John's being a bit of an old fart

Dr Rant loves John Crippen. But occasionally he can be a bit of an old fart.

Today he has a go at Dr Sarah Blayney, and I think he is totally off target.

Sarah works at Arrow Park hospital, and says that she wants more flexible training so that she can have a family as well as be a consultant.

John and I both had the experience of working regular 56 hour shifts without a break (I spent several years working 9hrs, 9hrs, 33hrs, 9hrs, weekend off, 9hrs, 9hrs, 24hrs, weekend off, 9hrs, 33hrs, 9hrs, 9hrs, 56hrs, 9hrs, 9hrs, 33hrs, and so on).

This took a terrible toll - I was regularly reduced to tears and despair by sheer exhaustion. For example, I once catheterised a patient after 42hrs on my feet without a break with a nurse holding a vomit bowl for me to vomit into occassionally as I was so exhausted.

And much of our time was spent doing other people's jobs because we received half-pay for overtime while others received time and a half pay. A junior doctor at the weekend in 1995 was paid less per hour than anyone else in the hospital, including the cleaners.

So it was right that doctors were paid fairly for on call, and paid to be up when they were needed (for emergencies that provided our experience) but in bed asleep the rest of the time (ie: not up all the time making up routine iv antiobiotics into bags because we were cheaper than either pharmacists or nurses).

What has gone wrong is that the Government has cynically used the Jaeger decision (that resident on call be classed as work time even if the person is asleep) on the EWTD to avoid paying doctos and replace them with cheaper, less safe, alternatives.

Are you noticing a patern here? Doctors are the cheapest labour at night in the 1990s, so managers had them up for 56hrs straight doing everyone else's jobs as well as their own to save money.

Then doctors started to get paid properly for working nights and weekends, so managers got nurses and paramedics (who are now cheaper) to do the medical work to save money.

NHS management has never been about providing good, safe patient care. It was about counter-productive attempts to save a few pennies in 1995, and it's still about counter-productive attempts to save a few pennies in 2007.

What the female doctor in your piece wants is not shorter training hours, but the same training hours provided more flexibly.

I could not agree more. Why should family life be sacrificed simply because the NHS can't provide flexibility. For too long the needs of staff and patients have been minced into the needs of managers.

Let's have creches in the hospital. Lets have more job sharing. Lets have longer training, with more sebatical and personal time (for families and travel).

The most telling comment about the old training system was that it was survival of the fittest, but that the fittest were not necessarily the best.

I think the best doctors are doctors that have a life. Not burnt out, bitter, alcoholic divorcees (present company exlcuded). There are compromises to be made, and we can't by any means have everything in life, but these compromises should not be made simply out of a macho mindset.