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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
No, the SHO is a professional and as such should pay for professional adequate childcare- ie a nanny, and not be at the mercy of a mursery who is going to tell the mother/father off for being late for pick up. Completely unacceptable for the doctor to walk off at 5 if the work isn’t finished and expect someone else to do it for them.
Still a medical student but painfully aware of the implicit unpaid overtime situation that occurs seemingly ubiquitously.
Forgive the ignornace, but what does 'exception reporting' actually do? Are they expected to be acted on? Or are they a CYA thing so that if, say, someone dies because of of an unsafe handover and there's a significant event analysis (etc); they can be pointed to and the situation explained by 'insufficient staffing'- with accompanying sage nods and sighs of resignation?
The SHO is unlikely to be able to afford a nanny!!!
I have been in this situation, and I have just had to swallow the bitter pill, and accept that if I raise my voice, I will be ridiculed as being asocial & unkind.
Even though I have parents who I look after, it is not the same as having childcare responsibilities.
Unfortunately there is little sympathy & empathy, and no voice for people who are always ‘covering’ for colleagues with children, there is no obvious solution, apart from exception reporting, and as someone suggested, payments should reflect the hours worked. If I decide I want to focus on family, I should not penalise my colleagues.
The following misses the main thrust of the SD blog; but on a tangential note:
I've heard tell, in song and legend, of a hospital that provided some basic childcare; used by medical and non-medical staff alike to cover the gap between other childcare and shiftplusextrawork-end. The story further goes that this service was withdrawn under the guise of 'cost-saving', to the tune of (at the time) less than 20k. The inevitable consequence was that staff started either leaving on the clock or reducing work patterns.
I am completely sure there is no doubt the money saved on the crèche/afterschool service paid for the inevitable locum/agency staff required...
I'm an SAS Doc.
Of course there is a huge problem. We must be careful however not to put all potential job candidates or the problem will escalate. In my experience the hours issue is a lot to do with unfilled posts. Encourage more people to join our NHS in all rolls.
As The Secret Doctor rightly alludes to, drop the pretence of a 'normal working day' and move to a shift pattern just as our nursing colleagues do. As a junior I found almost without exception that the most useful work of the day was done between 06.30 and 0900 or from 1700 onwards when you could concentrate on your own jobs and your own patients rather than being bogged down with other departments or consultants needs. Those areas which do run a shift pattern tend to run more smoothly with people rarely leaving later than their allotted time, at least in my experience. As a nurse for twenty years I worked shifts without ever appreciating there was another way of doing business and thoroughly enjoyed my four or five day weekends or ability to take a fortnight away using only five days annual leave. I was astounded when I started work as a doctor fifteen years ago and discovered my ability to go to the dentist, optician, garage, bank or any of a myriad of other services and suppliers was severely curtailed and I had to join in with everybody else over the weekend. Then I discovered that not only did I work every day of the week but half the weekends as well!
Doctors in general and juniors in particular have their working day built around somebody else's, thus, if a consultant surgeon finishes late the registrar closes late, the ward round is performed late and even though the consultant goes home an hour after time the job-monkey is looking at an ever-expanding list of 'can you justs' and 'it won't take a seconds' several hours after they should have walked out of the door.
Clearly one cannot walk away from patients in need and nobody wants to jack on their colleagues, the response to this needs to be collective but to those who are horrified at the thought of proper shift work (as opposed to on-calls on top of a normal working week' I say give it a try, it's really not as bad as you think. You miss rush hour so the commute is always more pleasant no matter which way you do it, as above you have the opportunity to get your own admin done during the 'normal working day' and most importantly you get paid for all of the hours you work.
Handover is a GMC requirement and as such brings into question the leaving Doctor's position in the eyes of the GMC. In the bigger scheme of things a committed doctor who stays behind is likely to be noticed as being more responsible and is probably going to have a more fruitful progression in their career, albeit at the cost of having a rather 'old school' approach to training. However, this is an unsustainable option as those who want to stick to rota hours are by far the majority, understandably, and fundamentally the reason work is carried beyond reasonable time, is because of an inherent problem with under-staffing. Until something is done to appreciate the amount of time needed for junior doctors to learn and also care for their patients, there will never be a solution. Adjusting rotas to be 'legal' will appease the politicians, but does nothing for the professionalism of the health service, and in the longer term raises some questions as to how doctors' learning progresses.
