How long should Junior Doctors working hours be?

Guest Editorial

16 Hours Daily Shift Too Long for Doctors

Last week the Honourable Minister of Health Dato’ Dr S Subramaniam replied in Parliament with the assurance that junior doctors were working between 65-75 hours a week, and a maximum of 16 hours in their shifts.

As a senior retired medical consultant of the Ministry of Health, and a former National SCHOMOS/MMA Chairman in 1994, I am able to compare the difference in working conditions of the junior doctors, then and now.

For many decades now, until the shift system came in, the junior doctor would work seven days a week, i.e 8.00 a.m.-5.30 p.m. or later, with half-days on Saturdays and Sundays, i.e. from 8.00 a.m. to 1.00 p.m., with an average of two days of being on call, i.e. an extended work from 5.30 p.m. through the next morning and working till the next day is over.

That work schedule per week will add up to a total of 84 hours a week, which seems to well over the 65-75 hours of the current doctors who work shifts.

However, we were able to be back for dinner almost daily, except when we were on duty, and we could go to the movies in the weekends, and even found housemanship enjoyable, as the ward team was like a family, of less than five or six people usually. We certainly worked as a team, if not as a family.

The number of doctors have now increased exponentially, and the team has become even the size of an organization, with several dozens of doctors in each unit. However, the new shift system has changed the working conditions significantly, apart from the working conditions.

Firstly, almost all housemen in the past were provided with residential quarters in the compound of the hospital. This meant that the exhausted, sleep-deprived doctor, at its worst, scrambles and walks from room to ward, within ten minutes at the most.

Junior doctors now travel to work, often by car, risking fatal accidents due to tiredness. It has been quoted that up to a quarter of junior doctors’ accidents in the UK are due to fatigue and sleep-deprivation.

Next, comes the `killer-shift’! The typical shift on a normal day begins at 6.00 a.m. for the junior doctor. Since it is a shift, he has to arrive an hour earlier, which will be 5.00 a.m. for the passing over of cases. The day, when he is tagging officially ends at between 9.00 p.m to 10.00 p.m., but due to the process of passing over, as required by shifts, he may often be around till 11.00 p.m.

That makes it a total of 16 hours of working time, as mentioned by the Minister, with two additional unofficial hours due to the passing over of reports. If we add the travelling time, the poor junior doctor may actually have five to six hours of sleep.

This is the true situation, when the junior doctor is tagging. During the tagging period, the house doctor works easily 90-100 hours or more for the week. Although the tagging period is meant to be for only two weeks as recommended, the junior doctor may not be off-tagged for months, if the senior medical officer or specialist deems so. In the past, tagging was usually less than a week, and used as an exercise for familiarization, unlike the present where a junior doctor is off-tagged only if the senior feels that “he or she is safe’ to be on duty.

I suggest that the shift system be abolished. Even before it is removed, the Ministry can allow the juniors to begin at 8 a.m. and end their work by 8 p.m., while the doctor on call comes at 7 p.m. to take over till the next morning.

The 16 hour rule is good only for the on call duty, and each call should be followed by an off day, and should not run consecutively. Tagging with 16-hours consecutively should be stopped. Furthermore, the tagging period should never exceed two weeks, as it is more for familiarising, rather than for competency. Currently, to be off-tagged, the junior doctor needs to be assessed, and hence tagging extended for various reasons.

The health care environment is already stressful with the long hours, demanding patients and hard work; we should at least make it a happy, compassionate and healthy one.

I urge the Ministry of Health to urgently act on this matter, with input from the junior doctors themselves, so that the drop out or resignation rate will reduce, and `accidental deaths’ prevented.

Dr KH Sng
Kuala Lumpur

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