By the way ... B rex it could be good for patients

WHEN I was a house surgeon, the most junior member of the team at the hospital where I trained, there was one particular colleague who was an inspiration to me.

As a senior registrar, he was the highest-ranking member of the team and a thoroughly experienced surgeon. At the age of 37, with 15 years of surgical training under his belt, he was waiting in the wings for a consultant post.

He could do anything within general surgery, from major operations on intestines and arteries to treating gunshot wounds and even prostate operations. This was general surgery in every sense of the word.

Two years later, Great Britain entered the European Economic Community, and soon we were hit with regulations over which we appeared to have no control.

One example is the European Working Time Directive, which reduced the working hours of junior hospital doctors to 56 and then 48 a week, and had a profound impact on training and experience. Like the curate’s egg, it was both good and bad in parts.

Clearly the long hours junior doctors were then working were unacceptable — and unsafe. U.S. studies have since shown that doctors working an 80-hour week make more errors than those working 60 hours, something we cannot ignore.

But one major consequence of the cut in hours was the reduction in experience junior doctors gained before reaching consultant status. This led to increasing specialisation.

In the field of orthopaedics we now have different surgeons for shoulders, hands, knees and spines, whereas previously we had general orthopaedic surgeons who might simply develop a special interest in a particular area.

On the plus side, such super-specialisation concentrates great skill into one area. But in cases of multiple injury, several different specialists must be involved. And when this happens, who is in charge?

Another disadvantage is that broad spectrum wisdom — that is, balanced judgement based on an understanding of holistic care that takes into account a patient’s history and family dynamics — is often sacrificed in favour of advanced technical skills.

Brexit will not result in immediate changes in healthcare, and reversal of the European Working Time Directive is unlikely to happen. The genie is out of the bottle and today’s junior doctors won’t take to working longer hours, even if this means greater experience.

Nevertheless, at least now we may be allowed greater flexibility in hours, so that in rural areas, for example, hopefully there will always be a relevant specialist available.

The way ahead is murky, but I sense freedom from the constraints of this directive can only be a good thing for medical care and practice.