Yes, we do

I would like to add a small personal observation to this. I am married to a doctor. When she was training, which was before the Working Time Directive came into force, there were occasions when she went on shift at 9 AM on Friday, and came off shift at 5 PM on Monday. The shift was, in other words, 80 hours long and covered four days and three nights. She was, of course, provided with a room to stay in at the hospital during the course of the shift but on occassion got less than three hours sleep a night on each night she was there. As she puts it, at the end of that period she was hysterical with tiredness, and quite unable to make effective decisions.

Is that the sort of doctor Johnson and Gove want to recreate?

It takes many thousands of hours to train a doctor. Doing so at 40 hours a week means they will be trained at about the age they’re able to retire.

59 thoughts on “Yes, we do”

  1. Why bother when you can loot them from other countries, undermining their health systems, AND feel virtuous and smug while doing it?

  2. “As she puts it, at the end of that period she was hysterical with tiredness, and quite unable to make effective decisions.”

    Stop women from becoming doctors then. Men managed the intensive learning process for decades quite happily.

  3. You do wonder how effective training of someone who has been awake for 21 hours is. Also do you want them working out what medicines to give you?

  4. Solid Steve 2: Squirrels of The Patriots

    Eh, I dunno. I’d rather the physician looking at me wasn’t hallucinating about cool, fluffy pillows and cozy duvets.

    How much do you really learn when you’re shattered?

  5. Is this the first mention of his family for a long time? Or has he been blathering on as usual but nothing worth Tim repeating?

  6. So the hospital blunders back then were down to tired doctors.
    What is the reason for hospital blunders now?

    I’ve had a consultant in 2012 order antibiotics for the wife that were half the dose required for her weight – then when she went back in a week later with far worse problems as the antibiotics had done little to prevent infection the doctor on duty required a student nurse who had seen her legs the previous week to come and confirm they were worse at this later date.
    They were pretty bad – that could be seen at a glance.

    No ’80 hour shifts’ involved in 2012. Merely medical negligence followed by incompetence.
    And as a result a lifetime on low dose antibiotics.

  7. quite unable to make effective decisions.>/em>

    Such as declining to marry Murphy.

    Is that the sort of doctor Johnson and Gove want to recreate?

    One that thinks Murphy is someone she wants to spend time with? Absolutely not!

  8. @Richard,

    First mention for a long time. Note that “he’s married to” her, most normal people would say “My wife is…”. Various youtube videos show he no longer wears a wedding ring, although that might be because he’s got too fat.

  9. As she puts it, at the end of that period she was hysterical with tiredness, and had to come home to me, which was the point where she truly became hysterical”.

  10. Sorry. This is where the very small violin comes out. If we are to believe doctors, this sort of thing had been going on since they gave up on leeches as a main proscriptive treatment. So all the senior doctors at the top of the pecking order have been through it.
    Over here, in the private sector, when things get busy we all pitch in. The little concern I’m involved with, the amount of dreamtime she was getting would have been what I would have been dreaming about if I’d had her dreamtime, last summer. But shit needed doing & organising. And I’m not even under the slightest obligation to do it. But… that’s what we do, don’t we?
    She hasn’t got a problem with politicians. She’s got a problem with her profession. That doctors who’ve completed their training don’t feel an obligation to leave their golf courses, comfy sofas or duvets when needs call. Despite having been through it themselves. In other words, doctors aren’t particularly professional.

  11. So Much For Subtlety

    Aspiring Army officers go through sleepless hell. Because when you come down to it, the ability to work under pressure with little sleep is kind of important for the job.

    Doctors? Not so much. But a little. I would rather a doctor who is tough enough to cope with stress.

    Admittedly most of it is simply keeping the numbers of doctors down. Most of a GPs job could be done by a nurse with google.

  12. Bloke no Longer in Austria

    Tsk… as BiS says, like it doesn’t happen anywhere else.
    Even in Austria it is quite normal for a duty junior to be on a weekend-long shift with a room to kip in. Mind you they tend not to get the nutters that hospitals in London have to deal with turning up at 2am…
    When I was having my knee done in Vienna, the consultants even came in on Saturday morning to see how I was. Get them off the golf course over here.

