Why pick a fight with junior doctors?

Abstract

Every doctor is a junior doctor at heart. We’ve all worked long and inhumane hours, worried about our ability to maximise patient safety and experienced the dearth of support services at evenings and weekends. Hospital patients know the pressures too, when a scan has to wait until the morning or it’s taken several hours for a busy junior doctor to arrive on a ward to prescribe a simple analgesic.

Junior doctors become hospital consultants, general practitioners, professors and journal editors, but they don’t forget what it was like to be a junior doctor. It’s an experience that shapes and binds us. Doctors are very different people embarking on diverse careers, but we all share the legacy of our time as junior doctors.

Why, then, would England’s Secretary of State for Health pick a fight with junior doctors? Why has Jeremy Hunt imposed a new contract on junior doctors, the manner of which will only further alienate not just junior doctors but also the rest of the profession and patients? While some commentators draw the conclusion that there is a hidden agenda to dismantle the NHS as we know it, only time will unravel the reasons behind Mr Hunt’s baffling war on juniors.

In the meantime, we are left with attempting to understand the consequences of the contract imposition, in a climate of disillusionment in hospital medicine and general practice, against a background of NHS deficits. Azeem Majeed and others with experience of being a junior doctor attempt to make sense of the contract imposition.¹

We’ll be in a better place if everybody’s focus shifts to what’s best for patients. Here, in an unusual and fascinating piece of research, a US team attempts to understand the effects of team dynamics on operative efficiency.² The authors find that the more familiar the team are with the each other the quicker the operating time. The effect of experience is similar but only up to a point. Around 30 years of working together, operative efficiency starts to wane.

If you do not believe this finding rest assured that this is a single-centre study and the hypothesis needs to be retested in other settings. Once several studies are published on this research question it might be time to consider a systematic review? Would you be convinced then? Evidence synthesis dates back centuries but has evolved rapidly in the last 25 years. Mike Clarke, a pioneer of evidence synthesis, provides an effortless history of this important research methodology sprinkled with pearls of wisdom for any aspiring critical thinker.³

References

McKay AJ, Parekh R and Majeed A. Implications of the imposition of the junior doctor contract in England. J R Soc Med 2016; 109: 128–130.

Maruthappu M, Duclos A, Zhou CD, Lipsitz SR, Wright J, Orgill D and Carty MJ. The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis. J R Soc Med 2016; 109: 147–153.

Clarke M. History of evidence synthesis to assess treatment effects: Personal reflections on something that is very much alive. J R Soc Med 2016; 109: 154–163.