Jenny Nicholls looks at the crushing workload of those on the health frontlines. Review
The crushing workload of those on the frontlines of health.
Athena Drummond hates the term “junior doctor”. It implies she is inexperienced, with “limited responsibility”, she says. After hearing her story, we think she has a point.
Dr Drummond is, in a way, a doctor twice over. The 40-yearold, a solo mother to nine-year-old Aiden, has more than a decade of training behind her, including a PHD in diabetes research from the University of Auckland and postdoctoral research on osteoarthritis genetics at Oxford University.
When Drummond decided to swap the lab bench for a hospital ward – “to make a difference in people’s lives” – she was granted just one year off the usual six-year medical degree. After graduating two years ago, she began work as a “resident medical officer” in an Auckland hospital. Her favourite ward? Emergency. The drama and stress of the job didn’t faze her. “I love being a doctor,” she says.
Resident medical officers (RMOS) like Drummond are the backbone of every New Zealand hospital. Registered medical practitioners, they range from first-year doctors to those with more than 12 years’ experience. Their aim is to either become a specialist (which can take 10 years) or to train as a GP, after a minimum of two years as an RMO.
If you fall off your motorcycle and are taken to a hospital emergency department in an ambulance, an RMO will be one of the most important decision-makers you’ll meet in your first hours post-accident. Whether you are sent on your way or rushed off to see a neuro- specialist will be down to them.
It is difficult to imagine a responsibility more profound, and less “junior” than this.
As Drummond says, no patient would want to be assessed by a tired, let alone exhausted, doctor. But as she describes her own workload, it becomes clear that this remarkably grounded, caring and intelligent woman is, too often, not just tired but exhausted almost beyond endurance.
Every day, Drummond must fight to relieve the pain and disability of her patients. On night shifts, in her hospital, two doctors are responsible for up to 10 wards, or 100-plus patients each. “You can be faced with any kind of medical situation,” she says, “from prescribing medication to dealing with an acute condition, such as a heart attack.”
A roster for Drummond can involve seven night shifts in a row. After four of them, she feels “pretty exhausted. I feel a reduction in my empathy levels due to fatigue.” At the end of a recent 12- day run that included seven night shifts, she tells North & South, chillingly, “I was not able to function properly.”
In one recent general-medicine rotation, Drummond worked for 26 days, with just two days off. As her roster ended on a night shift, one of those days should have been – but wasn’t – spent sleeping. Not only did she need to readjust to daylight hours, but chores she couldn’t finish during a week of night shifts had banked up. So, after working for 12 days straight, she went without sleep for 24 hours as she tried to catch up. Her so-called “break” was barely enough time to recuperate.
Drummond is supposed to work no more than 16 hours a day, 72 hours a week, or 12 days in a row. But if no one else is rostered on after a shift ends, she points out, she can’t leave the hospital, as this would mean leaving patients who need to be seen.
Bizarrely, Drummond’s roster is drawn up only a few months at a time, meaning she can’t make longterm plans – or even know how much she’ll be paid. That friend’s October wedding in Queenstown? Sorry.
Even worse, for an RMO to get leave in Drummond’s hospital is, she says, extremely difficult, even impossible. She needed to enlist her union to squeeze a single day’s leave from her district health board after her son broke his arm. She has just been refused annual leave, she says, for Aiden’s school holidays. “They don’t have relievers to cover my leave. They are not saying we can’t have leave... just not when we need or ask for it.”
New Zealand has a poor record of keeping RMOS, haemorrhaging expensively trained graduate doctors to Australia. State to state, Oz offers better working conditions and money.
But it isn’t the pay that appals Drummond. “How can we be expected to perform at our optimum if we’re not allowed enough time to recuperate?” she asks. “How can we be expected to have empathy for others if we are treated without empathy? I want to be a good doctor to my patients – but also a good mother to my son.”
Drummond says she cannot face another eight years of the sacrifice she’d need to make to become a haematologist, the speciality she loves – and for which she would have been perhaps the most highly qualified candidate in years. Instead, she aims to begin training as a GP later this year.
• Within the past few months, Drummond, along with other RMOS, has gone on strike twice, seeking changes to crushing work rosters. Last month, striking doctors managed to limit night shifts from seven to four worked consecutively, and “days” (which can include night shifts) from 12 to 10 worked consecutively, with four rostered days off in a fortnight to recuperate. +