UNDERPAID AND OVERWORKED, THEY'RE LOSING PATIENCE

DEBORAH CULHANE TALKS TO SOME WEARY YOUNG HOSPITAL STAFF.

Doctor Ian Bell has come off duty at Cork University Hospital. He has just finished a 132 hour week. This week was easier one than usual the young doctor says. Normally he would work 138 hours straight and finish at 5pm on a Monday. However, Ian like all junior doctors was only paid for 65 hours only because this is their contract.

"Some weeks you work exactly 65 hours," says Ian. "But these are rare - more often it is 110 hours, at least. For those in surgery it is worse. They start at 7.30 in the morning."

Long hours and low pay are a fact of life for junior doctors. Dr. Bell completed six years of study last year and has worked as an intern at CUH for 10 months. "You get used to it," he says. "Besides, after six years of having no money at college, a pay cheque is a welcome sight."

At the Accidents and Emergency Department, however, an overwhelming majority of people are supportive of the doctors' strike. At the same time, they have fears about how it will affect them. Apart from the long wait, patients and visitors alike cannot find fault with the quality of service delivered. Vincent Byrne of Bishopstown Cork is visiting his mother in hospital. He is fully supportive of the junior doctors' plight. "Doctors are grossly overworked. I work for myself - If I work 12 hour days I reap the rewards. There are no extra bonuses if you are state employed. It is morally wrong for doctors to strike but, practically speaking, they have no alternative.

"The old and the young will suffer. Patients will be forced to have a shorter stay in hospital. This will put an added burden on the community and there are not enough resources for the community to cope," he says. "It's a sad reflection on the government."

Mary, a patient at Accident and Emergency, is emphatic in her support for the doctors. "Doctors are worked to the ground. Yes, I have fears for my own health. Nobody ever knows when he or she is going to be in hospital, but doctors deserve something as well."

Andrew Murray, a visitor the hospital says he too backs the junior doctors' strike 110% if it brings about improvements for the well-being of the patients in the long term. "No other industry works these hours - it's illegal. It's against the Health and Safety Act. If it were bin men who had this problem, it would be sorted out by now."

One patient is attending Accident and Emergency because she has wrenched her back. She feels it would be "against the doctors ethical oath to go on strike". While accepting that doctors are hard done by and have a genuine grievance, she is convinced that they should not strike. Another patient, Patrick Kenny, says that often it is the same doctor that sees him over a 48 hour period. "They just seem to keep going. I often see the same doctor two days in a row. They just seem to accept it."

Susan from Mitchelstown, Co. Cork, is visitng Accident and Emergency with her daughter. Susan's involvement in a car accident two years ago meant she had to undergo surgery where bone was taken from her hip and put in her back. She attends monthly check-ups at St Vincent's Dublin, Outpatients Clinic and fears a strike will delay her visits and create longer waiting lists.

"Doctors seem overworked," she acknowledges," but ultimately it's the government's resposibility."

"Fundamental questions need to be asked," says Mark Smyth, a visitor to the hospital.

"W need to ask ourselves what are our values? Public services have been neglected for a long time. Investment is badly needed. Problems could be tackled now that the country is economically viable. There is no debate about this."

A quality health service depends on the resources available. In comparison to other countries, such as France or England, equipment and resources are appalling.

Dr. Bell outlines the mounting pressures of an increased workload. "If there are 60 patients in Accident and Emergency, then the quality of service provided will obviously be less than if there were 10.

"Technically speaking, you could walk out after 65 hours of work. But it's not done. I have a list of things to do when I come in and if these are not done when I leave, they simply will not leave. Patients would suffer. I cannot pass them on to the next person who comes on because they have their own responsibilities as well. It's just not practised. It would be disrespectful to colleagues."

Cover is frequently unavailable, particularly for doctors who are on sick leave. Management say they cannot find a locum - a deputy acting for a doctor - and frequently approach staff to do the cover.

"We have to fill in the gaps," says the junior doctor. Available manpower may be an issue. Irish doctors are leaving this country for better working conditions elsewhere. Foreign doctors are required to sit an entrance exam to work in Ireland.

"This way quality care is ensured," says Dr. Bell. "This exam is not a pre-requisite in other countries, and foreign doctors frequently go to England instead.

"The hierarchy which exists in hospitals is worldwide; it's the rate of pay which varies. In Australia, junior doctors only work an 80-hour fortnight, at double the pay we receive." But they had to walk out en masse, in order to get the contractual clauses changed.

"Eight hours sleep is a good night's sleep but it is rare. Some nights it is 40 minutes," says Dr. Bell. Litigation is also a fear, particularly in Ireland which has the highest litigation rate in the world. One such case could destroy his career.

"Hospital insurance covers doctors, but at the end of the day you just don't know. The lack of sleep takes it's toll. It takes much longer to think. The simple things like putting up an IV take much longer."

Protected learning time is also a bone of contention for doctors. Medicine is constantly changing. New techniques are always coming to the fore.

"Doctors need to learn these techniques in order to give the best possible service," he says. Committed learning time is rare. The bleep must be answered at a lecture or a seminar.

"Extra study must be done in your time, be it reading medical journals, studying or speciality medicine exams. Even then you have to fight with management to make sure you have a week off for study.

"Hospital management have been aware of this situation for almost 20 years. The Southern Health Board, the HSEA-Health Services Employers Agency and the Government need to address these problems. The only way we can get management to sit up is if we demand double pay for overtime. Then management will have to hire more staff because the hospital budget will not be able to pay doctors double pay when they could hire others at single time."

It is ultimately in the patients' best interests. "Better for a patient coming in at 4am into Accident and Emergency to be met by a doctor who has been on for 10 hours than one who has been on for 20," he says.

But what services will there be in stike? " At the end of the day the sick will be looked after. Cover will be provided. I can't say who will go off - that hasn't been decided. Outpatients and waiting lists could be set back almost a year."

Dr. Bell mentions that the nurses have been very supportive throughout this time. "During the nurses' strike, we could carry out some of their tasks, like giving antibiotics. However they are not legally covered to do some of our jobs. Doctors do not want to let patients suffer. Management knows this and can use this as emotional blackmail."

The turnover of staff gives management a stronger position when resisting change. A contract for a junior doctor is normally six months. That means it's easy for management to put change on the long finger.

Despite the current difficulties, it is obvious that Dr. Bell still enjoys his work.

"I love the buzz; the responsibilities it entails, the support you give to patients and families, as well as the medicine itself. But I also want a decent quality of life."

Social life is limited as it means getting even less sleep. Long hours mean doctors rarely get to see their children. Still at the start of his carees, one can't help but wonder how long Dr. Bell will last. The EU has placed a cap on the working week for all professions except doctors. The 65-hour plus week still stands for junior doctors. The four year directive proposed by the government is too far away.

"I cannot wait that long. I will be dead," he jests. "The momentum is there. Action needs to be taken now."