I'minworkjeremy

I was at work last weekend. On Friday, Saturday and Sunday night I was the surgical FY1 on call, covering all the surgical patients in the hospital (with support from a team of dedicated more senior docs on call). Fortunately for me there were no real emergencies to deal with and the number of tasks was fairly manageable compared to other shifts I've done. Over the course of thirty six hours over three nights I prepared patients for surgery the following day, I assessed patients in pain or nausea and prescribed medications and fluids. I assessed unwell patients and alerted the seniors where appropriate. I sat and talked with anxious patients and I quietly examined and verified those few who had passed away. I prescribed anticoagulation for patients to prevent strokes and DVTs and started patients on treatment for infections. I organised blood transfusions, inserted intravenous cannulas and clerked and admitted emergency patients when the surgical admissions team were busy in theatre. This is all routine FY1 fare,  and this particular shift was far more tolerable than the average night; there wasn't all that much to do and I was never expected to do anything beyond my training or experience- I even managed to get through a decent chunk of a novel during the unprecedented bleep-free periods.

I was told that on this weekend over 20% of the hospital beds were occupied by patients who were "medically fit for discharge". These are patients who are awaiting social care input and so cannot be discharged until there is somewhere safe for them to go.  It makes the job of the ward cover on call doctor (moi) a bit easier when a large proportion of the patients are not officially unwell (though far too many of them will get a hospital-acquired infection whilst awaiting discharge and so become unwell again, further delaying discharge but also risking preventable death). If "spare" hospital beds are occupied with such patients then new patients can't be admitted. On Saturday night there were 87 "breaches" in A+E; on this single day 87 patients were are not admitted within the 4 hour target time, at considerable financial cost as each breach results in a hefty fine to the trust. Clearly the problem of insufficient beds is not solved by forcing more doctors to work at the weekend.

Although my latest weekend was relatively, and frankly astonishingly, quiet, it was still fairly unpleasant because of course it is unpleasant forcing yourself to be awake when you're too tired to think or speak, and of course it is unpleasant working straight through a weekend.  Believe it or not I'm not really complaining about this - it is important to have medical cover 24/7 and so some people will have to work evenings, nights or weekends. All sane people know this and all applicants to medical school knowingly sign up for this. It would be churlish to complain about my current rota in the current system as it really isn't bad as far as junior doctor rotas go; I probably work one weekend in three or four, and for every Saturday or Sunday I work I get a midweek day off -allocated at random. It's worse for FY1s at a lot of hospitals (a close friend has double the number of nights that I do), and almost certainly worse beyond FY1 as  in many specialties fewer and fewer doctors are available to fill on-call rotas. Under the current system anti-social hours are recognised and doctors receive a "banding" supplement to their basic salary to compensate.

One of the most infuriating things about the government's steamrollered "7-day" new doctor's contract is their refusal to acknowledge that a) the NHS already provides 24/7 emergency cover, obviously, and b) weekends are more valuable than weekdays, obviously. On Saturday I missed a gathering of close non-doctor friends I've not seen in months because I, and only I, was at work. Having Tuesday off, alone and fairly disoriented to time, was not much of a substitute. This year I also worked through the new year bank holiday weekend, as one of the lucky ones have escaped working Christmas. So, like almost all doctors in training, some weekends #iminworkjeremy, and happy to be. But to suggest/force/blackmail doctors into working more hours, more nights and more weekends for less pay is insulting, as is recognised by 98% of junior doctors who voted for, carried out, and will continue to take part in industrial action over this issue and others.