Worked To Death - The Australian

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+ 18 — THE WEEKEND AUSTRALIAN

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APRIL 23-24, 2005 — 18

Health Weekend

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The death of a young girl in a Queensland hospital has raised awareness of the safety threat posed by doctors’ long working hours. Jane Lyons reports

G

EOFF Dob clearly remembers the exhaustion of his first six months as a junior doctor: expected to work 128 hours a week and 36-hour shifts, the darkest hours were those before dawn when coffee seemed to be the only thing that would get him through the night. And even after this initial training period there was very little respite as Dr Dob and his colleagues continued to work 80-100 hours a week. Now 56 and a senior consultant at the intensive care unit at the Royal Perth Hospital, Dob says these hours may sound medieval but it was common practice when he started in 1973 — and not much has changed since. The Queensland branch of the Australian Medical Association is currently undertaking an audit of doctors’ hours in their state, and has found that many doctors, both senior and junior, are still working dangerously long hours. Forty-one per cent of the doctors surveyed have fallen into the high-risk category, with 80-plus-hour weeks, shifts of 14 hours or more, at least three night shifts and no days off. Fifty-six per cent have fallen into the significant risk category, having worked 60-hour weeks, with two night shifts, three days on-call and only one day off. The audit was in response to a recent case against a junior doctor found guilty by the Health Practitioners Tribunal last December of unsatisfactory professional conduct . In 2002 Andrew Doneman, who was a second-year resident at Queensland’s Caloundra hospital, was in the 20th hour of a 24-hour shift when he made the decision to send home a 10-year-old girl who had come into the hospital after falling out of her bed and hitting her head. The girl subsequently worsened, was brought back to the hospital and later died.

RISK FACTORS ■ Are doctors regularly scheduled to work more than 10-hour shifts? ■ Do doctors work more than 14 consecutive hours in any one period (including overtime and recalls) at least twice a week? ■ Is the minimum rest between scheduled work less than 10 hours? ■ Are the total hours worked in a sevenday period more than 70 hours (including overtime and recalls)? ■ Is the minimum non-work time in a seven day period less than 88 hours? ■ Is there less than a 24-hour break free of work in a seven-day period? Extract from the AMA’s National Code of Practice — Hours of Work, Shiftwork and Rostering for Hospital Doctors (AMA, 1999)

But despite finding against Doneman, the tribunal’s report made strong mention of fatigue as a contributing factor. ‘‘One does not need medical evidence to know that anyone who is in the 20th hour of a continuous duty must have reduced capacity to assess the situation when it presents itself,’’ it said. ‘‘If this tragedy leads to nothing else, it should lead to the abolition of such brutally long shift hours, which must in itself reduce the standard for care available to patients.’’ The Queensland Government last month asked the state’s Medical Board to decide a safe working hours benchmark for doctors after being criticised over the death. The move was welcomed by the AMA, but the standard could take two years to implement — and it is understood work is yet to begin on drafting the new standard. David Hewett, chairman of the Australian Medical Association’s Council of Doctors in Training, couldn’t agree more with the tribunal’s concultion that long

INSIDE:

Too many hours common: But hospital administrators won’t admit it, says the AMA’s David Hewett hours threaten standards of patient care. Despite a 10-year Safe Hours Campaign by the AMA and the development of a Safe Hours Code, Dr Hewett says this case has underlined the fact that there is still more work to be done on the issue of junior and senior doctors’ hours. ‘‘Twenty-four-hour shifts are much more common than (hospital) administrators like to admit,’’ he says. According to Hewett, vague and out-

dated industrial agreements have allowed rostered on-call hours to extend agreed shift lengths, creating unsafe hours such as those experienced by Doneman. He argues that the Doneman case highlights the need to shift more of the responsibility back on to the institutions that are creating the unsafe rosters, rather than focusing solely on the individual doctors, ‘‘who must fall on their

Picture: Patrick Hamilton

sword for the public and media’’. Sue Page, president of the Rural Doctors’ Association of Australia, says poor rostering practices contribute to the loss of rural doctors in an industry that is already understaffed. ‘‘The biggest single reason why doctors leave the area is related to workplace issues that are possibly fixable, and of those the biggest single reason is tight

