Doctors' Working Lives News
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Tuesday, September 28, 2004
Workers today "sleep less and perform worse"
A new Demos survey reports that over the past 100 years, workers have lost 90 minutes sleep a night - down from 9 hours a night to 7.5 hours, with a massive effect on work performance. The report suggests daytime naps may be useful in counteracting this problem. (HR Gateway)
A letter to the Canadian Medical Association Journal about the reality of overwork and sleepless nights for physicians, provoked responses from Christopher Parshuram and Steven Howard. "Health care is a hazardous industry where we do risky things to patients", Howard argues. "Practitioners owe it to their patients to be optimally alert and able to perform. No health care professional would find it acceptable to arrive at work impaired by ethanol, yet many of us similarly impaired by chronic loss of sleep continue to care for patients."
The Guardian has a Q&A on the Working Time Directive.
Indiana's Purdue University is planning to launch a center which will use engineering and manufacturing principles to change healthcare delivery, time & resource management. (AMed News)
A letter to the Canadian Medical Association Journal about the reality of overwork and sleepless nights for physicians, provoked responses from Christopher Parshuram and Steven Howard. "Health care is a hazardous industry where we do risky things to patients", Howard argues. "Practitioners owe it to their patients to be optimally alert and able to perform. No health care professional would find it acceptable to arrive at work impaired by ethanol, yet many of us similarly impaired by chronic loss of sleep continue to care for patients."
The Guardian has a Q&A on the Working Time Directive.
Indiana's Purdue University is planning to launch a center which will use engineering and manufacturing principles to change healthcare delivery, time & resource management. (AMed News)
Thursday, September 23, 2004
EWTD - Commission publishes proposed revisions
The European Commission has released its proposals for revisions to the European Working Time Directive, which effectively overturn both the SiMAP and Jaeger rulings.
European Commission Press Release and proposals
The proposals include:
* Inactive on call time not to count as work
* Compensatory rest to be given within 72 hours
* Restriction of opt-out to 65 hours per week
* Reference period remains at 4 months but member states can in som circumstances extend that to up to 12 months.
The CBI and the European TUC have both vowed to fight the revisions, which have yet to be discussed by the European Parliament. An EU source quoted in the Guardian comments: "The Brits have got away with murder on this one". Interesting times...
European Commission Press Release and proposals
The proposals include:
* Inactive on call time not to count as work
* Compensatory rest to be given within 72 hours
* Restriction of opt-out to 65 hours per week
* Reference period remains at 4 months but member states can in som circumstances extend that to up to 12 months.
The CBI and the European TUC have both vowed to fight the revisions, which have yet to be discussed by the European Parliament. An EU source quoted in the Guardian comments: "The Brits have got away with murder on this one". Interesting times...
Wednesday, September 22, 2004
Latest issue of Calling Time released
Calling Time issue 12
Overseas update
An early study on the effects of US hours reductions reports that "Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced." (JAMA Archives of Surgery 2004;139:933-94)
A study by the US Department of Labor suggests that working more leads to sleeping less.
Australian doctors are often working 16 hours at a stretch, putting patients' lives at risk, according to the Herald Sun. The report suggests that safe hours will be difficult to achieve in rural areas.
A study by the US Department of Labor suggests that working more leads to sleeping less.
Australian doctors are often working 16 hours at a stretch, putting patients' lives at risk, according to the Herald Sun. The report suggests that safe hours will be difficult to achieve in rural areas.
Tuesday, September 21, 2004
EU "plans to overturn Jaeger" - BMA to protest
The EU Observer reports that the European Commission's plans will lead to "turning back the clock" on the Jaeger ruling, allowing all on-call time to be treated the same way. The BMA is to protest against this.
The BMJ has a survey by the London Deanery on bullying among doctors in training.
The Medical Journal of Australia continues its series of tips on teaching on the run.
The BMJ has a survey by the London Deanery on bullying among doctors in training.
The Medical Journal of Australia continues its series of tips on teaching on the run.
Monday, September 20, 2004
Dealing with shift work
The August edition of the journal Anaesthesia has a great editorial on shift work and EWTD entitled "Shift work, the anaesthetist and Santayana's warning". It is subscription only, but if your hospital or your anaesthetists have a copy, try to read this article. It weighs up the effect of shift working on clinical error, and the "two main areas of concern: gastrointestinal dysfunction and the effects of chronic sleep deprivation".
The article provides a review of the ways in which the negative impact of shifts can be minimised, and the way shift patterns should be designed.
The article provides a review of the ways in which the negative impact of shifts can be minimised, and the way shift patterns should be designed.
Thursday, September 16, 2004
EU proposals - latest predictions
The EU is likely to propose a union veto on working over 48 hours, and a complete ban on more than 65 hours per week, according to an article in the Financial Times. However, Poland has indicated that it will support the UK on retaining the opt-out, which would give Britain a blocking minority vote.
The full proposals are expected next week - watch this space!
In the meantime, I've come across a fascinating discussion in Worthwhile Magazine from back in July this year, on the topic Should You Be Allowed to Work Yourself to the Bone? Should HR professionals and managers have the right to stop workers from working 70 hours plus per week?
The full proposals are expected next week - watch this space!
In the meantime, I've come across a fascinating discussion in Worthwhile Magazine from back in July this year, on the topic Should You Be Allowed to Work Yourself to the Bone? Should HR professionals and managers have the right to stop workers from working 70 hours plus per week?
Tuesday, September 14, 2004
EWTD update
Tony Blair has written to EU Commission President Romano Prodi to plead the case for the EWTD opt-out.
