Chronic Fatigue Syndrome
No, this is not one of those articles in which some doctor - inevitably subsequently described as 'unhelpful' and out-of-date' - dares to suggest that chronic fatigue syndrome is really nothing more than a big pile of made-up poo. Certainly not...I would never suggest such a thing. I would never suggest it because I know that chronic fatigue syndrome exists and I know that because I have it. I am tired right now. I was tired when I woke up. And I'll probably be just as tired when I wake up tomorrow. In fact, I am tired pretty much all of the time.
Is this surprising? Well, not really I suppose. My job is busy, busy, busy. I haven't had any lunch for the past three days, let alone a coffee break. There isn't enough time to do everything I'm supposed to do in my working day so I end up staying late. Last night I left at 8pm when I'm supposed to finish at 5pm. That's nothing too unusual. The hospital managers recently thrust diary cards in our direction to check how many hours we were working. Don't be fooled - this isn't so that they can accurately assess the size of the problem of too-much-work-too-few-people before doing something about it. Oh no. Diary cards exist only to make sure that they are not paying us a penny more than they have to by law. The idea is that we record what hours we work each day and what we were doing and then they pay us a intensity supplement if the job necessitates a lot of out-of-hours work. Except that's not quite how it works. The problem is that everyone works so terribly hard that those cunning foxes in management have had to devise some wily tricks to ensure that people feel obliged to minimise the extent of their voluntary overtime. Take the last set of cards I filled in; they carried the following in bold at the bottom:
"Please note: only the hours that you are required to work should be recorded. If you are consistently required to work out of sheduled hours this must be raised with your consultant and a solution put in place prior to completing these cards. If you stay behind later or arrive earlier than you are scheduled to, this is a voluntary choice and should not be recorded."
Riiiight. So I get what you're saying here. I stay behind at work because I love it so much that I just can't bare for it to end and, besides, I've got absolutely nothing better to do with my time because I have no existence outside of the hospital. Of course, it has nothing to do with the fact that there isn't enough time for one person to do all the work required to look after the patients properly. No, nothing at all. Absolutely nothing to do with that fact that I know very well that if I didn't stay behind then Mrs Smith wouldn't have her CT because nobody would have discussed and ordered it; Mrs Jones wouldn't get any antibiotics because nobody would have wrote them up and put the cannula in; and poor Mr Kent might die because the even-more-ridiculously-outnumbered hospital at night staff wouldn't have got round to considering his lack of urine till the wee hours of the morning. Nope, it's all for the thrill of the medicine that I'm here till late.
My arse.
Essentially the statement above ensures that the only acceptable way to fill in the diary card would have been to copy out my rota verbatim. That way the hospital managers can claim to be reducing hours while doctors work late into the evening on a supposedly voluntary basis. If anybody dares to suggest that they simply couldn't leave or the work would never get done, they are told they should hand over what they cannot do in the day to the night team. Yet, the night team is a pitiful skeleton crew and no decent human being with a conscience would be able to walk out the hospital having left it to those wretched souls to sort out all the left-over shit. If everybody were to do so, the entire system would simply buckle and collapse. But then perhaps that's what it needs. Perhaps we ought to do exactly what they say and hand whatever we can't reasonably fit into our working day over to the night team. Then, maybe once a few people had died because the night staff couldn't cope, something might actually be done to remedy the situation.
The fact is, though, that I know we never will; and what's more horrible still is that They know that too. It's hard to leave innocent people to suffer the consequences of poor policy and, on the whole, doctors are a kindly bunch. And so I'll continue to start early and stay late. And I'll continue to be fatigued. Chronically fatigued. Except, unlike those whinge-bags with the syndrome, nobody will ever give me a nice medical diagnosis and put me out to pasture, where I swear I'd be ever so happy just to chew the grass all day long.
Is this surprising? Well, not really I suppose. My job is busy, busy, busy. I haven't had any lunch for the past three days, let alone a coffee break. There isn't enough time to do everything I'm supposed to do in my working day so I end up staying late. Last night I left at 8pm when I'm supposed to finish at 5pm. That's nothing too unusual. The hospital managers recently thrust diary cards in our direction to check how many hours we were working. Don't be fooled - this isn't so that they can accurately assess the size of the problem of too-much-work-too-few-people before doing something about it. Oh no. Diary cards exist only to make sure that they are not paying us a penny more than they have to by law. The idea is that we record what hours we work each day and what we were doing and then they pay us a intensity supplement if the job necessitates a lot of out-of-hours work. Except that's not quite how it works. The problem is that everyone works so terribly hard that those cunning foxes in management have had to devise some wily tricks to ensure that people feel obliged to minimise the extent of their voluntary overtime. Take the last set of cards I filled in; they carried the following in bold at the bottom:
"Please note: only the hours that you are required to work should be recorded. If you are consistently required to work out of sheduled hours this must be raised with your consultant and a solution put in place prior to completing these cards. If you stay behind later or arrive earlier than you are scheduled to, this is a voluntary choice and should not be recorded."
