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File photo. Sasko Lazarov

Column Working conditions in hospitals are so bad that sometimes I get no sleep at all

Writing under the condition of anonymity, one junior doctor describes a typical work week in a busy Dublin hospital.

I WOULDN’T SAY there’s been a single week since I’ve started working about a year and a half ago in the hospital that I’ve only had to work 48 hours a week – as the 2004 EU Working Time Directive instructs.

It can be anything up to over 100 hours a week. There was a couple of hours where I was working over Christmas where I was on call three times a week and you’d have to work the next day post-call as well.

Generally you wouldn’t get any sleep, or you might get one or two hours. You could end up working anything up to 36 hours in a row.

Thirty-six hours would be a record. But once a week you’d generally have to work 32 hours in a row.

It’s a killer. Adrenaline tends to get you through the first 20 hours. You start to feel the burn at around 4am. You focus then on the ward for a few hours, you make your way through it, you’re generally okay that night, but then the next day is really exhausting.

Overtime pay

They say you’re supposed to get time and a half. But there are all sorts of issues about NCHD overtime pay, and a lot of us aren’t getting our pay back. I didn’t get any overtime pay on my last pay cheque.

They ask us to fill in all these special sheets where you give reasons for all the extra hours we’re working, which shouldn’t really be feasible, because there’s never a single excuse for why you’re working an extra ten hours. There’s always a hundred reasons why you have to do that. It just doesn’t really work – they have to just believe that we’re working those hours and pay us the overtime. I think they’re just looking for any reason not to, and they’re putting loads of red tape in the way, so that they don’t pay us really so the hospitals don’t run out of money.

Thankfully, I haven’t made any major mistakes. There are lots of minor mistakes the whole time. There’d be occasions where you don’t look particularly professional the next day on the ward. You’d be just so exhausted and your eyes would be sort of closed and you’d just be nodding off. Things like that just don’t really look good.

Patients ask the whole time. When we’re on A and E, you might see a patient on the day at 3 o’clock. You might then get called to see them at midnight and then you might be called to see them again at 6 o’clock in the morning. They’re very surprised by that. It’s not covered up well, it’s pretty obvious that we’re working these hours. I don’t think they really understand the shifts that we do work. I don’t know if a lot of people turn a blind eye to it. I think it’s something that does really need to be addressed.

EU Directive

The 48-hour EU Directive is just being ignored. It seems to be the worst for SHOs and Registrars. Interns seem to get the next day off. But they would have to do a 24-hour shift, which is still a lot. That would be overdoing the 48 hours in itself. SHOs are constantly doing it. The Registrars are meant to be doing it as well, but they might get more sleep at night time. If a particular Reg is on call, he might get three or four hours of sleep – it’s much easier to function then. So far, when I’ve been on call, the most I’ve gotten is two hours of sleep and sometimes I get no sleep at all.

It depends on the hospital. And it depends on the speciality you’re in. In some specialities – like dermatology – patients wouldn’t need to be seen at night time, so they wouldn’t have any late hours. And there’d be doctors working in microbiology and lab-based things where they don’t need to be on call. But if it’s general medicine or general surgery, you’re going to need about three doctors on call every night.

They don’t have the resources to be getting different people in. What they should do is what they do in nursing, where they have some people working nights and not having to do the whole thing for a couple of months. Just do your week of nights, then just go back to your normal 9-5 job. It’s not usually 9-5 though. My normal job is probably around 8-7.

It’d be all the big Dublin hospitals who ignore the EU Directive’s instructions – I know doctors working in all of those. And it’s the same in some regional hospitals. People there have echoed my concerns.

‘Rite of passage’

A lot of the consultants tend to ignore the problem. They say that ‘it was like that for us in our day – we all had to do it’. Working excessive hours is kind of like a rite of passage, which isn’t really the way to look at it all – as a stagnant practice. There’s definitely room for change.

I think we’re certainly being exploited – and that’s the reason that so many young Irish doctors are leaving. Actually, about 50 per cent of my class that graduated in 2011 have left the country. They’ve gone off to Australia and New Zealand. A lot of them went off travelling the world and things like that, just because the system had drained them. Of all the lads that I lived with, none of them are currently working as a junior doctor in Ireland, they’ve all opted to do something else.

It’s because of the working hours and the working conditions. A lot of the time, we’re not getting paid a fair day’s wage for a fair day’s work.

A lot of consultants say if you press the issue too much, you’ll look bad. It’s the sort of situation where they say ‘we had to do it, now it’s your turn’. They say ‘this is what being a doctor is all about. You have to deal with the pressure of these late nights.’

I do think it’s very taxing on your health. I’ve been off work sick the past couple of days. It was after one of these 33-34 hour shifts.  And I’d have to work maybe 70 hours a week on average.

A lot of the people who end up doing medicine tend to be quite placid people, and are easily exploited. A lot of the reason why we don’t complain too much is that there’s no real alternative. When I was supposed to go home at 5 o’clock today, I couldn’t have decided to go home, because there’s a load of patients that haven’t been seen yet, or there’s a load of things that have to be sorted out for tomorrow. People might get acutely unwell, so you kind of have to be around for that.

Your own morals keep you in as well. There’s no clocking out at 5 o’clock and forgetting about everything.

The Irish Medical Organisation

I’m not a member, as it’s too expensive to join, but I have friends who are members of the Irish Medical Organisation and they don’t seem to be doing very much. I know there’s been efforts asking to make sure they pay for overtime or there’ll be legal cases brought against them, and I think, for the most part, the hospitals are paying the overtime, but there’s a bit of a fight for a lot of it. We have to give excuses for overtime, but a lot of the doctors just don’t bother. Some of them are lazy about it. Some of them just don’t have the time. They end up not getting their overtime, and a lot of them don’t complain about it either, which is mad.

The head of the IMO and his multi-million euro pension is another issue. It’s kind of hard to trust an organisation when the CEO is walking away at about 53 with this payoff – that could certainly have paid us a lot of our overtime.

It seems like the only alternative at the moment is emigration. That’s the path a lot of people are following, including a good lot of my friends. And I would be tempted by it. It’s not all about the money, but it is a factor. The money we’re making at the moment is literally just enough to pay rent and pay back my loans from college, and just general living expenses. And when you’re working those hours, it’s pretty unsatisfying.

It’s not all bad. There’s a lot of good teams working in the hospital, and you find that the junior doctors are all in the same boat. There’s a camaraderie, and everyone’s kind of pissed off together.

On a morbid note though, there were two suicides of junior doctors in the past year. The girl was a friend of one of the lads I’m working with. It does highlight the strain. Obviously, there’d also be a lot going on in someone’s personal life for that to happen, but it doesn’t help when they’re exhausted from their work.

The person who wrote this column did so under the condition of anonymity. He is a junior doctor working at a major Dublin hospital.

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