How protective is the working time directive?

Editor—The working time directive is a step in the right direction, but its implementation should not be underestimated, as MacDonald discusses.¹ In New Zealand the number of hours worked has been limited since 1985, but even today, almost 20 years later, the problems associated with implementing these restrictions have yet to be fully overcome.

Firstly, there was an initial shortage of doctors. As in the United Kingdom, more doctors were needed with the introduction of legal rosters. This led to the importation of many doctors from around the world and affected the quality of medical care delivered to patients. More recently, the education and training of overseas trained doctors has been scrutinised, but more home trained junior doctors are still needed.

Secondly, the attitudes of trainees (especially surgical trainees) are important. Most trainees want the best training they can get and the most clinical exposure while appeasing their consultants and the hospital management. They want to fit in and show they can “hack the pace.”

Thirdly, attitudes of consultants matter. “We did it, therefore they need to.” With the implementation of consultant led practice, what many consultants thought their job would be when they trained is different from what it is in reality today.

Fourthly, the dinosaurs, usually older consultants, who seem to think that the world should revolve around them and their attitudes, never change. Before they become extinct with a move to retirement they are often in a position to advise management and can make the introduction of change difficult.

Underlying these changes there must be a realisation that patients' safety and quality of care require that things change. How reasonable is it to expect a patient who needs an emergency operation for a potentially life threatening condition to have an operation from a resident who has worked 80 or more hours? It is no longer acceptable.