Junior doctors will walk away from our dumbed-down medical regime

AS a consultant psychiatrist in the HSE, I wish to express my dismay at the severely unjust financial treatment proposed in relation to my non-consultant hospital doctor (NCHD) colleagues.

I was, until recent years, an NCHD and I can testify to the tremendous efforts made by this body of doctors to keep an ailing system from complete collapse. Junior doctors are the backbone of the health service.

That is our fault, or should I say the fault of those in command of the service in recent decades.

We have relied entirely on their goodwill and willingness to train outside their normal working hours, many of which are in the range of 70-100 hours per week.

Having worked and trained for long periods in the Britain, I was proud to see the high standards brought to the medical profession there by my Irish colleagues. Our standards of clinical practice are second to none.

This is to a large degree because of the spirit of vocationalism that pervades the Irish medical training system. But medicine in the 21st century is not just a vocation. It is also a job, plain and simple. As such, it should attract the basic rights and privileges that accrue to any person in employment. Meal breaks are not a privilege, although I must admit they are a most movable feast and there is currently no protected time for them, nor has there ever been in my experience.

Needless to say, lunch is often missed and I have the stomach ulcer to prove it. Imposing an unpaid lunch hour on those who rarely get a paid lunch hour is simply unjust. Why should doctors be left unpaid while they avail of something that every other worker takes for granted?

Doctors’ overtime payments are the result of the chronic failure of the health services to employ sufficient of them to staff a working week compliant with the European working time directive. NCHDs should not have to pay for the lack of planning of their management colleagues.

Training grants are provided to doctors to encourage them to seek higher qualifications by paying for university and other courses which they could not otherwise attend.

One of the most senior of my NCHD colleagues recently told me the retraction of the training grant would mean she had to discontinue her higher degree, which would have been of service to Irish patients. This is a disgrace.

We are dumbing down the profession and I can assure you Irish doctors will leave in their droves for foreign shores in the knowledge they will work less hours for full pay, even while they are eating, and that their further studies will be supported by the governments of Britain, Australia, New Zealand, Canada and the US where their high standard of basic training is appreciated.

The decision to refuse to pay doctors who attend in-house teaching, where they see the presentation by their colleagues of the less usual conditions, will result in their not recognising these conditions when they do occur.

I know this because I witnessed the slide into ignorance of doctors trained in the NHS whose working week and lack of on-call exposure to the more unusual psychopathology left them blind to the more unusual cases they met.

Making doctors cross-cover, which means making them cover for the specialities in which they are not working, is dangerous. It will inevitably lead to mortalities. Some years ago I worked a 118-hour week for six consecutive weeks. I have no memory of the experience other than that it was soul-destroying as a result of sheer exhaustion.

I remember saying at that time, in the bad old days, I would not stand idly by in future when my junior colleagues were treated as medical automatons and the patients as the victims of bad medical practice.

The profession must stand by the junior doctors at this time. The Irish people — potential patients all — must stand by the vulnerable young doctors if they want quality of clinical service in the future.

The proposed cuts are the death by a thousand cuts of medical training in Ireland. Do we want to be forced to import labour after the brain-drain? Do we want to be treated by these doctors who cannot hold a candle to our own graduates? The answer is simple and echoes throughout the land. Believe me, I’ve heard the patients.

Dr Seán Ó Domhnaill

PRO

Med Support Ireland

Sallins

Co Kildare