Overworked SA junior doctors are calling for new regulations on working hours following the death of a young intern who allegedly fell asleep behind the wheel after working a very long shift.
The Cape Times reports that young doctors are blaming the Western Cape Department of Health and the Health Professions Council of SA (HPCSA) for allowing interns to work shifts of up to 30 hours or even longer. The matter was raised by a concerned citizen and member of the medical profession, Dr John Roos, who wrote a letter to the newspaper to highlight doctors’ concerns.
In the letter Roos used the tragic death of 25-year-old Paarl Hospital intern Ilne Markwat to throw the spotlight on the long hours doctors work. Markwat was driving towards Cape Town on the N1 near Klapmuts at 10am on Friday last week when she fell asleep behind the wheel. Her vehicle crashed into the barrier before rolling and colliding with two other vehicles in the oncoming lane. The young doctor succumbed to her injuries en route to Milnerton Mediclinic.
The report says Markwat, who lived in Durbanville, started her medical internship at Paarl Hospital in January. She worked in the obstetrics unit, where last year interns had complained to the Junior Doctors’ Association of SA (Judasa) about working long shifts.
Roos said he had done extensive research on the consequences of working long hours. “There seems to be a failure on behalf of the government to take cognisance of the consequences related to medical doctors who work overtime. We know of doctors who make serious mistakes while working long hours,” Roos said.
Earlier this year, Safe Working Hours, a group of local doctors campaigning to reduce the hours doctors have to work, petitioned HPCSA for a limit of 24 hours a shift. Judasa chairperson Zahid Badroodien said junior doctors were currently expected to work 40 normal working hours and then 60 to 80 hours of overtime a month – equating to over 300 hours of work a month.
Badroodien said it was common for junior doctors to work continuously for more than 36 hours. “This results in an increase in medical errors which can lead to poor patient management. This is dangerous to ourselves as well as our patients.” He said young doctors were being bullied by senior medical staff who had the perception that “long slogs through the night are a rite of passage” and will make them better doctors.
“We are held to ransom by the threat of not being approved for completion of the specific rotations…,” he is quoted in the report as saying.
HPCSA spokesperson Fezile Sifunda said: “It is imperative that the contractual relationship between doctor and employer is consistent with the Basic Conditions of Employment Act and Conditions of Service that are applicable in the public sector.” Sifunda said questions about overtime should be directed to the National Department of Health.
Western Cape Department of Health spokesperson Mark van der Heever admitted that medical interns worked for up to 30 hours in accordance with the provincial department and HPCSA’s policies. “Interns should not exceed 30 hours of continuous work,” van der Heever said. Hospitals in the province monitored the working hours of interns within the policy parameters. “There will always be isolated incidents when hours will be temporarily extended due to the demands of service delivery, but this should not become a regular practice,” he is quoted in the report as saying
The young doctor, who qualified in 2008, was described as someone who went out of her way to help others, reports The Times. The police have not said what caused the accident, that killed three others, but doctors believe working long hours was almost certainly to blame.
The report says Cape Town’s Red Cross Children’s Hospital limited shifts to 27 hours this year after paediatric registrar Alastair McAlpine demonstrated to staff that there was a link between exhaustion and a greater likelihood of making mistakes to the detriment of patients. He warned of car accidents caused by tired doctors and said a shift longer than 16 hours would lead to fatigue that could contribute to an accident.
Badroodien said that even though doctors must leave their hospital at 2pm after a 30-hour shift, many are told to keep working by senior doctors. “We need to start standing up for our legal rights,” he said. van der Heever said: “The department manages the overtime duties of all medical interns in accordance with the HPCSA guidelines and the department’s own policy.”
In Scotland in 2014, the call to limit hours worked by junior doctors was heard and hospitals were told to reduce the working hours following the death of a young medic on her drive home from work. The Herald Scotland reported that Health Secretary Alex Neil announced that NHS managers should end all rotas that make doctors work seven night shifts in a row and more than seven days back-to-back.
The report said the move came in response to a campaign initiated by Brian Connelly, the father of Dr Lauren Connelly, who was killed in an accident after seven intense weeks in her first job. Connelly was quoted as saying that 23-year-old doctor had worked 10 days in a row on commencing work at Inverclyde Royal Hospital in Greenock and had completed another 12-day run of more than 107 hours in the weeks before she died. He believes his daughter was suffering from accumulated fatigue at the time of her fatal crash.
The report says earlier official government responses to Connelly’s concerns stated that all health boards were meeting the requirements of the EWTD, which restricts junior doctors’ hours to 48 a week. However, the report says, the health boards achieve this by averaging working hours over six months. Freedom of Information requests revealed some doctors were rostered to work more than 90 hours in a week.
Dr David Reid, chair of the British Medical Association’s Scottish Junior Doctors Committee, said there was growing evidence that arduous shift patterns affected the safety of patients and how well doctors performed.
He welcomed the action on night shifts, but added: “Many junior doctors still work a combination of both day and night shifts, which for some means they can be working up to 90 hours a week. It will be a challenge for NHS employers and the Scottish Government to achieve the target to end long stretches of day shifts.”