  13. Noel: Note that “he’s married to” her, most normal people would say “My wife is…”.

    Well, as everyone’s favourite fictional character would observe, “rem acu tetigisti”

    In the first (tuberous) instance “a doctor” is an indirect object while “I” (Tuber) is the subject.

    In the second (standard) example, “a doctor” is the subject in apposition with “My wife”.

    He can’t help his overweening self-love oozing fatly into his every sentence.

  14. Given that I’ve spent most of this morning driving my mother around, first to a walk in clinic because she can’t get the Betnovate she needs for her contact dermatitis without prescription, and she can’t get a prescription without a GP appointment they haven’t got until next week, then home again because they can’t give her a prescription either, as she’s had one from them before (the last time when she couldn’t get a GP appointment) so it would count as a ‘repeat’, and we have to wait for an appointment with an out of hours GP, which we can’t even phone for until 2pm when the lines open, my sympathy for any NHS worker is so tiny, you couldn’t see it with a scanning electron microscope.

    I get better service from my vet. But then, I pay for that. The NHS is ‘free’… *laughs hollowly*

  15. JuliaM, if anyone is visiting from Europe or the US, they can buy it over the counter at 0.5%strength. I evengot 1% in the US. Have you tried just asking a pharmacist?

  16. That is how you train an eperienced doctor if there are enough levels of supervision above the junior doctor. There are a terrifying number of British doctors missing stuff because they haven’t mastered the art of physical examination or developed the sense that someone is in serious trouble, acquired only by exposure and experience.

  17. PS not every eighty hour shift is a nightmare and you stop being a snowflake. Good supervision should catch potential errors.

  18. > there were occasions when

    So twice in a decade-long training programme?

    Seriously, we need an idea of the magnitude of the problem before we set about correcting it. If a junior doctor only works one 80-hour shift a year, in peak Winter Flu Season, then it’s perfectly manageable. If they’re doing it every other weekend, I suggest we have something of a problem.

    How do we find out if it’s a problem? We can look at the number of sick notes written for junior doctors signed off with exhaustion.

  19. So far as I am aware, the main reason for doctors working long hours (and getting high pay) is that the BMA (essentially a labour union for doctors) limits the number of doctors they will train/license. They have a monopoly on their production, so they restrict supply to keep prices high.

    A shortage of doctors combined with political pressure to treat ever more people allows them the ability to offer to work longer hours at even higher pay.

    It’s the same problem as people moaning about high house prices, but then moaning about the ‘negative equity’ they get stuck with if house prices drop. A lot of people have half their lifetime income invested in their house – they’d be pretty annoyed if that evaporates because the government doubled the issue of planning permissions. Likewise, doctors moan about long hours, but they’d be pretty upset if the BMA fixed that by training twice as many doctors and in the process halved their salaries!

    One of these days, they’ll invent an AI able to diagnose and prescribe…. then we’ll see.

  20. @NiV
    Spot on. The doctor’s union is only worried about doctors’ pay and conditions and virtue signal about patients’ care only when it suits them

    Despite £squillions spent on the NHS i doubt Dr finlay would notice much difference in general practice

    The whole system is administratively inept and fundamentally inefficient, kept that way by producer interests

  21. “It takes many thousands of hours to train a doctor.”

    Doctors are glorious BS artists because we let them be. They are little more than a price fixing medieval guild and the entire mess needs to be re-structured.

    I doubt that .000001% of the doctors will ever encounter the stress level they are all supposedly trained for, or ever could encounter that stress level. Why does a podiatrist, a skin doctor or similar specialist need that nonsense?

    Answer: Medieval guild, rites of passage, price fixing by controlling supply just like New York Taxi medallions.

    We need a medical Uber.

