Emily Shine, second year resident doctor at North Shore Hospital, specialises in obstetrics and gynecology. Dr Shobna Singh works 12 days in a row with a two-day break in between, and spends her days and nights treating patients for up to 14 hours a day at Auckland's North Shore Hospital. The 26-year-old resident doctor is one of hundreds who will go on strike across the country next week because they believe their workloads endanger their patients. The New Zealand Resident Doctors' Association has been pushing for District Health Boards to cut the maximum number of days worked in a row from 12 to 10, and for the number of consecutive night shifts to be reduced from seven to four. "At this point I feel delirious," she said at the end of a 14 hour shift, on day 11 of a 12 day stint. "Those two days off recharge you enough to keep plodding, barely, but that's not enough to be a great or even decent doctor. Right now I'm pretty apathetic," she said. Singh said she had to re-prescribe doses "probably three times" regularly, and once, she became sick enough on duty to require a drip herself - but not stop work. "I was in ED at 4am with the drip in one hand and my phone in other, sending directions to back to my ward," she said. "We're so dependant on pharmacists as a safety net for the mis-prescriptions - but if something had gone seriously wrong when I was sick in ED, I could not have dealt with it properly." NZRDA secretary Deborah Powell described the current rosters as "archaic and out of touch with the realities of the current health system". She said that medical advances meant that expectations of doctors' performance had soared since the rosters were introduced - and doctors' workload needed to reflect that. "Back in the day we didn't have the drugs or capacity to deal with emergencies every minute of every day. But we do now and it's just expected," she said. Four years worth of negotiations with District Health Boards over roster terms reached stalemate in September; in that time only Gisborne DHB switched to the shift-load the union rallied for. Doctors who work 12 consecutive shifts get up to two subsequent paid recovery days under the current contract, if their final shift falls mid-week. The DHBs want this condition wiped from any new contract with 10 days as the consecutive maximum; the NZRDA do not, and therefore called the strike. DHB spokesman Mick Prior said that DHBs were not against the reduction in workload per se. "The main sticking point is that we would not be willing to keep paying the doctors for the weekdays off they would get under reformed rosters," he said. Other DHBs have made varying commitments to reduce resident doctors' workloads, but Patterson said "commitments aren't enough and we need a contract for a collective employment agreement" across all DHBs. Second year resident doctor Emily Shine, 25, said that doctors did build up stamina for the long days - "but doing them again and again is what wears you out". "The way you interact with patients changes, and you miss things like dropped blood pressure or allergies. They affect what dosage you prescribe and you just don't notice these things when you're tired." Critics of the resident doctors have claimed that their generous pay packets make up for their hours; a second year resident doctor could earn up to $111,028 annually, working 65 hours per week. Powell said that perspective "misses the point entirely" because the doctors would get paid less if they worked less hours - "which is what the NZRDA is calling for". Resident doctors get paid a flat rate determined by the amount of hours they work. A second year house doctor earns around $28 per hour. If that doctor worked between 40 and 45 hours a week they would earn $60,561 per year. A DAY IN THE LIFE OF A JUNIOR DOCTOR Dr Emily Shine, 25, second year resident doctor at North Shore Hospital. Fourteen hour shift - 8am until 10pm on the obstetrics and gynecology ward. 7:30am: Emily arrives at the North Shore Hospital with wet hair after a hurried shower, porridge, and commute from her Ponsonby flat. Before her shift starts at 8am, she has a lesson to attend about postpartum hemorrhages. She said she felt active and empathetic. 9am: Coffee in hand, Emily declared handover on the ob/gyn ward complete, with staff fully updated on the women in the ward. They knew a small mother was expecting a whopper baby (who may need a c-section), which patient had which STI, and who on the team would break the news of ovarian cancer to a woman. Emily was assigned to look after new arrivals. 