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I’ve always felt that long shifts make a rota more ‘honest’. 12 and 13 hour shifts are a marathon, but staying back significantly later than that has, for me, always been the exception, rather than the rule. Yes, my commute might mean that a thirteen-hour shift means sixteen hours out of the house, but at least every single hour of my time is accounted for by the rota.
The medic in me remembers that ‘normal working weeks’ of 9am-5pm, were in reality more frequently 8.15am until somewhere closer to 6pm. There would always be just one last job to do before you left, one family that had just arrived and really wanted an ‘update’. The extra half hours added up and a 40-hour weeks easily stretched to 50, or more.
Recently I have started a job where I have more ‘normal days’ in my roster than I have been used to. Something that resurfaced was the age-old issue of those on the team who have children who need to be picked up from nursery, and those who don’t.
It’s a problem that cropped a lot when I worked on the medical wards, but has rarely been an issue for me on a long shift pattern. On this occasion, the senior house officer was about to leave without participating in the hand-over at all.
It had been a busier than anticipated afternoon and time had gotten away from us a little bit. I spotted him on his way out the door, lifting his hand to say good bye and I looked surprised. ‘You’re off?’
‘I finish at 5pm,’ he said, while glancing at the clock that confirmed the little hand was indeed at 5.
I say: ‘Me too, but we have to handover our patients.’
He replies: ‘I have to pick up my child from nursery.’ And therein lies the trump card, because in reality I could hand over the patients by myself.
A friend of mine recently had the same issue with another junior on their team. I remember as a house officer, regularly being left behind by one particular registrar to finish up ‘just one or two things’, because the nursery would issue a fine if they weren’t on time.
When my friend and I discussed what she should do about the one member of their team who seemed to be immune to carrying the burden of how stretched they were on the ward, it was difficult to offer any advice at all.
Nobody wants to show a colleague the unkindness of not appreciating their family responsibilities and after all, it isn’t that person’s fault that the ward wasn’t staffed appropriately. Why should their child suffer?
My friend’s colleague suggested that they should just all leave on time too; they were choosing to stay. That is true, but perhaps it is easier to take a stand and say ‘I’m off’ when you know you are leaving other members of the team behind who are tying up the loose ends.
It’s an issue that I’ve never really figured out a satisfactory response to.
So, what would you do?
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
Have an overlapping shift pattern?
Hi everyone! I've applied to medical school and am waiting to hear a response. Throughout my work experience I've asked doctors about their work-life 'balance' and how they cope with long shifts and understaffing. I've had the feeling that they have dumbed things down as to not scare me away from the profession, and that the media which I stay up-to-date with are almost scaremongering.
Could I have an honest opinion - one which truly reflects what day to day life is like as a doctor with regards to stress, understaffing, stretched resources and what frustrates you most on a daily basis at work.
(If you could write your current level of training too so I may see how work differs throughout training)
I would be so grateful for a reply! Thank you! :)
It is the team’s job to stop this from being an issue. If you are staying late, this should be exception reported and escalated, and staffing levels adjusted. It doesn’t sound like you have adequate handover arrangements in your job. This is in no way the fault of the junior who has children.
It is a little disingenuous, and even rather insulting, to refer to your colleague’s children as some kind of “trump card” which they use to get out of pulling their weight, and to imply that they are “dishonest” for doing so. I have children, and I have to leave to pick them up. I don’t get to choose where I work. If I finish at 5, and I have a 50 minute commute, then I have to leave at 5 to pick up my kids. It’s not just about the fine - it’s about the fact that my baby will have spent 11 hours in childcare. It’s about the fact that I have ultimate responsibility for picking them up. It’s about the fact that if I don’t, I am letting them down. My patients have other doctors - my children don’t have other parents. So I will let them down once, for an emergency; I will not, categorically not, let them down repeatedly to prop up a disorganised understaffed work situation.
I have always striven to leave on time. Not because I want to - because I have to. I put in hours of my own time to this job - but that is an hour that I won’t put in (so long as there is no emergency) - because I have no choice in the matter. I make sure in return that if I am on a long day, or if my partner is collecting the children, that I send everyone else out of the door on time. I take their bleeps and I take their jobs and I take handover and I send them home. I am lucky that in my specialty we have a good system of handover which is scheduled and timed to send people home on time most days (unless of course there is an emergency).
So instead of implying that colleagues who have other obligations are failing to “share the burden”, address the burden as a team.
Make sure that handover happens at 4.30.
Exception report any late finishes.
Discuss job pressures with your boss.
This isn’t the fault of the doctor who has to leave on time - for children, for a train, for a lesson.
This isn’t their issue.
It’s a system-wide issue, and one that nobody has the right to pin on any other individual. And it’s an issue that is your responsibility - and everyone’s - to fix.
Maddy Fogarty Hover
ST3, paediatrics, Yorkshire
BMA LTFT forum co chair
All views my own.
Thank you for your reply. Firstly let me be clear it is not my intention to suggest that anybody is 'dishonest'. I would actually go as far as to say that I categorically did not say that at any point...or indeed intentionally infer it. . I did however actually say that i would never show a colleague the unkindness of not recognising their family responsibilities and also that I recognised that there was no reason a child should suffer because a ward is understaffed. Indeed, when I say that a child waiting to be picked up is a 'trump card' - I do mean it in the sense that it is a deserved one. In this situation the bottom line is that two people want to leave on time and of course the responsibilities of being a parent are an important factor - declaring them will, rightfully so, give that person the advantage to achieve what they need to - which is get to their child and I will concede to that most often.