  22. NiV

    The Higher Education Funding Council for England and the Department of Health control the number of places at medical schools. The problem is state planning, not the BMA (vile organisation that it is)

  23. Theophrastus, Thanks. You’re right. And it turns out it was the GMC I was thinking of, not the BMA.

    Nevertheless, I still maintain high prices are an indication that supply is being restricted somewhere. Whoever’s doing it, that’s where action needs to be taken.

  24. @NiV

    ” I still maintain high prices are an indication that supply is being restricted somewhere. Whoever’s doing it, that’s where action needs to be taken.”

    It could be that the time and effort required to be a doctor is the restriction.

  25. John □

    My understanding is that there is no shortage of decent applicants, but that the numbers of places are severely restricted, so competition is intense. A not unrelated problem is that female doctors prefer to work part-time and only ‘family-friendly hours….young women were behind the junior doctor’s strike for this very reason.

    The problem is the NHS…state-funded, centralised, provider-focussed…

  26. ‘Most of a GPs job could be done by a nurse with google.’

    Most of them likely wouldn’t even need google
    Wife worked ICU for many years and the experienced nurses act as a buffer for a lot of the errors juniors may make the ‘you sure about that’ type of questions or ‘do you mean that unit of measure’.
    I’ve also seen it in an emergency room where a junior wanted to send me home and the nurse took him outside the cubicle and bluntly told him I needed to be admitted and either he called the senior or she would do it for him.

  27. “Mechanical voice: “do you smoke?””

    Apparently the AI lie detectors are getting quite good now too.

  28. I’m a Doctor.

    The ‘ohhhhhhh poor me’ story telling of younger Doctors merely reflects their weakness and inability.

    It’s hard, the pay is good and you control your job, when you become senior. It’s very good.

  29. Interestingly, my local hospital now sends details of how to get an appointment in unstamped letters to the GP surgery, they phone people, who go and collect. Quite a good idea, now that a phone call is cheap, and a stamp expensive. But, the cost of driving to and from the surgery is approximately three first class stamps, so even counting the receptionist at the surgery’s time and phone call as 0p, this works out as an expensive way of doing it – I’ve already paid for the NHS service, this is extra and unnecessary. Why not e mail?

    Incidentally, this saves admin time, not doctor or nurse time.

  30. “Is that the sort of doctor Johnson and Gove want to recreate?”

    The question he needs to ask is – why do we train doctors the way we train them now?

    When he understands why we do this, *then* maybe he can change it.

  31. “anon
    December 21, 2017 at 11:28 am

    You do wonder how effective training of someone who has been awake for 21 hours is. Also do you want them working out what medicines to give you?”

    Well, we certainly have no problem with them making ‘shoot-don’t shoot’ decisions in these conditions.

  32. JuliaM,

    “I get better service from my vet. But then, I pay for that. The NHS is ‘free’… *laughs hollowly*”

    But there’s lots of human care that’s better. Even some bits of the NHS.

    There’s no problem at all with my daughter getting spectacles. We get them free. 2 sets a year. Paid by the NHS. It works because I can drop Tesco next time if Specsavers makes a better offer.

    But you suggest a similar model for hip replacements, people think you’re a cross between Mengele and Ayn Rand.

    I’ve done software consulting work for the NHS on 3 occasions and it is the worst organisation I’ve ever worked for. It’s almost impossible to make any change to processes.

    It’s not just Stalinist. None of the management gives a toss.

  33. First post by Rob: Yes, yes, and a thousand times yes. I can’t believe how often that the automatic position of self-proclaimed progressives is imperialist looting. I’ve almost got into stand-up shouting arguments about it with people, it’s a though there’s a part of their brain missing.

  34. Now let me see – who was it who decided that the cure for the problem of junior doctors working long hours was to increase the number of consultants on an extremely high rate of pay?
    Oh now I remember – it was that nice Mr Brown – you know the guy who raised NHS staff pay but didn’t increase the budget allocation for the NHS.
    No, that’s not the doctor that Johnson and Gove want to recreate – it’s the sort of doctor that was created by Gordon Brown. Anyone with an ounce of sense would have extended the training period from three years to four so that each junior doctor only worked 75% of the hours per week but Brown chose to bribe the BMA executive with more consultancy posts.

