Sunday, February 17, 2008

Walking backwards, slowly.

I have been following, on and off, a thread on Paging Dr about how to "Survive First Year". After three pages of posts it is a bit muddled about the first year of what, but all the talk about work-life balance has raised the hairs on the back of my neck.

Now don't get me wrong, I am not against doctors having a social life and being able to wind down away from work. Heaven forbid, my family would be very unhappy if I completely ignored them to work all day and all night.

But this concept that doctors (and medical students) are entitled to a fun and enjoyable experience during their work or study irks me. Medical school is meant to get you trained up as a decent doctor... but it just so happens that all the students want it to be fun and enjoyable. Being a doctor is about treating patients as best as you can, and drawing appropriate reward (personal satisfaction is a form of reward) from doing so.

There are many previous generations of doctors who chose to let (or failed to stop) work taking over their lives. 50 years ago it was normal to eat, breathe and sleep medicine all day every day while you were a RMO or Registrar. Even as a GP in a solo practice it was normal. And your patients appreciated it. Doctoring was not a job, it was a lifestyle.

These days, nobody (in any profession) wants to make any personal sacrifices for the sake of work. We all want to clock off at the end of our shift, turn off our pagers and forget about work. And by that I don't mean just doctors, but everyone in the wider community. No longer is the community expectation "8 hours work, 8 hours rest, 8 hours sleep" (care of the trade union movement) but so is the 2 week overseas holiday, investment property, beach-house, private school education, 4WD, and token sustainable garden. Are we becoming a society of spoilt brats?

I increasingly see it in the surgical trainees (and I must confess that I am and was no exception). They don't want to move out of town for rural rotations, let alone interstate or overseas, for fear of disrupting their personal or family arrangements (neither did I, at that stage). They want to claim every single dollar of their award entitlements (as do I), though obviously this eats into the budget for treating patients. There is a cost and a benefit to each of these decisions - though self-interest increasingly outweighs that of community-interest.

But back to the point - if you want to give up your social life you will make significant professional and educational advances. If you want to prioritise your social life you will suffer some impediment to your career or study (in comparison to those geeks who don't sleep and talk med all day long). You may well live longer as well. BUT IT IS YOUR CHOICE.

Some people like to blame "the system" for making medicine stressful and demanding. Blame it all you like. "The System" is the way it is, and if you want to go into medical politics and change it for everyone else, it will have community-wide ramifications (not necessarily all for the better). A plethora of large and small organisations from the AMA to the DRS push their views on how to improve the health system and also working conditions for doctors.

Sometimes I don't know whether reform of the medical profession or medical employment is for the better or worse. I find it a rather ego-centric view that we have to demarcate roles, engage professional industrial representatives, or wage public campaigns in order to maintain wages and conditions for doctors.

It feels like we are stooping to a lower level, and that it demeans us as a profession that we have to engage in underhand tactics, or play hardball in order to maintain conditions. Every "victory" over some measly little payment or benefit seems to degrade my professional self-respect even more. Perhaps it says more about our government, our industrial landscape, or our lawyers. Most of all, it sickens me that the time spent on this detracts from what I want to do - treat my patients well.

I'd like to see someone stand up and say "Good Job, Doctors. Here's a pat on the back, a few days off, and a pay rise because you deserve it." But I know I'm just dreaming.


Michael said...

Perhaps the day when doctors were respected for their position no longer exists. More likely though, it never existed except as a fantasy, a group delusion on why we as a group accept ridiculous conditions.

It should perhaps be reframed in a different way. Arguably, doctors and medical students have no entitlement to have a fun or enjoyable experience in their work or study. However, if work or study is truly structured in such a manner, you will not attract the best people to the position. It is in the economic interests of those holding the purse-strings to treat their staff well, something any well run private enterprise knows. I would argue that the loss in productivity and costs associated in retraining / rehiring far outweighs the costs of adhering to the standard conditions of the award.


Michael Tam

Krebsy said...

I can see your point of view .....I tend to feel that there are a number of factors implicated in the sentiments you have expressed.

The health care as an industry has changed dramatically in the last decade. Health care groups and organisations once held high altruistic plans and operational systems that focused on the patient, doctors were committed to their profession to the detriment of their out-of-work lives etc. The shift has seen a corporatisation of the health care industry. These changes have resulted in financial bottom-line decisions taking precedence over patient care decisions - this is on a organisational and individual level. Businesses because there is an expectation that a profit is made, and individuals because there is an expectation that you are paid for the work that you do.

I believe generational differences in the medical profession also plays an important role. Older generations of more senior doctors viewed their education, jobs and career as the #1 priority - important position in society with societal recognition for work done, good renumeration etc. These generation Ys coming through are keen to pursue a medical career but there is the knowledge that alternative careers in business/IT etc wound net a vastly greater renumeration value/hour, a greater emphasis on work-life balance is advertised and taken on early in the piece, feeling that medicine is a business and should be treated as such.......

Is this a 'right' way to think? I don't believe that either point of view is 'correct', but the profession of medicine will have to deal with these issues to ensure that the upcoming generations are able to uphold the quality of care provided by older generations and in the current economic health environment.


Anonymous said...

Your quote below polarises and misrepresents the issue of Dr workload :

"But this concept that doctors (and medical students) are entitled to a fun and enjoyable experience during their work or study irks me. Medical school is meant to get you trained up as a decent doctor... but it just so happens that all the students want it to be fun and enjoyable."

It's inane to suggest people want their work to be fun and enjoyable. No-one in medicine actually expects that all the time (as they don't in any other job). They do however want reasonable hours.

Current Dr hours are not reasonable, can be downright dangerous - they serve neither doctors nor the public well.

Given this, I can guarantee that within 5 years or so we will have adopted the EU model where intern/PGY2 hrs will be legally restricted back to a safe level. The macho/misogynistic model of Dr workloads needing to be excessive will change, quite possibly as soon as the next court case on patient safety comprise due to fatigue.

DHS said...

You are not entitled to a fun and enjoyable experience, but if you are not having fun and enjoying it, it might be that medicine is not for you. [As an aside, though, I am enjoying being a JMO much more than a student, so experiences can and do change.]

As for reasonable hours, asking for award entitlements, going out of town, etc: you gotta do what you gotta do, but management should not use that as a way to screw you over, which, without doctors fighting for their rights, will surely happen.