So, that said I think that your response, although of course is I am sure informed by your own real experiences is perhaps not exactly reflective of what I have actually said.
..and also that I know very few doctors who get to pick where they work and I have at no point said that I don't also have other obligations. As grown ups in training who pretty much don't get to pick where they work, I presume that applies to everyone; children, parents, unwell siblings, partners, personal physical or mental health problems...the spectrum is huge. But again, my point is not to query the validity of any personal obligation but to think about how one of these things (in this case children being picked up) can cause rifts in a team
But also I think it is 'ok' to say, that in these stretched times, just sometimes it is hard to maintain team harmony in these situations - because it is the truth.
My purpose in writing this blog was not to suggest you need to defend your reasoning for leaving on time to pick up your child. So I do apologise if you felt obliged to do so. I had intended to be clear that leaving to pick up child is a valid reason and thought that ending the piece by asking what the best response is, I was being clear that the emphasis here is looking for answers/solutions. And that I think it has to be 'ok' to discuss these things. There is no pitch fork here
If none of that was clear, perhaps it is now. I can assure you we are without a doubt on the same side, or 'team' so to speak.
The Secret Dr.
Easily solved. Normal working hours and then overtime when you go over. The guys and girls that want or can stay get paid more, the ones that can’t don’t lose out and if they did stay it pays for the nursery fines.
I can’t wait for EWTD to be scrapped and work as a professional again.
The overtime pay is peanuts, especially since it is cheaper for them to have a Dr stay late for 2 random days of the 5, than actually hire enough staff to put sufficient slack in the system. They are getting a cheap Dr on totally flexible (for them) retainer, in a sense, who cannot refuse to do the work. Still leaves us unable to plan anything after work within 2 hrs of our supposed shift end.
I was suggesting a system where overtime was not ‘peanuts’ but suitable to be attractive to doctors that were able to be flexible.
The problem is healthcare doesn’t conform to shifts. If doctors were treated as professionals and paid for the work required to be done and not by the clock morale and pay would be boosted and patients would get continuity of care.
I'm a LTFT ST in the Midlands. I think this is a very perceptive and balanced piece and it's right to acknowledge the inevitable tensions in a blog space like this.
I agree with the first point about overlapping shifts. We had them in one trust in London and they worked well.
On a separate point I think Maddy was right in most of her points but maybe she should put them in a separate blog because they don't really answer this one. They sound more like a response to a critical voice. The SD is not at all critical. Also, as a local BMA rep, I think members should have a voice here and the BMA hierarchy only chip in to add useful points or challenge matters of fact, but that's a matter for individual choice. I should add that I've met Maddy's co chair and think they're both amazing.
Generally, I think it's right that all of us should be able to leave on time but this blog isn't about those teams where you're going hours over every day (I've worked in one and we changed it) but those where there is a bit of a grey area - the odd half hour here and there. I know we're told we must ER everything but actually most of us don't work like that.
I should admit that I'm fortunate- I have half an hour built into my day before child minder collection just in case and I'm also lucky to work in a specialty where this is rarely a problem.
To reiterate - a great piece and a discussion we're sometimes afraid to have.
The question is much more why are you not all leaving on time? How ever this needs to be achieved is the teams responsibility and in fact the person in your leadership team who has accountability for the roster. If you burn yourself out who will you blame? who will look after you. whether it is childcare, a hobby or life ...work other balance is important and necessary... I make sure all my nurse and doctors leave on time..
Of course the ltft ones are piping up - they are often the ones leaving in this scenario. Exception report and increase staffing levels, more empty rhetoric put forward by the inept and impotent bma. The nhs is sinking - enjoy the decline folks.
You should not have chosen to be a doctor if you are watching the clock for whatever personal reason. You are supposed to be a professional. What has happened to the medical profession? Doctors should together fight non-doctor managers who prevent or hamper them in any way from doing their jobs properly. Doctors have a professional responsibility to their patients.
I think it is a team responsibility to fix this issue. The doctor waving a hand to leave does have a right to but has a professional responsibility to ensure that an appropriate handover is given. They should not assume that because someone does not have a young child that they do not have equally valid things that are important to them that they also need to get home to. So yes I think handover time would need to be moved forward.
“You should not have chosen to be a doctor if you are watching the clock for whatever personal reason”
This is a ridiculous comment. And cutting out all doctors with personal responsibilities outside medicine would leave approximately three young doctors with potentially limited life experience to run the NHS. All parents and carers have responsibilities outside of medicine and so do many many other doctors.
I have just started training and face a similar problem every day. I am reluctant to bring it up, being the newest trainee in the department, however we have a 40 minute long handover and if someone else does bring it up, the consultant brushes it aside by saying "exception report it" . This does not help me or most of the other trainees....feels like a bit of a hopeless situation .
this also conflicts with GMC duties of a doctor unless the team have agreed a solution that makes for safe handover . It gets worse when there are several parents with child care commitments on the same team and needs to be agreed upfront