Working hours still need addressing
BY AMA VICE PRESIDENT DR TONY BARTONE
The AMA recently released its latest Safe Hours Audit report and it was certainly an eye-opener. Though for those at the front line it probably came as no surprise.
The audit, undertaken in 2016, shows there has been no overall improvement since the last report was issued in 2011. There has certainly been an improving trend since the audits first began in 2001, but it appears things have slowed down in recent years.
This is disturbing.
What the latest audit shows us is that one in two doctors at public hospitals are still working hours that put them at a high risk of fatigue.
Working long shifts, double shifts and too many shifts can only translate into higher levels of stress and fatigue for doctors and ultimately has the potential to put patient care at risk.
We are talking about doctors’ health and wellbeing. Invariably doctors are routinely missing lunch breaks, missing meal breaks, having to withhold toilet stops. They're working consecutive shifts, often back to back.
What we're seeing here is a system that would not be tolerated in any other industry. Employers have an obligation to provide a safe workplace for their staff and for others who frequent the workplace.
Hospitals and community health practices are no exception to this rule and, as such, administrators and management have an obligation to ensure safe working environments to protect our key resource – our doctors – as well as the patients they care for.
If we do that then, obviously, it will lead to improved productivity, improved outcomes, improved patient experiences, and better life expectancy and outcomes for doctors themselves.
It is clear that the system is under stress. The system overall is functioning at peak capacity and with no accessible relief valve.
Numerous research reports from overseas confirm that errors are occurring under such difficult conditions.
It is clear that ultimately the journey of the patient through the health system is also being retarded. Things are not being coordinated in an efficient way because of tiredness and because of fatigue. This is both frustrating and disappointing, especially when we have got a limited amount of health resources and a limited budget. Hospitals absolutely need to ensure they are really performing at peak efficiency.
Doctors genuinely and routinely report back to me of having a situation of feeling tired, of perhaps falling asleep at their terminal while doing the notes. It is certainly not an environment that you want to have a vulnerable population – our patients – being exposed to in a routine manner.
The report found that intensive care physicians and surgeons are working long hours more routinely than other doctors in other parts of the profession. So they are particularly at risk. Obstetrics and gynaecology is another specialty that was highlighted for working high stress long hours.
It is important to note that it’s not just the hours they work, it’s the un-rostered overtime that also goes into the mix. These doctors are rostered on for long hours but then, because of their duty of care, because the system is not coping under the stress, they're staying back longer and then working later and later. And then they go home to families… and very commonly hours and hours of study and exam preparation.
Registrars are often working the highest percentage in terms of those hours worked. This is not work-life balance, this is not good for their future, and this is not good for their long-term wellbeing. The latest report reveals that it is a problem right around the country.
Every hospital jurisdiction should look at the AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors.
This is an agreed guide but it’s not a mandatory guide. It looks at flexible work practices and arrangements and is a guide in terms of safe rostering.
This issue is about rostering smarter and more efficiently. It is not necessarily about working drastically fewer hours.
Doctors understand their responsibility and they want to learn. The need for training comes with the expectation that there is a need to work a certain number of hours.
The 2016 Audit is a timely report. Doctors do want to provide the best care they possibly can for their patients. But they can’t do this if their own health is constantly under threat due to the shifts being demanded of them. Let’s hope the system does not fall asleep at the wheel on this one.
Published: 16 Aug 2017