11:30am: The morning brought a slew of cervical abnormalities and a woman in cervical shock, bleeding from her uterus, with "a heart rate just 44 beats per minute when it should have been 80". Emily beamed as she explained how satisfying it was to be able to "solve and explain" problems for a worried patient, putting their minds at ease. 2pm: Emily had sent patients with suspected uterine holes off for ultrasounds and assessed an ectopic pregnancy that would require an abortion to save the mother's life. She said that adrenaline rushes were helping her "dipping" energy levels. "The thing about this job is that it's physically, mentally, emotionally, and socially draining every day and I don't always feel recharged," she said. "But then you get these adrenaline rushes from helping someone desperate, and they keep you going." She said she was starving by now and off to the staff cafeteria for lunch - falafel salad. 5pm: Checking in after the 4pm handover, Emily was less vibrant with eyeliner smudged under her eyes. She had been at work for 10 hours. "At this stage I'm middling tired. I don't want more people to come in, but when they do I will be nice," she said. Emily had sent patients into theatre to repair uterine holes identified by ultrasounds. She feared the ectopic pregnancy would result in the woman losing an ovary. She said that the next five hours' uncertainty was daunting and that tiredness had increased her anxiety levels. "Anxiety is really awful. It comes because you're trying a lot harder in that exhausted state, but you know you can't keep it up and you don't know how much you're missing." 7pm: Emily had perked up, having found some croissants in the RMO room - "plus there's only 3 hours left and that's a much nicer feeling," she said. But she admitted thoughts of home-time made her less feel empathetic towards patients, who might keep her in the hospital for longer. "It's bad timing, really, because after hours there are less staff on hand, responsible for more and sicker patients coming in. And this rotation sees a lot of very upset people - they'll be suffering miscarriages and pain they just don't understand." In the last two hours she had discussed contraceptives with a teen suffering an STI-caused abdominal infection, and the implications of hysterectomies, abortions, and infected vaginal tears with assorted patients. 10pm: "It got very busy in the final stretch," said Emily. There were patients with "retained products" from a miscarriage, post-op infections, and "generally lots of bleeding". The doctors went through another handover and it was Emily's time to clock off. Slumped against the hallway wall she said that she was exhausted, with a headache and sore throat. "I just want my bed. Am very pleased I don't have to pretend to be happy anymore. That certainly gets harder as the day goes on." WHAT IT'S LIKE TO SHADOW A JUNIOR DOCTOR Amanda tries out a 14-hour shift at a cafe in North Shore Shore Hospital: I started off at a cracking pace - that 7.30 to 9am slot always feels like a head start on the rest of the working world. The next six hours passed productively enough too. I conducted phone interviews from a hospital cafe, I chatted with everyone from the barista to a befuddled man thwarted by the vending machine, I wrote screeds. Then around 3pm I started to droop. Eyelids wilted, mind wandered, and I did a bit more staring out the window than keyboard bashing. I was nearing the end of my usual 8-hour shift and my body anticipated a change in environ. The sugar rush of a plum brioche and a brisk circuit of the roundabout outside was enough to trick my brain into giving me another two hours of hard yakka - definitely more menial than cerebral though, and my friendliness had burnt off. Other people's conversations annoyed me. It was at that point I felt grateful for the option to change gear. Emily, however, had to show the same bright smile, apply the same compassion, make the same life-altering decisions on behalf of people trusting her mental faculties as she did four hours ago. By 6pm I realised I was changing my Facebook profile picture instead of finishing an article. Then I was hunting the recipe of a strange pudding I'd had once in Turkey, and messaging a Czech cyclist I'd met four years ago in Albania but hadn't heard from since. It seemed important to know how he was doing. More important than writing this article. The coffee I bought to get back on track made me more jittery than focused. I'd been working 10 hours by that time, and still had four to go. Half a normal day left. Those final four hours' productivity was about a quarter of what it was in the first four. My typed text was striped with red underlinings, I made rambling phone calls, I was sluggish. Emily, meanwhile, was examining cervixes, prescribing drugs, and mopping up miscarriages and tears. By the time 10pm rolled around my eyes felt full of sand and water. I couldn't get warm, though it wasn't a cold night. And my head had become one of those weighted wobbly dolls. I fought the parking ticket machine, took a bunch of wrong turns, and spent minutes unsuccessfully turning up my car's radio volume with its tuning knob. Emily had told me that she had "nearly crashed so many times driving home after late shifts because you just get so zoned out." It was easy to believe. And not the sort of state you want your doctor in. Source
