Practice makes perfect for doctors
I was interested to hear about some side effects of the working time directive being applied to junior doctors. According to the British Medical Association, the limits of 48 hours have led to hospital shifts becoming more demanding and leaving less time for doctors to practice their basic skills.
Earlier this year, I was admitted to my local general hospital as an emergency. I needed to have my medication administered intravenously. A junior doctor had six (yes, six!) attempts to insert a cannula into a vein, before saying tearfully, ‘I’m sorry, I’m sorry’ and rushing out of the cubicle. A charge nurse followed a few minutes later and inserted the needle into the back of my right hand first time. The nurse apologised for his colleague. ‘ I’m really sorry’, he said. ‘She’s new on this ward and very busy. They don’t get a lot of time to practise nowadays’.
I survived, but felt a little distressed – and had bruises on my arms and hands, one of which lasted for over a week. But if the operation of the directive means that doctors don’t get the time to perfect the skills they need under supervision, then surely it is counter-productive?
No-one wants a return to the era of junior doctors working highly excessive hours purely in order to staff wards, but it is important to make sure that the pendulum has not swung too far the other way in limiting doctors’ progress.
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Comments
06 September 2010, 3:34 pm
The 48 hour threshold is just short of a ten hour day, in the professional services sector that’s the point at which we start charging clients extra. They pay us for a 7 hour day, they generally get somewhere between eight and nine, when we pass ten we put them on a different charging schedule. Essentially it’s recognised as exceptional.
I’m unconvinced by the whole ”not enough time to train” argument, as I’d question how much learning is actually going on if the trainee is already working that length of day.
I have a lot of sympathy for your experience, needles leave me very uncomfortable and I’ve been subjected to a similar experience with a trainee nurse leaving my arm a mess. But I’m left feeling that there is quite a lot behind the comment from the nurse. If the doctor in question was already in a state where running away in tears was seen as a professional response then I’d consider excessive tiredness as a factor.
The whole tenor of the medical community position on this has been ”it was good enough for us…”, this current iteration of the same arguments isn’t leaving me with a different opinion.
I’d add that I do have some sympathy for the doctor concerned, it’s difficult to get kicked out of training and straight into a situation where people expect one to be fully worked up and experienced. We in the military have a similar issue as junior officers.