Diary of an FY1 – Tiredness

[box] In the latest edition of his diary, Oscar talks of the doctors unwelcome companion [/box]



Over the past months, though medical practice has stopped becoming so elusive, as my brain gathers ever more understanding of the conditions and complications that occur as patients come into hospital, I still find myself unable to come to terms with one thing. That thing is work fatigue.

Yes, I’d been tired in university before, normally paired with that notorious thing the hangover, to the point where the two were interchangeable. But learning to deal with tiredness directly as a result from work is another thing. For one, unless I decide to blame my eighteen year old self, it is not a self-inflicted act of mortification. Indeed, short of taking sick days, it is unavoidable.

I remain continually astounded by what the rota co-ordinator manages to achieve whilst still maintaining 2a banding. The current surgical rota has achieved this amazing feat whilst fitting a 78 hour week and one in two weekends. The rota co-ordinator should clearly have trained to be a stockbroker.

The other alternative of course, is that the rota was in fact created by a machine, which would of course explain why it has such unreasonable expectations. The fact that many people’s needs are never taken into account often leads to people doing even worse hours just to have a chance to go to such facile events such as their own wedding.

One really doesn’t appreciate tiredness until it’s forced upon them. Basic tasks that they take for granted such as inserting blue needles into veins they can normally fit a grey cannula become a Herculean task, as does the similar task of checking something before signing it. Tiredness leads to errors and yet this is simply accepted as a necessary part of our jobs.

Tiredness and overwork also have effects on our wellbeing. Stressed colleagues become emotionally volatile. Indeed a lot of the stress of the first few weeks is primarily caused by this emotional unawareness. I’ve found myself  both shouting and simultaneously apologising at nurses because stress eventually makes our emotions an uncontrollable mania. It almost makes me pity the neurosurgeons (although I strongly suspect they are actually just unhelpful wells of sarcasm).

But the other thing overwork does is that it makes us ill. This of course creates a vicious cycle as colleagues are left to cover gaps and themselves becoming overworked and ill. Indeed, no-one ever finds locum posts for jobs that are easy; they are almost always for a long shift that someone has no longer been able to do.

Indeed, the fact that quality of life is the primary reason many people prioritise specialties that they choose reveals just how out of control bad rota management is, as staff find themselves having impossible standards to maintain.

The fundamental reality is that if we want a system that allows people to have a quality of life, we need to have more doctors so that the system has a physiological reserve so people are not pushed to the brim so often.

The junior doctor’s contract is only going to exacerbate this problem. The fundamental fact is that the more excluded we become from the rest of society, the less we are going to care about it. Weekends are symbolic but the fact is we will find ourselves increasing isolated if we are always working them. A secondary effect of the contract will be a brain drain as people leave the country in search of a better life that leaves fewer and fewer doctors working in here as the system reaches breaking point.

Of course, none of these problems are new. The fundamental fact of it all is that medicine is not in control of itself, now at the hands of faceless city bankers looking for lucrative management jobs. Will this change any time soon? I doubt it. But I read that our generation, ‘the millenials’ are less willing to compromise on the values we hold over the jobs we find ourselves doing. Whether this means we will end up taking back control of our lives is up for debate. But one thing is for sure, tiredness isn’t going to get us anywhere.

Dr. Oscar To

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