Jenny Ni­cholls looks at the crush­ing work­load of those on the health front­lines. Review

The crush­ing work­load of those on the front­lines of health.

North & South - - Columns - By jenny ni­cholls

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. +

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