My trainee years were spent mainly in the Glasgow Royal, and my memories of those days are filled with nostalgia.
We all lived in for the first year and the bedrooms were adjacent to the ward you were assigned to. You lived and breathed medicine, apart from the ‘occasional’ visit to one of the many fine hostelries dotted about Castle Street.
The hours of work were ridiculous, often exceeding 100 per week. I remember on at least one occasion nodding off while taking a history from a patient. I am sure we all made mistakes as a result of fatigue. There were however many advantages.
Most importantly, you did get to know your patient and they got to know you. I believe the patients benefited from this continuity of care, and derived comfort from seeing the same face each morning, albeit a bleary eyed one. Your consultant also got to know you and was able to see your strengths and weaknesses, and thereby mentor and advise you. I can reel off the names of all the consultants I worked for. You provided service and were trained at the same time. The other key player in your training was the ward sister. They were intensely proud of their ward and ran every aspect. Falling out with the ward sister was not a recommended option.
When I became a consultant in Stobhill, the same relationship existed with my trainees. I saw them most days, and tried to replicate the support I had received.
Then in the early 90s things began to change. The European Working Time Directive (EWTD) came in to protect the health and safety of the European workforce. It was difficult to argue otherwise when safety issues dictated the number of hours worked by, for example, long distance lorry drivers and airline pilots. None of us wants a tired pilot at the controls of a plane.
The hours were gradually reduced, so by 2009, trainee doctors could no longer work more than 48 hours per week on average. This necessitated shift systems with all their attendant challenges. When mandatory rest periods were added in, we began to see our trainees less and less. The spirit of the directive was at times lost with the hours still long in some weeks, and then evened out by shorter weeks. Hospitals were penalised if the juniors stayed on beyond their shift and this led to a clock watching mentality. The patient also had to contend with a different doctor most days. Young doctors had to learn how to handover, something that our nursing colleagues were so expert at. There was always the risk of mistakes, the more handovers there were. Support for trainees was diminished by shift systems. The rotations were so rapid that at times I struggled to remember the trainee when a reference was requested. The trainees (especially in surgery) themselves became concerned that they were missing out on operations and some are campaigning for an increase in hours. The health service is based on the trainees providing part of the delivery of health care, and this aspect also suffered by the shortening of hours.
It is gratifying that Government agencies are now addressing ways with the profession, to achieve that right balance between hours of work, and the need for training to the highest level. This must involve more flexibility and a return to better continuity of care. We need to look after our trainees, by providing rest areas and improved evening and night time catering. In addition, the consultants have to be given the time to teach in tandem with their own clinical duties. The hit song “Getting to know you” from the musical, The King and I comes to mind. The rotas need to be designed in such a way that the patient, the trainee and the consultant get to know each other to the benefit of all.