By EK Wills
There are many systemic issues in our current public health system but from my perspective within that structure, the heart of it is seems to be related to an ‘old boys club’ that perpetuates the notion of ‘if we did it, then you have to do it too’.
Recently, the media has been reporting incidents relating to workplace issues for doctors and more specifically for surgeons. This came to light again with the latest junior doctor revelation about appalling work hours and lack of a clear line of accountability in order to lodge complaints before it is too late.
First come the long work hours, and the idea that if you do the most, then somehow you are the strongest and most capable rather than possibly the most fatigued or dangerous to yourself and your patients. This is supported by those who had to endure the system’s demands in the past who see it as a test of resilience and if you don't pass then you mustn’t be cut out to be a doctor.
In an interview with the Sydney Morning Herald, Health Minister Brad Hazzard said …
medical colleges needed to hold their members to account to ensure they did not perpetuate the demand for junior doctors to work themselves into the ground. “Just because it has been done for 40 years doesn’t mean it should continue," …
This was in reference to some surgeons claiming the latest problem is the “feminisation” of the specialty and believe that the new generation of surgeons should “man-up” as previous generations have done.
The article went on to say that senior surgeons - male and female - have rubbished that claim, saying the inclusion of more women in surgery was modernising the profession.
This further indicates the messiness of the issue and not just in the surgical profession but the entire medical profession. But what is the issue: is it women, expectations, funding, old ways of doing things or all of the above?
Dr Kadota’s predicament highlights a flawed system with her endurance of inhuman conditions with no support for such a long period of time before breaking.
I have discussed the issue several times within different institutions with respect to work conditions, not just work hours but on-the-job training or lack of support, which has often been met with division amongst colleagues and fear of speaking out.
Naturally, there are many who think the system needs to be addressed, other doctors comment that trainees should know what they are entering into and so be prepared for such bullying and neglect. Some say that it is our duty to help people and so we should be grateful we are privileged to do such work. Then there are those that feel the need to endure it because others have and thereby prove their own worthiness.
Interestingly, there are more entrants to the profession now that have worked outside the health system. They have a benchmark to compare the actual hours worked and are outraged at the expectations of non-award approved hours that get brushed under the carpet or actively changed in order to appear to comply with NSW standards.
I remember submitting my accurate timesheet during an internship rotation and being taken aside by the director of the unit. He proudly told me that he used to work till 11pm at night without pay to impress the bosses and he expected the same of me. I felt that my family deserved more than that so I was granted time in lieu and advised not to add overtime to the timesheet in future.
Some doctors speculate the culture will have to change with the new generation of medical professionals that are coming through the system: the ones that are prepared to speak out at the expense of their own career because that is what it could cost. But we also have to wait till the old mentality retires and for the appearance of funding to become available to pay staff for actual hours worked.
The problem goes deeper when the new cohort still endures the old ways or, worse, is unable to support colleagues because we are all expected to ‘man up’ and not be ‘emotional’.
Thankfully, many medical schools are changing their approach to entry requirements in order to attract people with ‘a good bedside manner’ that includes communication skills and people skills as well as academic rigor. When their voice becomes loud enough, and the community demands their doctors to be safe, there could be more opportunity to change.
Then the system may need to adjust to accommodate the new breed of doctor that want to sustain a healthy work-life balance, just as they prescribe for their patients. And patients will benefit from non-fatigued and adequately trained doctors.
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Well said! Advocating for better workplace conditions is a win-win for everyone .