Hope for change

DOCTORS OPTIMISTIC ABOUT IMPROVEMENT IN WORK HOURS, CONDITIONS AFTER DISCUSSION WITH QEH ADMIN
By Shamar Blunt

Junior doctors at the Queen Elizabeth Hospital (QEH) are hoping that talks with officials at the state-run institution will bring an end to the excessive workloads that have resulted in some of their colleagues quitting and even seeking mental health intervention.
And as the medical professionals warned that the current state of affairs created room for medical errors, the Barbados Association of Medical Practitioners (BAMP) expressed support for a reduction in their work hours to protect the public from harm.
In a statement sent to Barbados TODAY, the ‘Concerned Junior Doctors’ identified themselves among those who Government Senator Dr Crystal Haynes and consultant physician at the QEH and Deputy Dean of the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus Dr Kenneth Connell said were forced to work 32 hours or more on a stretch.
“While we remain dedicated to providing the best care for the patients under our charge, the vicious cycle of long work days and even longer on-call shifts continues to take a negative toll on our physical and mental
well-being,” they said, noting that burnout and long sick leave are commonplace.
“As of today, several of our colleagues have either migrated to the US, UK or Canada – creating brain drain –, resigned from their posts, taken protracted sick leave periods or even require mental health counselling for physician burnout and the sequelae thereof.”
Senator Haynes, speaking in the Upper House during the debate on the Appropriation Bill, 2023 earlier this week, and Dr Connell in an interview with Barbados TODAY on Wednesday called for an end to the long workdays that were putting strain on the medical professionals and had the potential to also put members of the public at risk.
“We join with Senator Dr Crystal Haynes to make a valiant effort to come to a reasonable, safe and practical approach to regulation of working hours for the medical staff employed at the institution,” the non-consultant doctors said.
They further expressed optimism that discussions with hospital management would bear fruit soon.
“We have been in communication with the administration of the QEH to implement measures that lead to the restructuring of our various departments to ensure both patient and doctor satisfaction as well as safety in the administration of our medical care to our charges,” they disclosed.
“It is, therefore, our hope, in the year 2023, that with the drafting of legislation, the times of 32-hour shifts, severely sleep-deprived physicians – [a situation] affecting our cardiovascular health – and the resultant risk of medical errors from the above is fully abolished and put behind us.”
Highlighting their “arduous plight”, the doctors said while the general public may not be fully aware of their working conditions, some patients could attest to the long hours they were on the job.
“On several occasions, patients remark in awe that the same speciality doctor that attended to them at 8 a.m. while waiting in the Accident & Emergency Department remains on active duty until 4 p.m. the subsequent day, oftentimes without lunch [or] dinner breaks and little to no sleep,” they wrote.
“This equates and corroborates the 32-hour shifts mentioned [by Senator Haynes] that junior doctors in almost all specialities – including Internal Medicine, General Surgery, Obstetrics & Gynecology and Pediatrics – experience once every four days. Added to this, on average, a standard workday can easily go beyond the recommended eight hours due to the persistent issue of increasing patient loads, perpetuated by delays in both investigations and administration of treatment.”
The doctors also noted that in 2019, with the advent of the COVID-19 pandemic, “an already mentally and physically exhausted workforce from critical departments were split in two to attend [to] the dynamic needs of the Harrison Point facility while still meeting their contractual obligations at the Queen Elizabeth Hospital”.
“Thankfully, with the significant reduction in the number of severely ill COVID patients needing specialist care, our efforts no longer need to be strained in providing care to two facilities,” the doctors noted.
However, they said, they remain overworked and have made it a priority to take their physical and mental health more seriously than ever before.
Their call for that to change was supported by BAMP president Dr Lynda Williams who welcomed “an urgent examination of the hours that junior doctors now work”.
“We fully support the need to transition to an ideal number of working hours that will allow them to have safe, productive and fulfilling lives and that will protect the public from harm,” she said in a statement sent at the request of Barbados TODAY.
Noting the dangers posed by doctors working excessive hours, she referred to several studies, saying: “Fatigue causes significant negative physical and psychological effects. For every hour that a doctor works beyond 11 hours of continuous work, there is a measurable decline in cognitive performance, psychomotor skills, clinical acumen and prescribing accuracy. Depression and burnout, risks to physical health and fear of litigation also affect junior doctors disproportionately.”
Dr Williams acknowledged that the costs associated with expanding the allotment of junior doctors at the QEH would be significant, but said allowing the current situation to continue without intervention would be even more costly.
“In order to reduce junior doctors’ working hours, as Senator Dr. Haynes pointed out, a large influx of new staff would be required. This requires careful investigation because increasing junior staff also increases the need for supervision and training.
“BAMP appreciates that in a developing nation such as ours, a large increase in staff at once will have a significant economic cost. However, we also believe that no cost is greater than the safety of our junior doctors and, ultimately, the lives they care for,” the doctor said.
Though noting that the practice of doctors working 30 hours or more per shift was “a longstanding and complex problem which is not unique to Barbados”, Dr Williams pointed out that other jurisdictions had proven the situation could be addressed.
Even so, she acknowledged, reducing doctors’ working hours was only part of the solution.
“Several developed countries have introduced restrictions on the number of hours that junior doctors can work; however, organisational cultures of working long or antisocial hours often exist and doctors in training reported being unofficially expected to work extra hours voluntarily, even when working time restrictions were implemented,” the BAMP president noted.
“Furthermore, lack of resources available for work, lack of nursing staff and ancillary staff, poor workflow, poor shift design, lack of adequate facilities as well as interdepartmental pressures may mean that simply restricting the number of work hours may be insufficient to address issues relating to stress, fatigue and their consequences for the junior doctor. In short, reducing junior doctors’ working hours only partially addresses the problem.”
Dr Williams gave BAMP’s commitment to working with the Ministry of Health and Wellness and the QEH to find “workable solutions to the highlighted problems”.
Up to late Thursday, QEH officials could not be reached for comment.
shamarblunt@barbadostoday.bb