“NHS junior doctors have little time to eat or sleep.” Said the headline of an article from the Herald in Edinburgh, Scotland. It described a NHS (National Health Service) manual—no longer posted on the Internet—advising trainees to “be prepared for dehydration and hunger” and to keep water and a food bar handy because they would rarely have a chance to eat.

A man whose daughter, a junior doctor, was killed in an auto accident on her way home from the hospital blamed it on the fact that she had worked a long shift. For the record, she had worked a 12-hour shift overnight.

Of junior doctors, he said, “They are under intense pressure, they are working excessive hours, they are getting no respite.”

I tweeted the link to the story with a question wondering how it could be that conditions are so bad in the UK. After all, I thought the European Working Time Directive (EWTD) stated that trainees in the European Union could only work 48 hours per week.

A flood of tweets in response soon explained the true situation to me. I was amazed, and you will be too.

It seems that the so-called 48-hour work week is a sham. Trainees can work only 48 hours per week, but it’s averaged over 6 months—6 months!

What hospitals apparently do is work the junior docs like dogs and then give them a week off so that the average per week is only 48 hours.

Here are quotes from some of the UK physicians:

That’s the key; as long as they give you a week off and the average is ok, all bets off.

What the working rules are & what occurs (& are paid for) are 2 very different things.

In my case, was asked to do the 36 hr shift by hospital manager and consultant.

Upcoming survey results from Association of Surgeons in Training show majority [of trainees] come in on their time off.

Shorter shifts with no more doctors means more shifts. Gaps in rotations mean longer shifts

It’s not much different to how it was before, just lower pay now!

The Herald piece also said that a survey of 4913 junior doctors in Scotland … “found almost 20% were short of sleep because of their shift patterns and more than half worked beyond their rostered hours daily or weekly [emphasis mine]. Some 40% described the intensity of work as heavy or very heavy.” In an editorial, the Herald said, “In practice, the [EWTD] directive is being broken every day in hospitals across the country.”

The understatement of the millennium was made by the chairman of the Scottish Junior Doctors Committee, who said, “Although all the rotas [rotations] are compliant with the European Working Time Directive they are not necessarily in the spirit of what the law intended.”

He also said that junior doctors could be scheduled to work up to 12 days in a row without breaks and confirmed that they sometimes “struggle” to find time to eat.

Some of those who responded to my tweet said they would much rather work a scheduled 24 hours in a row than the life-disrupting shift work that the “48-hour” week has resulted in.

What is my point?

We have all been led to believe that all is well with the 48-hour work week in Europe, which is clearly not so.

And let’s just keep ratcheting down the hours here in the US so we can achieve the same nirvana enjoyed by the trainees over there.

As always, I welcome your comments.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 9600 followers on Twitter.