That doctor may have worked 100 hours already this week…

As I said a week or two ago, I started my working life 25 years ago as a junior doctor, looking after sick people through the weekend without any sleep. Apart from the massive toll on my personal life, my patients certainly didn’t get the best out of their exhausted doctor. My career soon moved in other directions, and I thought junior doctors’ hours had been sorted. But it seems not. The story of junior doctors’ hours is an incredible extreme of how society fails to balance different human needs.

Granted, things are better than during the 1980s when an 80 hour week was seen as an unattainable aspiration. In the late 1980s Dr Chris Johnstone took to his bed in the street in protest at his work hours, eventually winning a high court ruling that working an employee so much overtime that their health was foreseeably damaged, was unlawful. By 1994 the maximum week was ‘only’ 72 hours (although this was weakly implemented with many doctors working longer).

Further progress came with the UK implementation of the European Working Time Directive, which meant that hours had to be down to an average of 48 per week by 2009. Still way too many – but allowing something approaching a normal life, even though the work was even more intense.

However, the devil is in the detail, and in this case in the averaging. Some doctors are still working weeks of over 100 hours, with fewer hours in other weeks. This summer, as if we were still in the early 1990s, it was debated at the BMA whether there should be a 72 hour maximum in any one week.  But as Dr Andrew Collier, co-chair of the BMA Junior Doctors’ Committee said, you can’t average your sleep across 26 weeks.

Even worse, in July 2014 the government announced that it would encourage junior doctors to opt out of the Working Time Directive, using the tired old argument that doctors need to work long hours to get enough experience (when did anybody, including a human being who happens to be a doctor,  learn anything useful while sleeping on their feet?) Medicine is a notoriously patronage-ridden profession, and ‘encouragement’ to opt out is unlikely to be limited to a friendly take-it-or-leave-it request.

Remembering my own horrendous experience of bad personal decisions and tears over tiny problems while I was working as a junior doctor – definitely the worst year of my life – I find it incredible that the situation has moved on so ambiguously in a quarter of a century. It seems to me that someone should fire up a campaign over this.

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Shorter working week, better mental health, less human misery

You can’t think straight and you feel constantly sick. You feel utterly overwhelmed with stuff that must be done, and so get nothing done.  Pleasure is a vague and distant memory, and there seems to be an invisible wall between you and the world. There seems no point in getting out of bed, so you don’t.

This is what mental illness can feel like. It’s a horrible, awful place to be.

There is a welcome focus on mental health services in the news today. But how much better for the sum of human happiness to prevent the mental illness in the first place.

A shorter working week would help, says the UK’s top public health doctor John Ashton. In July, he said in this article, “When you look at the way we lead our lives, the stress that people are under, the pressure on time and sickness absence, [work-related] mental health is clearly a major issue. We should be moving towards a four-day week because the problem we have in the world of work is you’ve got a proportion of the population who are working too hard and a proportion that haven’t got jobs”.

Working hours may even be the single most important factor in mental health. “The pressure of an increasingly demanding work culture in the UK is perhaps the biggest and most pressing challenge to the mental health of the general population”, says the Mental Health Foundation. They say it is estimated that nearly three in ten employees will experience a mental health problem in any one year. Long-time expert on well-being, Professor Cary Cooper, estimates that stress costs employers £100 billion per year. The human cost is, of course, incalculable.