Caring and the EWTD

There’s been a lot of talk recently about the European Working Time Directive and the detrimental effect that it’s had on training; particularly in the “craft” specialities.  (EWTD limits the amount of time that junior doctors can work to an “average” 48 hour week, and places some other restrictions on working patterns.  You can still work 100 hours/week as long as the average is <48).  There seem to be increasing attempts to subvert the EWTD, either by trainees who stay late for “educational” purposes (I know, I’m one of them) or by official bodies.

Generally, the view seems to be:

  1. EWTD is a bad thing for medical care
  2. It’s bad for trainees as it prolongs training/reduces experience
  3. We should all complain about it

I trained in a fairly old-fashioned medical school, and I was shocked when I started working as an FY1 to see how much my hours had been cut.  I grew up watching “Cardiac Arrest”: I was going to be Dr Claire Maitland  (although possibly without the complicated social life).  And so I’ve been very anti-EWTD.

Gradually, I’ve come around to the idea that maybe it’s a good idea for patient safety if healthcare workers aren’t exhausted all the time.  I hadn’t really thought about the other aspects of being tired until this week.

I have just finished 5 night shifts so I may be feeling slightly jaded.

They weren’t easy nights in many ways (and I won’t go into details); but what always amazes me is how much the team cares about the families.  Sometimes, they’re people that we’ve known for a while; some are acute admissions with no previous contact with health services.  But I work with a great network of nurses and HCAs who listen & laugh & joke & cry with these families.  And doing that takes energy and commitment.

It’s exhausting, but it’s such a vital part of our job.  And it gets harder and harder to do well when we are tired & run-down & hungry & haven’t slept for 48 hours.  Every time I’ve seen a colleague breakdown at work, it’s been at the end of a run of long-shifts.  Every time I’ve had to slide into the treatment room for a minute to take some deep breaths, I’ve been working a long-day.

Being compassionate is tiring; caring is tiring; doing this job properly is tiring.

I know when I’m tired, I have to really think about what I’m saying; to take time & be patient feels harder.  It gets harder to do the “little things” that matter.  And they do matter, because if I can’t be bothered to get you a blanket or a cup of tea, then why would you think I was bothered enough to look after your child?

So maybe the EWTD is cutting training opportunities; maybe it is reducing patient contact time.  Does that really matter?

I don’t really care if my training gets extended.  I do care if I’m so exhausted that I’m not doing my job properly.

Being a doctor is about more than technical skills & being a diagnostician: this is supposed to be a caring profession.  Limiting the hours that I work doesn’t decrease my training opportunities, but maybe it does change them away from the purely technical and towards the human factors side of medicine.

Should we keep the EWTD? Yes. Not just because it’s safer for patients & staff, but because it allows us to do our job properly; it allows us time & energy to care. And really, that is the job

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