A day in the life
Doctors say they routinely become delirious with fatigue, and it’s dangerous for their patients, writes Amanda Saxton.
Dr Shobna Singh works 12 days in a row followed by a two-day break, and spends her days and nights treating patients for up to 14 hours a day at Auckland’s North Shore Hospital. The 26-year-old resident doctor is one of hundreds who will go on strike across the country next week because they believe their workloads endanger their patients.
The New Zealand Resident Doctors’ Association has been pushing for district health boards to cut the maximum number of days worked in a row from 12 to 10, and for the number of consecutive night shifts to be reduced from seven to four.
‘‘At this point I feel delirious,’’ she said at the end of a 14-hour shift, on day 11 of a 12-day stint.
‘‘Those two days off recharge you enough to keep plodding, barely, but that’s not enough to be a great or even decent doctor. Right now I’m pretty apathetic.’’
Singh said she had prescribed medicines to patients who were allergic to them ‘‘probably three times’’, and once became sick enough on duty to require a drip herself – but did not stop work.
‘‘I was in ED at 4am with the drip in one hand and my phone in other, sending directions back to my ward,’’ she said.
‘‘We’re so dependent on pharmacists as a safety net for the mis-prescriptions – but if something had gone seriously wrong when I was sick in ED, I could not have dealt with it properly.’’
NZRDA secretary Deborah Powell described the current rosters as ‘‘archaic and out of touch with the realities of the current health system’’.
She said that medical advances meant that expectations of doctors’ performance had soared since the rosters were introduced – and doctors’ workload needed to reflect that.
Four years worth of negotiations with district health boards over roster terms reached stalemate in September; in that time only Gisborne DHB switched to the shifts the union rallied for.
Doctors who work 12 consecutive shifts get up to two subsequent paid recovery days under the current contract, if their final shift falls mid-week.
The DHBs want this condition wiped from any new contract, with 10 days as the consecutive maximum; the NZRDA is resisting, and therefore called the strike.
DHB spokesman Mick Prior said the boards were not against the reduction in workload per se.
‘‘The main sticking point is that we would not be willing to keep paying the doctors for the weekdays off they would get under reformed rosters,’’ he said.
Critics of the resident doctors have claimed that their generous pay packets make up for their hours; a second-year resident doctor could earn up to $111,028 annually, working 65 hours per week.
Powell said that perspective ‘‘misses the point entirely’’ because the doctors would get paid less if they worked fewer hours – ‘‘which is what the NZRDA is calling for’’.
Resident doctors get paid a flat rate determined by the amount of hours they work. A second-year house doctor earns around $28 per hour.
A day in the life of a junior doctor
Dr Emily Shine, 25, second- year resident doctor at North Shore Hospital. Fourteen-hour shift – 8am until 10pm on the obstetrics and gynaecology ward.
7:30am: Emily arrives at hospital with wet hair after a hurried shower, porridge, and commute from her Ponsonby flat. Before her shift starts at 8am, she has a lesson to attend about post-partum haemorrhages.
She says she feels active and empathetic.
9am: Coffee in hand, Emily has completed her handover, with staff fully updated on the women in the ward. They knew a small mother was expecting a whopper baby (and may need a c-section), which patient had which STI, and who on the team would break the news of ovarian cancer to a patient.
Emily was assigned to look after new arrivals.
11:30am: The morning brought a slew of cervical abnormalities and a woman in cervical shock, bleeding from her uterus, with ‘‘a heart rate just 44 beats per minute when it should have been 80’’.
Emily beams as she explains how satisfying it is to be able to ‘‘solve and explain’’ problems for a worried patient, putting their minds at ease.
2pm: Emily has sent patients with suspected uterine holes off for ultrasounds and assessed an ectopic pregnancy that will require an abortion to save the mother’s life.
She says that adrenaline rushes are helping her ‘‘dipping’’ energy levels.
‘‘The thing about this job is that it’s physically, mentally, emotionally, and socially draining every day and I don’t always feel recharged,’’ she says. ‘‘But then you get these adrenaline rushes from helping someone desperate, and they keep you going.’’
She says she’s starving, and she’s off to the staff cafeteria for lunch – falafel salad.
5pm: Checking in after the 4pm handover, Emily is less vibrant, with eyeliner smudged under her eyes. She has been at work for 10 hours.
‘‘At this stage I’m middling tired. I don’t want more people to come in, but when they do I will be nice.’’
She fears the ectopic pregnancy will result in the woman losing an ovary.
She says that the next five hours’ uncertainty is daunting and that tiredness has increased her anxiety levels.
‘‘Anxiety is really awful. It comes because you’re trying a lot harder in that exhausted state, but you know you can’t keep it up and you don’t know how much you’re missing.’’
7pm: Emily has perked up, having found some croissants in the RMO room – ‘‘plus there’s only three hours left and that’s a much nicer feeling,’’ she says.
But she admits thoughts of home-time make her feel less empathetic towards patients.
‘‘It’s bad timing, really, because after hours there are less staff on hand, responsible for more and sicker patients coming in. And this rotation sees a lot of very upset people – they’ll be suffering miscarriages and pain they just don’t understand.’’
In the past two hours she has discussed contraceptives with a teen suffering an STI-caused abdominal infection, and the implications of hysterectomies, abortions, and infected vaginal tears with assorted patients.
10pm: ‘‘It got very busy in the final stretch,’’ says Emily. There are patients with ‘‘retained products’’ from a miscarriage, post-op infections, and ‘‘generally lots of bleeding’’.
The doctors go through another handover and Emily can clock off.
Slumped against the hallway wall, she says she is exhausted, with a headache and sore throat.
‘‘I just want my bed. I’m very pleased I don’t have to pretend to be happy anymore.’’