Always ensure finished by 5. Handover should be before 5 not at 5. You shouldn’t assume everyone will be able to or indeed happy to stay later on a regular basis. Trying to blame other colleagues alongside clear poor time management makes this article sound rather arrogant.
I would say all professionals with children have the same problem - not just doctors. I have been a full time doctor and brought up three children. We had to make robust arrangements to ensure the children were picked up on time if one of us couldn't get there. Sometimes it was awful and very worrying. My Partner was a non-doctor and very responsible professional also working very long hours. We both had to make sacrifices to protect the children and not at the expense of our colleagues. As was said to me: " you chose to have children". That is also the attitude of most other colleagues in other jobs.
It's true, all professionals do have this problem....that includes consultants too.
Just a few weeks ago I missed a parents evening as a case overrun in theatre, the trainee doctor had left on time.
There does come a point when as a professional we have to accept that we don't finish on time through no individuals fault, just the nature of work.
Didn't mean I wasn't upset and annoyed, shouldn't happen on a regular basis that's for sure. But it doesn't mean I can plan to leave on the button 100% of the time either. If I do I will be disappointed and frustrated on a regular basis, I won't last the course.
Work with your colleagues to make sure you can ease the pressures in a fair way.
Comments made relating to appointing colleagues being "old school" do have some truth. I want a colleague who is clinically sound clearly, however I have more desire to appoint a colleague who can be a friend and share our stresses and worries over the next 25 years together, not a colleague who rushes to the leave book, bags xmas and shouts I'm off!
There are ways to protect handover. It should happen at set times, and all members of the team should make the effort to be there in time. I work in an emergency environment. The only times we couldn't leave in time was when we had crash call right at handover time, but even then, you'll try to let your mates go as soon as possible. And anyone should plan half an hour extra for such moments. I personally think it all depends on how we respect each other and how we try to make things work. And, it has nothing to do with having kids or not. I have kids, and I don't want them to be waiting for me in the street, or even worse, to be referred to social services, like it happened to one my colleagues who was consistently late to pick his kids up. But, what if you have a date and you've already been late two times, will she/he still be there the third time you're late? So, in summary: it's all up to us and how we care about each other!
At every level of career progression in medicine there are those who stay longer and those who leave on the dot. I've been a Dr for 23 years and worked with a lot of teams. It also happens in nursing teams and in a lot of jobs generally.
On a professional level, the handover needs to be done well and by all members of the team. I think it is the consultant's role to make sure this happens so that the teams run smoothly and the patient care is safe.
We all work differently. For some of us it's far healthier to finish up on time and head home. This is how I work now (after many years of staying late) but it took me roughly 7 years to succeed at it. Some colleagues, on the other hand, feel less stressed if they "finish up" for 30-60 minutes at the end of the day - it's a personal thing and about keeping yourself resilient. We have to be honest with how we work best and try not to always look at how others work. Although childcare is often given as a reason to leave on time it's perfectly reasonable to be going to walk the dog, see friends or go to a Book Club.
You need to find the best way to leave each day feeling you've done a good job but not been put upon so that you stay well and feel ready for tomorrow's challenges.
...and hard work does not go unnoticed...
Best of luck
I think the issue is that doctors who leave @ 5 due to childcare reasons believe it is their right, completely ingnoring the rights of the poor colleagues who end up doing more than their far share of work. I am sure this is the accepted norm across the workforce, not just the medical profession.
There is no incentive in the current climate to accept responsibility for your decisions, and the consequences. If you choose to have the privilege of having a family, then you can also bear the consequences and make proper arrangements for regular childcare.
Maybe you can't afford a nanny, or maybe you can. But whatever your childcare arrangements they need to allow for some kind of flexibility otherwise you will get incredibly stressed out as leaving time approaches. Maybe there's a nursery that stays open later? Whatever the solution, it needs to allow you peace of mind as the day comes to an end so that you have time enough to travel safely to collect your child, and doesn't risk conflict with colleagues who don't have kids and might feel they are being taken for granted. [Hospital consultant married to same, both work full-time and brought up 3 kids - yes, it was hard]