EUPolitix.com quotes the letter: "It is ... important to the UK that the working time proposals retain the individual opt-out, while addressing other abuses. Our flexible labour market...depends on measures such as this which allow workers to exercise choice over their working lives."
The Herald also has an article on the struggle across Europe to implement EWTD, with many countries prioritising training and service over legal compliance.
EUPolitix.com quotes the letter: "It is ... important to the UK that the working time proposals retain the individual opt-out, while addressing other abuses. Our flexible labour market...depends on measures such as this which allow workers to exercise choice over their working lives."
The Herald also has an article on the struggle across Europe to implement EWTD, with many countries prioritising training and service over legal compliance.
Updates
A study at the University of Virginia has suggested that sleep deprivation does not affect operative results in cardiac surgery. The authors add: "These data do not support a need for work hour restrictions on surgeons."
The death of a patient in Belfast has been linked with the administration of four wrong drugs. At the inquest, a professor from the Pharmacology Department of the hospital suggested that EWTD impacted badly on continuity of care and the ability to review medical notes every day.
Chorley Hospital have declared that they have no plans to close A&E, after rumours that it would transfer services to the Royal Preston Hospital. Apparently, "The department had 509 applications for three junior doctors' posts needed" for compliance with EWTD.
The NHS Magazine has an article on Modernising Medical Careers.
BMJ Careers Focus has an article on how to be a healthy doctor without trying too hard.
HR Gateway reports that most staff work late to keep their workload under control.
Finally, E-Health Insider reports on the imminent development of a common European electronic health record. "It’s a laudable goal," muses the Insider, "and one which really would be an achievement for a continent that doesn’t even have a common electric plug. "
The death of a patient in Belfast has been linked with the administration of four wrong drugs. At the inquest, a professor from the Pharmacology Department of the hospital suggested that EWTD impacted badly on continuity of care and the ability to review medical notes every day.
Chorley Hospital have declared that they have no plans to close A&E, after rumours that it would transfer services to the Royal Preston Hospital. Apparently, "The department had 509 applications for three junior doctors' posts needed" for compliance with EWTD.
The NHS Magazine has an article on Modernising Medical Careers.
BMJ Careers Focus has an article on how to be a healthy doctor without trying too hard.
HR Gateway reports that most staff work late to keep their workload under control.
Finally, E-Health Insider reports on the imminent development of a common European electronic health record. "It’s a laudable goal," muses the Insider, "and one which really would be an achievement for a continent that doesn’t even have a common electric plug. "
Friday, September 03, 2004
Just one more thing....
Go Simon Eccles! who has just answered the question in the BMJ: I have just started a three year rotation and my first job is banded 2A. Is this pay protected for the rest of the contract?
OK, this is stated in AL/MD 1/2001, but Dr Eccles's explanation is much clearer for many junior doctors and managers who (quite understandably) get a bit tangled up in the knots of pay protection.
OK, this is stated in AL/MD 1/2001, but Dr Eccles's explanation is much clearer for many junior doctors and managers who (quite understandably) get a bit tangled up in the knots of pay protection.
I'm on leave for a week, and will update again on 14th Sept. In the meantime, please do continue to feed back on the overnight power nap debate!
Thursday, September 02, 2004
Overnight power naps - the debate continues
The issue of "power naps" or "anchor sleeps" at night has resurfaced, this time at Barnet & Chase Farm Hospitals NHS Trust, who have removed on call rooms from full shift doctors. The anaesthetics doctors and the BMA have objected to this on the grounds of patient safety; BMA JDC deputy chair David Macklin described it as "a short-term, short-sighted method to create office space". The Trust (of course) disagree; they believe that doctors on full shift shouldn't be sleeping on duty.
You may remember that this hit the front page of Hospital Doctor last year. Back then, anaesthetics registrars at St George's complained about having to sleep on chairs overnight after their on call rooms were removed. Simon Eccles has also argued for on call rooms for full shift doctors.
One significant problem that isn't being addressed in this debate is - what about other staff groups who have to work overnight? For instance, nurses can be sacked and/or struck off the register if they're found sleeping on duty, even on a rest break. Yes, there's certainly research evidence that power naps at night can help people work better and more safely (though there's also the problem of sleep inertia when doctors are called to an emergency). But equity for different staff groups also needs to be addressed - or if doctors are a "special case", that special case needs to be made.
What do you think? Is it important for doctors to power-nap overnight and are they a "special case"? Please post in the comments below or email me at admin@idwl.info. I'll update on this when I can.
You may remember that this hit the front page of Hospital Doctor last year. Back then, anaesthetics registrars at St George's complained about having to sleep on chairs overnight after their on call rooms were removed. Simon Eccles has also argued for on call rooms for full shift doctors.
One significant problem that isn't being addressed in this debate is - what about other staff groups who have to work overnight? For instance, nurses can be sacked and/or struck off the register if they're found sleeping on duty, even on a rest break. Yes, there's certainly research evidence that power naps at night can help people work better and more safely (though there's also the problem of sleep inertia when doctors are called to an emergency). But equity for different staff groups also needs to be addressed - or if doctors are a "special case", that special case needs to be made.
What do you think? Is it important for doctors to power-nap overnight and are they a "special case"? Please post in the comments below or email me at admin@idwl.info. I'll update on this when I can.
The New England Journal of Medicine (subscription only) has an article on the importance of cultural competence for the effective practice of medicine.
Wednesday, September 01, 2004
HRI NICU reopens
Remember the Huddersfield Royal Infirmary's neonatal intensive care unit, which had to close temporarily at the beginning of August because it couldn't meet EWTD requirements? Good news - it reopens today following successful recruitment and reorganisation for EWTD.
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