Editor—I endorse the concerns of Macdonald about the work of his doctor son compared with that of his pilot son.1 But aside from the reasons given for their very different conditions, I believe that history plays a part.
Air flight is a modern trade, born into a modern age with sophisticated citizens and a strong legislative framework, even at the start and more so today. Doctors share this environment now, but medicine developed as a profession with unsophisticated citizens, a much weaker framework of government and legislation, and much greater emphasis on self employment.
I believe that this has contributed to a culture in medicine that resists the kinds of monitoring that airline pilots take for granted. Airline pilots cannot fly privately for other airlines at weekends (I assume) within their contracts, and they are expected to arrive for work suitably rested. Without denying doctors their rights to earn their income where they can, I see no enthusiasm from doctors for close monitoring of how they spend their time, even in the NHS. Yet without this monitoring, those who fund or analyse the NHS can continue to believe that low productivity, not necessarily low staffing, is a root cause of the problems.
To a considerable degree, airline pilots may have Big Brother watching them, but partly to protect them and the public. If a pilot were working outside his or her hours, the plane would not take off. Perhaps we should be prepared to face this in the NHS too, with operations stopping when a surgeon is working outside of hours. But for this to happen, the profession would need to accept that monitoring by Big Brother has something to offer rather than tending to see it as a threat.
References
- 1.Macdonald E. One pilot son, one medical son. BMJ. 2002;324:1105. . (4 May.) [Google Scholar]