#But how it sometimes takes ethical principles to the extreme and even misinterprets ethical principles is just like..

[petercushingscheekbones]

House md taking medical ethics and drawing and quartering them and then spinning them in a centrifuge is just so… mmm to me

[dxmedstudent]

From the article: A group of 21 doctors, headed by Sarah Hallett, claims the NHS failed to honour contracts over an eight-month period in 2013 and 2014. John Cavanagh QC, for Dr Hallett, said: "The case concerns the entitlement of junior doctors to take breaks during the course of their working duties.

"This case is of general public importance... it is a test case which is of significance across the NHS."

He said the primary duty to ensure junior doctors get enough rest lies on the NHS trusts who employ them. Mr Cavanagh insisted the case was not about money, but the principle which affects their safety and welfare, "with consequent effects on patient safety".

NHS barrister Richard Leiper QC argued Dr Hallett's case was based on a misinterpretation of junior doctors' contracts.

He said: "The potential cost to to the trust, let alone to the NHS as a whole, would be dramatic".

You know, I don’t even think most doctors actually want more money, although the fincancial implications of this case are the main issue raised. What most of us would probably like, would be enough breaks. Unfortunately, due to things like rota gaps, increased bed occupancy or sheer numbers of patients waiting in A&E, this is becoming harder for junior doctors to achieve. It’s not always possible for people to take a break, as many doctors’ current working conditions stand.

It’s not a misinterpretation of the contract to suggest that we are enitled to natural breaks. That’s literally in the contract.

Frankly, if your employees are forced to work hours which they would have taken as rest (or indeed, if they had to stay late), then you, as an employer benefited from their labour during that time. And if there was regularly that much work to be done, then arguably the employer should be responsible for ensuring staffing is changed to address this issue. Unfortunately, for various reasons probably relating to the funding of the NHS and the difficulty in finding enough doctors and nurses, it seems that employers don’t, or can’t adapt staffing to increased demand. A lot of trusts already have severe staffing issues, with chronic understaffing, which means (at best) relying on expensive locums, and at worst, having their staff work with fewer colleagues, and therefore shoulder a larger workload.

I haven’t been happy with the switch from mandatory hours monitoring (where we all HAD to fill it in for an example two weeks) to voluntary exception reporting, simply because I fear that there’s a lot of pressure not to exception report. Doctors fear looking like they are struggling to cope with the workload, because the first thing that is thrown at us is that maybe we just can’t cut it. And this is absolutely borne out by the real life experiences of people I know. I do think exception reporting is important, and can be a cause for change, but I think it is very important for juniors in struggling departments to all report accurately, so that the scale of the problem can be seen.  The issue here is that currently that unlike nurses (breaks are routinely timetabled in) and A&E doctors (again, breaks routinely timetabled in), most hospital doctors don’t have any timetabled breaks. You’re meant to take your break when there’s time, between sick patients and urgent tasks. That, however, implies that there will be a time when a break would be a sensible idea. That the workload will be manageable enough that lulls actually happen, during which you could pause. And some shifts are like this. But many aren’t.   What happens if your seniors put pressure on you to work through, because of the sheer number of tasks? What if they all just set a poor example by not taing their own break and making it difficult for you to take yours? What if nobody checks to see if you’re struggling to get stuff done? What if there are just so many sick patients needing help that you don’t ethically feel you can pause, and keep putting it off until eventually breaktime never comes, because there’s always something urgent? What if the people you’re on shift with, who started quite a few hours before you, still hadn’t taken their break, and finally do so when it should have been your turn? Or what if nobody else takes breaks and therefore they expect that you wont, either? From what people are sharing on forums, it seems that many people don’t get a chance to rest when they should, for all sorts of reasons. Nobody brings a case to court because they had to work through without a break one day; people are bringing this forward because sometimes this becomes the routine. and when people stay quiet, it becomes accepted. When the seniors accept it, then their juniors feel pressured to accept the same, and that only demoralises the workforce further whilst driving down working conditions for everyone. Breaks are important; people all need time to rest and stop thinking for a minute. Humans aren’t machines. I won’t even go into the rather depressing commentary over at the Daily Mail when the same story was covered. Wanting to ensure doctors have breaks is not being a ‘snowflake’, nor does it mean these people lack vocation. The irony is that most people criticising these doctors for taking the case to court won’t have any idea what it’s like to work through 13+ hours with no break. With no food, or water, and no loo break because you’re too dehydrated to pee anyway. And the funny thing is, that most of those people criticising them won’t be working in high pressured, emotionally draining jobs in which the stakes are high and people could die if you make a mistake, leading to huge consequences for everyone involved. Simply because most jobs aren’t like that. And I’m in no way saying that it’s not horrific if your job entails doing paperwork without breaks, or something else equally non-life threatening. But it’s probably worse (for obvious reasons) if someone has to face mountains of tasks which involve lifesaving decisions, and there’s just too much to allow them to take a break. Everyone deserves to have breaks. But this story, and this issue is about how doctors being unable to take breaks makes for exhausted clinicians, and therefore not only contributes to clinician burnout and poor retention, but also potentially to poorer patient care or risks of mistakes. And as recent court cases have shown, nobody seems to care if a doctor was looking after lots of sick patients whilst shouldering the work of 3 doctors, if something goes wrong then they may ultimately blamed for the massive way in which the system failed everyone involved. There’s much to say about the Bawa-Garba case, and that may have to wait for another time, but the response amongst doctors, to her case and to this one, shows that doctors are tired for being scapegoated whilst working under extreme conditions. We would never, ever let airline pilots (or truck drivers) work under conditions like some of the public expect junior doctors to ‘suck it up’ and put up with. And if you don’t want the person flying your plane to be exhausted, why would you want the person looking after your emergency medical care to be in that state?