Continued next page

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$75, 616 (MAS2) Duties: The Manager, Clinical Engineering is accountable to the General Manager, Hills Mallee Southern Region for the operation of the Clinical Asset Advisory Service, a business unit within the Hills Mallee Southern Regional Health Services. The Clinical Asset Advisory Service is a statewide, selffunding clinical engineering service provider. The department’s principle role is the contracted management of the clinical engineering equipment used in regional hospitals for treatment, monitoring and therapy of patients. Additional the department also provides some contracted and fee-forservice clinical engineering services to other government non-regional hospitals and health services as well as private health providers. The Manager’s key responsibilities are: • the ongoing provision of services in accordance with the recommendations and requirements of Australian Standards at a service level sufficient to meet hospital accreditation requirements • the planning and implementation of management and operational strategies that will benefit the service provision and equipment facilities of Regional Health Units • the development asset and risk management strategies • the marketing of the Departments service capabilities to support the departments financial viability • the financial management the business operations of the Department on behalf of the Hills Mallee Southern Regional Health Service Essential Qualifications: Degree, Diploma or equivalent from a recognised tertiary institution combined with extensive industrial experience at a senior level relevant to the position. Special Conditions: Regular intrastate travel involving overnight accommodation. Regular out of hours work may be required. A current SA driver’s licence and willingness to drive health service vehicles is essential. Job and Person Specifications are available from: Peter Senn, Manager, Clinical Asset Advisory Service, ph (08) 8443 3111 or 0408 244 828 or by e-mail, [email protected] Enquiries and Applications to: Peter Senn, Manager, Clinical Asset Advisory Service, Building 3, 26 Stirling Street, Thebarton SA 5031, ph (08) 8443 3111 or 0408 244 828. Please forward an original application plus three copies and include the name, address and contact number of three current work referees. Applicants are required to address the job and person specification in their application. Applications Close: 6 May 2005 at 5.00pm

Make a Difference Join ACT Health.

Junior Medical Officer PGY2/3 Ref: MS11680 Department of Emergency Medicine Maroondah Hospital is seeking Medical Officers in the Emergency department to fill vacancies. Both positions are to commence in May 2005.

Applicants should note that Duty Statements, Selection Criteria and Application Packages including Referee Report Proformas are available on the Department’s website at http://www.health.act.gov.au/employment

The New Emergency Department was opened in March 2005 and sees approximately 40,000 patients a year. There are 29 cubicles with state-of-theart equipment, 12-bed short stay ward, 4 paediatric cubicles and 4 paediatric short stay beds. The positions are well supervised by enthusiastic 9 EFT FACEM consultants and Paediatricians.

THE CANBERRA HOSPITAL SURGICAL SERVICES CARDIAC SURGERY

There is an excellent education program locally, integrated with the very successful Eastern Health ACEM training program. Protected training time is also given for resident staff. The position is for a 6-12 month post with the possibility of an extension.

Clinical Perfusionist

Registration with the Medical Practitioners Board of Victoria is essential.

Health Professional Grade 4

Enquiries: Dr Peter Archer, Director of Emergency Services 9871 3150 or Dr Greg Mele, Clinical Director 9871 3550.

$69,899 - $75,367

Please apply on line: www.easternhealth.org.au or written applications quoting the position reference number to : Mary Hatchard, HMO Manager Medical Administration, Maroondah Hospital P.O Box 135, Ringwood East VIC 3135.

Canberra (PN. 28742 Expected Vacancy) Applications are invited from suitably qualified Clinical Perfusionists to fill an expected full-time vacancy in the Cardiac Surgery Department at The Canberra Hospital.

Applications close Friday 6 May, 2005.

The Cardiac Surgery Department has one operating theatre, with a case load of 330 adult Cardiac procedures per year. The successful applicant will share this case load with another full-time Clinical Perfusionist, rotating the on-call commitments, week on-week off.

Angliss Hospital

Eligibility/other requirements: Qualification Diploma with the Australian Board of Cardiovascular Perfusion with a current certification.

General Medicine Registrar/HMO3+

A minimum 5 years experience in managing Cardiopulmonary Bypass and its associate equipment. The ability to manage Cardiopulmonary Bypass and various Perfusion procedures independently, under the direction of the Cardiac Surgeon. Experience in working in regional Cardiac Units desirable.

or email: [email protected]

Commencing end May or February 2006 Ref: HH11684 Angliss Hospital is a 200 bed Hospital located in the foothills of the Dandenong Ranges, in Melbourne’s eastern suburbs. A new Emergency Department with co-located short stay and High Dependency and Coronary Care Unit opened in 2005. There are currently three general physicians each supported by a registrar and resident. Physicians contribute to the education of junior staff. There are excellent links with the local GPs who support inpatient care.

Selection documentation may be obtained from www.health.act.gov.au/employment Contact Officer: Kaye Collins (02) 6244 3096 Applicants must quote the above position number when applying. Applications Close: 5 May 2005 Applications to be addressed to:

The position will suit a basic trainee in medicine, emergency medicine or general practice seeking additional general medicine experience. The post is accredited for Basic Training with RACP - General Medical Registrar term.

The Recruitment Officer ACT Health PO Box 11 Woden ACT 2606

Qualification: Registration with the Medical Practitioners Board of Victoria. Enquiries: Dr Harvey Lander, Director of Medical Services 9764 6105 or to Dr Martin Walter, Head of Medicine 9764 6110. Closing Date: 13 May 2005 Apply on-line at www.easternhealth.org.au or written applications to Martin Smith, HMO Manager, Angliss Hospital, 39 Albert Street, Ferntree Gully 3156 or email [email protected].

www.easternhealth.org.au

or [email protected]

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