Jay Kuten: Safety first for striking docs

Junior doctors have gone on strike in Whanganui and around New Zealand. Photo / File

As a last resort, our junior doctors are planning a 48-hour strike that began yesterday. That will cause disruption at many DHBs, including ours, but in the interest of patient safety and from my perspective as both physician and patient, I wholeheartedly support them.

I can vividly recall my early days as a newly minted house officer in the 1950s.
In the States, when you get your diploma and then pass the state licensure exam, you can theoretically practise in any field of medicine or surgery.

In reality, you'd be a damn fool to attempt to do so without the further training that takes you from the shelter of academia to the real hands-on world of living patients, patients whose continued living after receiving your ministrations is by no means assured on the day you're first minted as a doctor.

It was the common expectation, in those distant days, that in at least the first year after medical school, we would work for 36 hours straight and then have 12 hours off, ostensibly to recover. Not one of my group complained, because this was simply accepted as a fact of life. So exhausting was this routine, that after a month or two, I came back to my apartment, sat down before a plate of soup, and found myself, literally, with my face in it.

The setting was a first-rate hospital, part of a highly regarded medical school. That last means that we, junior doctors, were expected to find time in a hectic day of patient care, to attend lectures and to read the latest medical literature in order to add our individual learning effort to that of the senior doctors whose daily teaching at bedside was a large part of our learning.

As the focus of the experience was on our education and training, not simply on how much work we could perform in relieving senior doctors of more mundane tasks, we juniors rationalised the demands made of us as initiation rites in joining the great medical fraternity. If we did feel overworked, we grumbled amongst ourselves. Who else would even listen?

After 60 years of practice, I look back and am appalled at what we accepted as "normal." In the intervening years junior doctors have organised, developed bargaining units to provide some leverage in the inequality between themselves and administrators and senior doctors and/or administrators.

Whereas we barely got subsistence pay as house officers (pizza, a movie was a rare luxury) today's juniors get a living wage — $50-60K to start.

Nonetheless, in 2016 when they took strike action over hours spent working and a pay rise of 5 per cent, DHB CEOs who earn $600,000 pa on average, fought vigorously, with no sense of shame. The DHB heads get bonuses for saving the system money.

The current strike is about hours of work. In the previous strike the DHBs "conceded" that junior doctors would work no more than 10-day shifts, four nights, and have four days off. They would work no longer than 16-hour shifts.

Now the DHBs are wanting to reverse those gains, get more work from juniors, sidestep their chosen collective bargaining agent to negotiate directly with each doctor. That last demand, if carried out, creates a situation ripe for abuse and institutional bullying.

Some 1500 patients die annually as a result of medical error — four times the road toll.
Significant contribution is doctors' sleep deprivation, which studies liken to 0.05 per cent blood alcohol.

We wouldn't want to fly with a sleep-deprived airline pilot. Following some major accidents, commercial pilots are required to have a minimum of 10 hours rest before flying.

While the bean counters at the DHB do whatever they can to minimise costs, these young doctors are on strike to ensure that the work they perform to foster the health and well-being of their patients is done in a manner to maximise safety.

As safety is the bedrock on which rests all medical care, we should all support their cause.

Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.