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Will a 48-hour working week for doctors affect patient safety?

Ami Banerjee
Last edited 17th March 2010

Ara Darzi’s departure as health minister last month was steeped in speculation and controversy for many reasons including how long one has to serve as a government minister to earn a place in the House of Lords, and whether clinicians can be effective in political roles and vice versa. Like many others, I think he has left his legacy by emphasis on at least three crucial aspects of the NHS: high-quality care for all; “clinicians as practitioners, partners and leaders” and innovation.

This week’s New England Journal included Darzi’s recommendations for US health reforms, which are being debated and observed all over the world. One of his prescriptions is “placing professional responsibility for health outcomes in the hands of clinicians, rather than bureaucrats or insurance companies”. One facet of this responsibility is ensuring safe working conditions for health professionals. In the NHS Next Stage Review, published in July, he talks of the significant changes in work culture in the last decade: “Pay and conditions have been made fairer. This was an almost silent revolution in making sure that the NHS recognises and rewards the talents of all its staff. Significant workforce contracts were changed, in partnership with the professions. There was an unprecedented investment in education and training that saw the largest expansion in the numbers of doctors, nurses, and other clinicians for a generation.”

One of the major changes of the last 10 years has been in doctors’ working hours. This happened largely due to the large body of evidence from all over the world, but particularly from the US, that showed negative outcomes for patients when doctors (usually early in their training) worked 100-hour weeks. In critical care, medicine and surgery, the mistakes made when doctors were tired were probably of most concern. Studies have shown that less mistakes happen when doctors were not sleep-deprived. Comparisons were made between working conditions in other professions with a similar responsibility for the lives of others. Doctors’ hours were found to be far longer. The long hours also had negative impact on doctor and patient satisfaction and medical training. This week, under European law, it became illegal for doctors to work more than 48 hours per week in the UK.

It is very unlikely that all doctors in all hospitals will immediately meet these time limits largely due to work culture and constraints on time and resources within the NHS. There are also legitimate concerns about the adequate training of future generations of doctors. Data suggest that it is not just doctors’ hours that are the problem and focusing on this aspect alone will not bring a comprehensive solution in the UK or in other countries. However, as long as future changes are made in consultation with doctors and with the welfare of patients in mind, as Darzi recommends, we are surely moving in the right direction.

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