The Royal College of Physicians lead on the European Working Time Directive has warned that junior doctors will miss out on training opportunities and patients will lose continuity of care as a result of change to the 48-hour week in 2009.
| One less day in hospital every week means it will be virtually impossible for a junior doctor to watch (and learn about) the progress of an illness|
| Professor Roy Pounder |
In an article in Clinical Medicine, Professor Roy Pounder expresses his concerns, saying that the shift from a 56-hour week to a 48-hour week on 1 August 2009 will have serious implications for everyone. He makes the point that, as the majority of junior doctors’ working time takes place during the day from Monday to Friday, this will be when most savings in hours will have to be made and this is also the time when most training is done. He says:
"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch (and learn about) the progress of an illness. This is not just a vital educational experience but it may also be lifesaving for the patient".
Professor Pounder also stresses that patients will be more likely to see more doctors than previously, losing continuity of care.
Hospital managers are also likely to be affected, with the resulting longer inpatient stays having a negative effect on finances. In addition, this effect will not be compensated for with savings on junior doctors’ pay.
Professor Pounder cites as an example an English hospital that switched over to 48 hours for the junior doctors working in its acute unit in 2007. He says:
"Not only was continuity of care a problem, there was an even bigger breakdown – there were not enough doctors left to get the clinical jobs done during the daytime. Fewer investigations were ordered, less patients examined, poorer continuity notes written, fewer relatives seen, and slower discharge drugs or letter".
It appears that most of Europe is struggling with this legislation, and that many are flouting it. Professor Pounder suggests that one solution might be to recruit more junior doctors and consultants, and advises all doctors to inspect the solutions put forward by their trust, and also the rotas for junior doctors from 2009