  35. “Could do better yourself +Google -of course.”

    I did once. Beat 2 GPs and a locum. Shattered all my illusions about doctors. Wasn’t that hard once I put all the information together with the help of forums and a few bits of anatomy.

    I Google before I go now. Figure out what the problem is. I’m not wasting another year being dicked around by GPs

    If you got rid of all licensing, lots of current doctors would be rapidly unemployed. I’ve met mechanics with better diagnosing minds than some doctors.

  36. Well, we finally got her prescription – after phoning the number from 2pm on the dot every 2-3 minutes on redial, because it was continually engaged, we got through at 3:25, were kept on hold for another 15-20 minutes, then given an 8:15 appointment to see a doctor at ANOTHER walk in clinic. The hallowed consultation took less than a minute.

    What an absolute waste of time. ‘Envy of the world’? My arse!

  37. Bloke on M4, I was involved in an NHS project in the late nineties. The IT departments in the Trusts and hospitalso is just sheltered employment for the brain dead.

  38. Very strange post from Ritchie today
    ‘the first family visit of Christmas takes place to the relative who is a doctor and is on duty for the following few days’
    presumably this is wife (or ex-wife)?

  39. @ Sam Jones:
    Simon Cohen says:
    December 22 2017 at 11:49 am
    Good Wishes to you and your family for ‘the time of year known as Christmas’ (as the 17th Century Quakers called it!).
    I bought my son (who is doing geography ‘A’ level) a book by Danny Dorling, for Christmas ( sad dad present!) and produced a bad joke involuntarily, : I told him that Dorling had ‘put geography on the map.’
    Well, I found it funny!
    All the best,Simon

    Richard Murphy says:
    December 22 2017 at 4:40 pm
    Danny would too
    I know him

    There must be a psychiatric diagnosis for it, it just screams at you……

  40. Social Justice Warrior

    Anyone with an ounce of sense would have extended the training period from three years to four so that each junior doctor only worked 75% of the hours per week

    What three-year training period? It currently takes at least 8 years after qualifying as a doctor to become a consultant, and at least 5 years to become a GP.

    And minimum training times were extended as part of the plan to increase the number of consultants.

  41. Where did I get the idea of a three-year training period?
    Oh from talking to doctors and from actually reading the reference that you cite that shows that until 2005 the training for junior hospital doctors took three years.
    My school was Non-Conformist so it took a practical view of its duty to its fellow-men and, as well as providing means-tested scholarships to a massive number of poorer/middle-class boys as well as Open scholarships, trained large numbers to enter the medical professions (so that even the boy who beat me in Maths in one term joined the “Medical Sixth and became a doctor).

  42. Social Justice Warrior

    Lovely for you to have been to the same school as a doctor-to-be, but you don’t know what you’re talking about.

    “Junior hospital doctor” means all hospital doctors below the rank of consultant. Training is and always has been much longer than three years.

    The NHS Plan 2000 promised to improve training for hospital doctors, create a clear career path, and modernise the SHO grade. It took the CMO until 2002 to publish a consultation paper on how to do it, and MMC was launched in 2003. Slow and careful it may have been, but it was all part of the same process.

  43. @ SJW
    A Registrar is a junior hospital doctor? LOL!
    SJWs always but always know better than anyone at the coal face.
    A Junior Hospital Doctor was undertaking a three-year on-the-job training before being alloweds to opt to become a GP or a specialist.

  44. Social Justice Warrior

    Since you don’t know what you’re talking about, why don’t you look it up? Say in The Lancet.

    While you’re deciding whether you know better than the medical profession what terminology it uses, let’s compare the previous and current training regimes. The old one started (post-degree) with a year as Pre-Registration House Office, followed by two or more years as SHO. The new one starts with two Foundation years, followed by training as a Specialty Registrar. The first two years as an SR are treated as equivalent to an SHO job.

    That is, under MMC the equivalent of PRHO+SHO, in so far as they can be compared, takes at least four years instead of at least three years. There was plenty wrong with the implementation of MMC, but it got this bit right.

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