You’ve got to love Australians and their no-nonsense approach to life.
I got some first hand experience of this when I lived in Terrigal, New South Wales, for a while and used to play ‘touch footy’ (for ‘footy’ read rugby) with medical staff from the local hospital.
It was a team of mixed gender and age and, while you weren’t judged on your abilities, you were judged on your level of commitment.
One night I excelled myself, outpacing a middle aged nurse (just) for a glorious try in the corner. I swallow dived in celebration. That act of flamboyance was to be my undoing.
When I jumped up I realised that my house keys - which I’d left in my pocket - were firmly and deeply jammed into my thigh. Did I receive any sympathy? No. Was I expected to finish the game despite bleeding profusely and requiring stitches? Yes. It’s what all of them would have done.
There’s a steely determination about many Australians that I admire - there’s a culture of getting the job done regardless of the circumstances and without whingeing about it (like a ‘pom’).
You can also see this attitude in their approach to work hours. Too many episodes of Home & Away might have us believing that Aussies ‘clock off’ early and disappear to the beach but, in reality, Australia is one of the few developed countries without an upper working hours limit.
There’s no namby-pamby, sherry-drinking Working Time Directive for them. Australian employers are obliged to provide a safe system of work but there’s no one-size fits all hours limit.
Maybe that’s where we have gone wrong particularly when the evidence suggests that trainees are more tired working a shift-based 48-hour week than the longer hours of yesteryear.
Queensland Health has recently developed a Fatigue Risk Management System that is being applied across the state. It’s a model that strives to integrate management practices, beliefs and procedures to manage the risks of fatigue.
The document includes lots of talk about developing governance structures, creating a local working group on fatigue, conducting a fatigue ‘scan’, setting up a Defence in Depth framework and an education programme.
It all seems to make sense - if I understood it right - but one bit in particular has stirred up the BMA’s junior doctors committee. With typical Aussie belligerence, the document also suggests that if doctors are feeling really tired then they should consume six cups of strong coffee. Guess what? Evidence suggests it perks you up.
Dr Shree Datta, JDC chair, is outraged. She comments in BMA News that it’s “a reckless suggestion which may have dangerous implications for the care patients receive as well as doctors’ health”.
Safe working patterns and appropriate rota design are what is needed to minimise risk, she says.
Of course they’re important. But, as we fret about ‘safe working patterns’, with one eye on the clock, the standard of our training and continuity of care are deteriorating.
Maybe our hard-nosed Antipodean cousins are on to something: a few more work hours in certain specialties with a few more shots of espresso might just result in more experienced doctors and better care for patients.
Tags: WTD
