Are working hours more frightening than swine flu?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2009)

As I write, swine flu is frightening the world and feeding the media, accompanied by a set of questions that have become routine in times of pandemic crisis. Is there a cover-up by hospital authorities (this time in Mexico)? Should we halt international flights (this time to and from North America)? Do we have sufficient stock of antivirals to save society from collapse (yes, we do apparently)? Will I get swine flu if I eat pork scratchings? And how the hell do I diagnose it in the first place, considering that the clinical presentation appears to be indistinguishable from non-swine flu?

The last question acquired a sense of urgency in my mind when I heard a government adviser suggest on BBC Radio 4's Today programme that anybody with swine flu should stay at home. No doubt, clinicians will be helped in their decision-making by the inevitable rush of cases of swine flu published in major medical journals. My money is on The Lancet to lead with breakthroughs on diagnosis and treatment, while the Department of Health and the World Health Organization will be either caught off guard, confused, alarmed or paralysed – possibly all at once.

It is an official response that many clinicians are familiar with. Take the European Working Time Directive for example. ‘It is a mystery to me,’ fumes Mark Aitken, ‘why the medical profession, which made the decisions about patient care before the NHS, now appears to be content to be frogmarched by the Department of Health and its sycophants down the road to perdition.’

Leaders of medical Royal Colleges and trade unions have repeatedly voiced concern. But individual clinicians, and Mark Aitken's editorial in this issue is typical, believe that the level of dissent is insufficient and are furious at the introduction of a policy that is out of step with the culture of clinical practice in the UK (JRSM 2009;102:168–9). Indeed, what's the evidence that the policy will improve patient care? Yes, doctors will generally be less tired – and nobody should wish for a return to the sleepless three-day weekend shifts that I experienced myself – but hasn't the pendulum swung too far? Aren't the warnings about inadequate training opportunities and lack of continuity of care serious enough for us to be concerned about patient care?

A recent ‘confidential’ survey by the Department of Health revealed that 80% of doctors believe that patient safety will be jeopardized. Medical directors believe that the working time directive cannot be safely implemented in the specialties of medicine, surgery, paediatrics, intensive care, critical care and emergency care. The Royal College of Surgeons is predicting fatalities. The College of Emergency Medicine believes some emergency units will have to close temporarily. Meanwhile, the Department of Health is focused on compliance with the directive.

Swine flu makes great headlines. It carries the excitement of a global crisis, an unknown threat, heroic treatments or death from pigs. Working hours are dull, intangible and are meant to make us more civilized than pigs. They don't make much of a scare story for the public but they have become a grave concern for doctors.