Doctors are living a ‘nightmare'

Conditions for junior doctors going through their training at the Midland Regional Hospital at Mullingar are “gruelling”, a young doctor who has been through the system in Mullingar has revealed.

And, what most members of the public don’t realise, is that the nightmare of lengthy shifts, working weeks of up to 100 hours, and long periods without sleep or meal-breaks have to be endured for up to seven years.

But, the doctor said, how the system in Mullingar operates is no worse than in most hospitals throughout the country, which is why en masse, junior doctors voted earlier this year to strike in a bid to improve their working conditions.

The strike, originally due to take place this Wednesday has been deferred for a week while the doctors consider proposals from the HSE.

The medic who spoke to the Westmeath Examiner undertook a training stint at Mullingar.

“Basically, as part of our training, every doctor who qualifies has to go through an internship year. It’s a year whereby they can make sure you are competent to work as a doctor,” the medic said, explaining that after internship, a doctor goes on to work as a senior house officer (SHO), for two years, and then, on to further training as a registrar.

“During your internship year, you apply for speciality training – anything from surgery to general medicine or general practice, paediatrics, etc, and you then commence your speciality training, which varies from four years for a GP, up to six or seven years – it’s hard to say the exact number of years because different specialities have a certain number of years.

“Most people change at four monthly or six monthly intervals, and go to a different hospital.”

Government changes of recent years mean that conditions for interns have improved – but not for SHOs or registrars.

“Mullingar has a handful of interns, and I know some of them don’t even do call duty: they would be on regular hours, so the whole issue with the 24 or 36-hour shifts really relates to SHOs or registrars,” the doctor said.

The rotas for staff are drawn up by the human resources (HR) department, and what happens is that on a “one-in-five” rota, SHOs and registrars will find themselves, after five days, rostered for an “on call” shift. “From my experience, you could be rostered to be on call from 9am until 9am the following morning – and you’d then have to go straight on and do your regular shift.

“That meant not leaving the hospital; carrying the ‘bleep’, so you are constantly accessible and constantly on call. We don’t do ‘out of house’ calls, which could mean you could go home.

“So, in that time frame, you aren’t rostered particular breaks or any sleep; there’s no one who could take the bleep from you.

“So you literally have the days and times when it would be busy, you might be lucky to get 10 minutes to get some dinner. But if the bleep goes, you have to answer it.

“We were supplied with a room and a bed – but not a definite time when you could avail of those.

“You sleep when you can; when it’s feasible, and there are also nights I got no sleep at all, and was literally awake all night.

“You could be in bed five minutes, and the bleep would go off, so you never knew if you were going to get to bed or not,

“When you come off call, someone would take the bleep at 9am, so then, you have another responsibility – anything from clinics to theatre, depending on what you are doing, and you wouldn’t get home until 3, 4, or 5pm.”

At other times, doctors can be rostered for a 12-hour shift – but have to do it for several days running.

The doctor cited a roster typical of what they faced in Mullingar – a Monday to Wednesday working from 9am to 5pm, a Thursday from maybe 11am to 5pm; a Friday from 9am to 5pm, then a Saturday on call followed by a normal shift, which meant working from 9am Saturday until 5pm Sunday, and then going on to a normal full week of work.

The doctor pointed out that going into medicine, students are aware that they’re never going to have a 9-5 Monday to Friday job, but the present system means it’s difficult to plan a life outside work; hard to organise weekends with family; impossible to commit to a club or an evening class, or do what most workers can take for granted.

While the nursing staff generally are sympathetic to the plight of the junior doctors, among some of the senior doctors, there is a ‘tough, get on with it’ approach, based on the fact that they have been through the system themselves.

“But that shouldn’t mean we have to continue in that vein. Tradition doesn’t mean it’s right.”

More seriously, there is a concern in this doctor’s mind over how the lack of sleep can affect performances at work; over how dangerous it can be for doctors without adequate sleep getting into their cars and facing, perhaps a long drive home. There is also the threat to the doctors’ own mental health.

“Some people think you sit in a room and wait for your bleep to go off. If only! You could cope with that. But at any one time, you could have people in A&E, a patient or two unstable on the ward, and someone ringing you from another hospital on an outside line looking for advice, so you have to prioritise.”

The current system means doctors are working way above what is allowed under the European Working Time Directive, which caps the working week at 48 hours.

“There would be weekends when I would have done 48 hours!”

The doctor believes the real solution is to employ more doctors.

“If you are asking people to work a 12-hour shift – and there are 14 of those shifts in a week – you will need a lot more doctors.

“Then, you need more resources.”