Not just about working hours

Cappuccio and Lockley are over-simplifying a complex situation.¹ Since the European Working Time Directive (EWTD) was introduced, consistent concerns have been raised regarding the reduced time that is available for training junior doctors, and the effect that this will have on both clinical experience and quality of care.² Of particular note, the 2007 National Confidential Enquiry into Patient Outcome and Death (www.ncepod.org.uk), which identified deficiencies in the care of emergency admissions, reports that because of the current working time constraints of junior doctors, resulting in reduced patient contact, the concern is that they are less able to recognise critically ill patients and act decisively. Many examples of this were seen throughout this study.

The inevitable trend of the EWTD is more shifts of shorter duration: doctors spend more days in the hospital and have shorter periods away from work to relax and spend time with family and friends. This is overwhelmingly unpopular with surgical trainees, some of whom have made informal arrangements to breach the EWTD in order to improve their quality of life, while calling for a derogation that will allow a return to the previous on-call system.³

Multiple short shifts require multiple handovers, each one introducing inefficiency and new opportunities for error. Both doctors and patients prefer continuity of care, and the ability to see a patient throughout the course of their illness.³ Junior doctors no longer function in traditional teams, rarely receive consistent supervision, and are demoralised by working arrangements that prevent them from forming stable relationships with their patients. Coupled with current uncertainties in training, it is hardly surprising that absenteeism has tripled among juniors in the past few years; a sure sign of declining job satisfaction.⁴