The sound of junior doctors cracking under the strain

IRISH LIVES:It is 9am on Wednesday, and Anthony O'Connor, a medical registrar at St James's Hospital in Dublin, is beginning his oncall shift by reviewing his inpatient files.

Towards midday he transfers to the emergency department, where he will remain on duty until 9am the following morning. There are treatment plans to draw up, lumbar punctures to commission and chest X-rays to order.

“There’s a lot of decision-making involved. You have to be nimble on your feet. Some of the elderly patients have stories to tell and you do your best to lend an ear, but there’s always the pressure to move on to the next patient,” he says.

An average of 25 patients come into the emergency each night, many with serious conditions. O’Connor, whose specialities are gastro-intestinal and general medicine, supervises his senior house officers’ work and is often called in by colleagues for advice on their patients.

There’s time for a cup of coffee but not much more, and even when his stint in emergency is up there are ward rounds to complete and more tests to order for patients. By the time he heads home he has clocked up 28 straight hours at work.

His other working days follow more regular hours but in an average week O’Connor reckons he puts in 65 hours at work and another 12 at home. That’s before study for exams and writing articles for medical publications.

Long hours and large doses of stress: it was ever thus for non-consultant hospital doctors (NCHD). Successive governments have promised the European Commission they would take steps to ensure Ireland conformed to the European working time directive, which limits the working week to 48 hours, but this aim has never been realised.

However, the current crop of junior doctors has decided enough is enough, or, more precisely, “24 hours is enough”. It started with a heartfelt column by O’Connor in the Medical Independent, in which he recalled his mental health challenges and the stresses of the job. Since then, a flood of NCHDs has taken to the airwaves and the internet to offload their anger at the working conditions they endure.

What distinguishes the current campaign is the palpable anguish among junior doctors, the unmistakable sound of people cracking under the strain.

“I qualified 10 years ago and have worked like a slave because of the HSE,” one doctor told The Irish Times. “I work on average 95 to 100 hours every week and occasionally up to 108 hours. The HSE have refused to pay me overtime and my colleagues too.

“During these 36-hour shifts there is no bed, no sleep, no time to eat and no time to wash or clean oneself. It is relentless and ruthless and every second of every day people are dying because of mistakes.”

With salaries shrinking and new work practices sweeping through the profession, many junior doctors are finding that medicine isn’t the Nirvana they might have imagined it to be, and that the slog of their training years might turn out to be a long-term condition in our resource-starved health system.

The use of social media has lent a confessional air to the campaign, with some doctors owning up to near-mistakes caused by the exhaustion of through-the-night work. One reported admitting an “old lady” to emergency who asked “whether I was like one of those doctors on TV working crazy hours”. “I thought it wisest not to mention that I’m currently on a 106-hour shift and will be involved in her surgery today!”

The S-word has also featured strongly in the debate among junior doctors well aware that a number of colleagues have taken their lives over the past year.

In particular, the tragic death of Cork woman Jess Murphy last December, five months into her training at Tallaght hospital, has galvanised many of her colleagues into action.

“She started work every morning at 7.30am and was never seen to leave before 10pm; she was routinely rostered for 36-hour in-hospital shifts ; she lived alone close to the hospital to shorten her commute in an attempt to ease the situation; and had barely any time to see her friends/family in person,” one of her friends said.

The reasons why a person take his or her life are often complex and it has to be noted that Ms Murphy had battled with depression. Yet her family has spoken about the pressure she was feeling at work in the days before her death and how she felt unable to bring her concerns to anyone because it might affect her career.

Steering groups and committees have been working on the problem for years, but there is little sign of a solution. The Irish Medical Organisation blames the HSE, but the latter claims it is up to hospitals to decide on rostering. Privately, some junior doctors say consultants with an “if it was good enough for me, it’s good enough for you” attitude are part of the problem.

The doctors are meeting next week to decide a plan of action – they went on strike in the 1980s – but for the immediate future hospital patients can be sure that if their doctor looks exhausted, he or she probably is.