Four days in the diary of a junior doctor

Junior doctors have gone on strike over their working conditions for the fourth time this year. As their union goes into mediation, one doctor shares his work diary.

When we met, Jay* had just finished his fourth day in a 10-day run in the hospital. Once he’s worked those 10 days – two of which will be 16-hour days – he will have four days off.

This four-day rest period was secured for junior doctors in the 2016 collective contract negotiations. Before that they worked 12 days, with two days off.

Overall, Jay said, the first half of the 10-day stretches aren’t too bad – it’s the weekends that really test you.

He said: ‘‘You do the ward round with the acute team, do the jobs from that, and at my hospital you’re also on call for between 80 to 100 general surgical patients.

Jay said there’s more to the dispute than long weekends.

Notably, district health boards have struggled to bring in the change under the 2016 collective negotiations – there simply aren’t enough doctors to staff the rosters. ‘‘Undoubtedly, doctors who are less tired and more focused will provide better patient care,’’ said Jay.

‘‘But having fairer rosters also means I get to recover from my work, and do normal things like see my family.’’

Jay talks us through four days of a 10-day week, saying that wanting a decent roster that addresses fatigue and burnout shouldn’t be a revolutionary idea in 2019.

DAY ONE:

The surgical ward round, which involves being updated on patients we’re looking after, starts as usual at 7.30am.

We see five patients before the registrar and consultant are called to theatre.

I switch to another team’s ward round. I complete discharges, update charts and make phone calls to other services for patients. By 11am, the surgical ward round resumes only to be disrupted again an hour later when another patient needs surgery. Only 12 of the 20 patients on the list have been seen. This means the remaining patients have to go without food or drink until the ward round restarts.

In the meantime, I headed to the emergency department (ED) which needs a surgical consult.

One complex case, where the cause of a patient’s bleeding can’t be identified, takes a bit of time.

As his time in ED edged toward the five-hour mark, one of the ED heads makes it clear he needs to be admitted to a ward.

They want people assessed and admitted within six hours but more complex cases often require a longer admission period.

Due to a personal appointment at 3.30pm, I have to hand off the patient and the surgical ward round to another doctor.

DAY TWO:

I arrive to find a full complement of staff. Ward rounds go seamlessly and finish by 11am.

Everyone is able to get on with their jobs. I finish on time about 4pm.

DAY THREE:

A roster mix-up and staff illness mean I am covering three roles across the acute, vascular and colorectal teams. The response from the roster coordinator is unhelpful – essentially there is no relief coming.

It is a hectic morning, starting with the colorectal ward round. I have eight patients to see and am able to leave slightly early as the last patient did not need to be seen by me.

I run to catch the end of the vascular team ward round. By 8.03am, I have seen 12 patients.

I go straight from vascular patients to the surgical handover.

From surgical handover, 10 acute patients are added to my list. One woman seems particularly worrying, so I make note to keep a close eye on her.

I spend the rest of the morning shuttling between pre-operative clinic appointments, discharging patients and fitting in the acute ward round. Thankfully, two other doctors are on for the acute team. A review of all surgical patient cases is next.

I grab a quick bite at midday before checking on a woman from the morning. The source of her infection is still not identified and her fever is spiking intermittently. Then I check on the latest test results. I order follow-ups, and hand over the woman’s case to the evening registrar. By that time, I locate one of the missing doctors who was sent to the wrong department for the day. Left about 4.50pm – not too bad.

DAY FOUR:

Back to the usual role with the acute team. The ward round is completed relatively quickly.

I head to ED with our trainee intern – a final year medical student – to see admissions.

I oversee him as he admits a woman who has come back to hospital after recent surgery. She is very unwell. I want to discuss her case with my bosses before moving her. At least in ED, everything is right there to manage someone going downhill fast.

Despite that, ED bosses continue to pester around prolonged admission period. They suggest ringing my bosses who are operating. Luckily, an on-call register is able to see her so surgery is not interrupted.

Just as finishing time rolls round, a head-on collision is called in. I decide to stay and help the ED registrar. Four patients arrive but none are too serious, so we just work to stabilise them. Head home about 6.20pm. *Jay is a pseudonym. He agreed to speak publicly about his experiences and leave out details about his patients on the condition of anonymity.