP training in 2014. At the time I felt that night work was killing me slowly. Driving home in the mornings I used to fear it might kill me quite suddenly. In that particular job I was obliged to alternate so frequently and jarringly between day and night work that after three months my life had blurred into a homogeneous grey fog in which I took pills to go to sleep and pills to wake up again. Driving was hazardous but working wasn’t straightforward either. On one occasion I fell asleep while phoning a patient’s relative in the middle of the afternoon. After three months I was struggling, my heart was skipping beats and I was so depressed that I started to think that maybe crashing my car wouldn’t be such a bad idea.
A&E was dreadful, but the doctors working there have one important benefit; they are generally guaranteed a break, of some sort. By contrast, the doctors working unsupported on the wards manage their own time and only take breaks if they reach the end of their jobs list. All too often that doesn’t happen, the bleep doesn’t stop bleeping.
The system is presently unsafe for doctors, I’d argue that it is unsafe for patients as well. A doctor who isn’t safe to drive isn’t safe to work. It’s hazardous, it has been for years but it’s a necessary evil and the prevailing attitude appears to be that we have to accept the risk.
There are plenty of factors maintaining the status quo, the availability of resources, both financial and human, and the expectations of other staff members, and patients to name a few. I would suggest there is another important but unspoken element to this that shouldn’t be overlooked. It involves the doctors themselves.
Doctors are a mixed bunch but there are common threads discernable in their psychological makeup. They are generally competitive high-achievers who are sensitive to social pressure. They often strive tirelessly to achieve the best outcomes for their patients, or to invert that subtly, to be the best doctor they can be.
This ideal best doctor character is a tower of strength, indefatigable and endlessly resourceful, no challenge too great, no demands too exhausting. It’s the ideal that society looks up to and praises, it is one that the average doctor is happy to embody. Unfortunately best doctor is indispensible, doesn’t need sleep and doesn’t leave work unfinished for colleagues to sweep up. Best doctor stands nobly in a proud tradition of colleagues who have undergone the same trials, nay, worse ones, as our forebears are ever eager to remind us.
Best doctor doesn’t moan about hardships, they are battle scars, a source of pride, evidence to show that this doctor stands shoulder to shoulder with the best of them.
The flawed diurnal human pulling the levers behind the facade is just going to have to cope. If they are too tired to drive their car and have to drink alcohol to make it all go away, well, that’s just the price that has to be paid.
Making night shifts safer would require substantial system changes to moderate demand, but alongside them an obligatory level of self-care for doctors. Anything less stringent will simply be ignored.
Unfortunately our chances of witnessing such changes are laughably remote. The current political will, with Health Secretary Jeremy Hunt as its hapless mouthpiece, is more geared towards exploiting these convenient character traits than compensating for them. As the system is placed under increasing strain I expect that the situation will only get worse.
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I used to fear working NHS night shifts would kill me
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