48 Hours...

... is the maximum number of hours per week that I am legally allowed to work here in the UK. The European Union have produced a European Working Time Directive (EWTD) to which all employees have to adhere, or sign an opt-out. In its infinite wisdom, the NHS has decided that although doctors-in-training were initially exempt from this rule, as of August last year, we’ve all had to comply both with average hours worked per week and with various rest requirements.

It’s a far cry from working in the un-restricted world of Kiwoko Hospital in Africa, although I actually believe I had a better work-life balance there and was generally less tired. I guess a lot of that depends on how busy the night-time workload is. Two years ago in Uganda, we generally worked 7.30am-5.30pm Monday to Friday. Then one week in three I covered surgical emergency operating outside of those hours Mon-Sun. I got a night off on Thursday, but had to work until 5pm on Saturday and covered the whole hospital overnight Sunday rather than just the surgery. The next two weeks were standard Mon-Fri only, with one extra Thursday night on call for the whole hospital.

That sounds a lot, but in general I wasn’t often called out overnight – there were occasionally emergencies before midnight, and a couple of 6.30 calls to theatre to help with a difficult Caesarean Section being performed by one of the other doctors who was struggling a bit, but in the main these weeks involved a decent amount of sleep except for the Sunday night which could end up being 4-5hrs only.

Now I’m back in the UK, the amalgamation of hospitals into larger centres, the transformation of out-of-hours healthcare to nurses answering telephones and seeing patients rather than the old model of General Practitioner doctor consultations, the reduction in training hours and therefore less experienced junior staff, as well as an aging population more prone to ill-health and with much greater 24hr expectations, has resulted in a much heavier overnight workload than was the case when I started work as a doctor over twelve years ago. The lack of expectation of sleep overnight combined with the EWTD means that I’m on shift work, and I hate it!!!! Unfortunately I’m one of those people who find it very hard to sleep during the day between night shifts, and so I get progressively more tired as my night-shifts go on.

Over the last three weeks I have worked: Friday, Saturday, Sunday nights; Monday to Friday daytime on a course 8.30-5.00; Saturday & Sunday off; Monday to Sunday Emergency Surgery shifts 8.00am-9.00pm; Monday off; Tuesday-Thursday nights. Admittedly my week’s course in the middle should have been a fourth night and then the rest of that week off, but it’s still a fairly punishing schedule. Fortunately before nights come round again I get five weeks of normal 8am-6pm Monday-Friday working. On paper it does eventually average out at 48hrs over the course of the rota, but of course in practice events require you to start earlier and finish later regularly. Life was definitely better with the old on-call one night a week and one weekend a month...

The best thing about this year is that in theory I finish my training at the end of October 2010 getting my Certificate of Completion of Specialist Training, and enabling me to register as a Specialist Surgeon and get a Consultant job. There’s the small matter of passing exams in a couple of weeks time, and then the need to find that new job. There are potentially a couple of jobs coming up in some of the medium-sized hospitals in Scotland – As a generalist with a laparoscopic surgery interest, I’m not specialised enough to go for jobs in the big city hospitals, which does limit the type of jobs available. I guess I’ll have to see what comes up, pray hard, and trust that I’ll end up somewhere I can be useful. Various things in life are suggesting to me that staying in this country initially would be better than heading immediately back out to Uganda... which is possibly what I would actually really like to do... but I’ll wait and see where God is guiding me.

One thing I am able to do much more easily from Scotland is head to the Alps to go skiing which is my next break at the end of February and hopefully a reward for getting through the exams. Anyone for Gluhwein?

Steve

P.S. The snow in Edinburgh (pictured above from Arthur’s Seat) has now all gone again. I hope spring comes soon!