Riiiight. So I get what you're saying here. I stay behind at work because I love it so much that I just can't bare for it to end and, besides, I've got absolutely nothing better to do with my time because I have no existence outside of the hospital. Of course, it has nothing to do with the fact that there isn't enough time for one person to do all the work required to look after the patients properly. No, nothing at all. Absolutely nothing to do with that fact that I know very well that if I didn't stay behind then Mrs Smith wouldn't have her CT because nobody would have discussed and ordered it; Mrs Jones wouldn't get any antibiotics because nobody would have wrote them up and put the cannula in; and poor Mr Kent might die because the even-more-ridiculously-outnumbered hospital at night staff wouldn't have got round to considering his lack of urine till the wee hours of the morning. Nope, it's all for the thrill of the medicine that I'm here till late.
My arse.
Essentially the statement above ensures that the only acceptable way to fill in the diary card would have been to copy out my rota verbatim. That way the hospital managers can claim to be reducing hours while doctors work late into the evening on a supposedly voluntary basis. If anybody dares to suggest that they simply couldn't leave or the work would never get done, they are told they should hand over what they cannot do in the day to the night team. Yet, the night team is a pitiful skeleton crew and no decent human being with a conscience would be able to walk out the hospital having left it to those wretched souls to sort out all the left-over shit. If everybody were to do so, the entire system would simply buckle and collapse. But then perhaps that's what it needs. Perhaps we ought to do exactly what they say and hand whatever we can't reasonably fit into our working day over to the night team. Then, maybe once a few people had died because the night staff couldn't cope, something might actually be done to remedy the situation.
The fact is, though, that I know we never will; and what's more horrible still is that They know that too. It's hard to leave innocent people to suffer the consequences of poor policy and, on the whole, doctors are a kindly bunch. And so I'll continue to start early and stay late. And I'll continue to be fatigued. Chronically fatigued. Except, unlike those whinge-bags with the syndrome, nobody will ever give me a nice medical diagnosis and put me out to pasture, where I swear I'd be ever so happy just to chew the grass all day long.
posted by The Venial Sinner at 6:34 pm
8 Comments:
That's outrageous! I mean, everyone knows of course that diary cards are an utterly pointless exercise - those that don't fit in with what management wants to see are frequently 'lost' or declared invalid, but I had no idea that they were being so blatant about it. Voluntary indeed. F***ers. Have you considered forwarding a copy of the diary card to the RCP/Deanery? Surely that statement is too blatant even for them to stomach?
Sadly I was too busy to forward anything anywhere. Besides, they'd worked in the perfect get out clause - that I was suppose to tell my consultant that it just wasn't on, my having too much work to do. Then with a wave of his magic wand, he'd make it all go away and everything would be hunky-dory.
I've said it before and I'll say it again: my arse!
Sadly this situation is far from uncommon. I have consistently filled out my diary card forms truthfully and accurately. When I have not had the opportunity to take 'natural breaks', I say so. Unfortunately, I have been reprimanded by both consultant supervisors (who are blamed for 'making me stay beyond my hours') and administrative staff. I have been accused of 'being inefficient', 'trying to get paid more' and told 'that maybe, in that case, hospital medicine was not for me' (by a medical staffing secretary, no less). My response is always the same. I stay because I care. Much like the venial sinner, I could not go home at 5.30pm on a friday without being sure that my patients, who would now not see another doctor UNTIL MONDAY MORNING (crash calls aside), were stable and were being treated appropriately. I care about my patients. I have NEVER asked to be paid more. I would love to be paid less - in an ideal world this would mean that I started at on time and went home on time. Sadly, the advent of 'Hospital at Night' has meant fewer doctors on at night/weekends and, as such, an extra burden on the staff not on call to stay beyond their hours. I, for one, cannot wait for the system to implode on itself. Maybe that's what it's going to take for trusts to employ an adequate number of staff at all times. Maybe then we'd be able to employ all our graduates when they qualify.
I agree with almost everything you say. Almost everything except the "I would love to get paid less" bit. I might care, but I'm not a charity.
Makes you sick, doesn't it? When I was a surgical house officer, I think I was working an 80 or 90 hour week (whilst, of course, being told I didn't know I was born by all others doctors who had had to suffer the 1637 hour weeks of old). Our consultant would phone us at 5pm to tell us to go home; we would of course explain that that wasn't entirely feasile if he wanted his patients to be alive the following day, to which he'd snap that that was what the on-call house officers were for. Well, they're not really. They're too busy running round sticking in venflons and all that crap to do my job for me because I want to comply with the EWTD. He'd then snap "well, you'd better not report me to the fucking deanery!"
Helpful.
I do love surgeons: such caring souls.
What about the BMA? They should be able to take this up - even after the event it's worth passing it to them, since it may well be a standard paragraph on all the hospital's diary cards.
The problem is I don't have it anymore. To lazy at the time to do anything about it. 'Tis very bad, I know.
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