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Last Updated: Saturday, 31 July, 2004, 23:33 GMT 00:33 UK
New era dawns for junior doctors
By Melissa Jackson
BBC News Online health staff

Jo Hilborne
Jo Hilborne remembers the bad old days

Senior registrar Jo Hilborne still remembers the bad old days of 100-hour weeks.

Things have come a long way since Dr Hilborne started her training in the 80s, she says.

Now she hopes a new EU directive, introduced on Sunday, will improve things further.

Dr Hilborne, a specialist at the Singleton Hospital in Swansea, said: "The changes have made a huge difference and have greatly reduced junior doctors' working hours.

"However, although their hours are shorter, the way they are distributed over the month, means it is more disruptive to life.

"You end up doing more 'bits of weekends'."

I had a feeling of dread when on-call weekends were approaching
Jo Hilborne, specialist registrar

Doctors used to be rota-ed on over whole weekends, but under the new system they must have a break of 11 hours between shifts, which could lead to disjointed weekend working patterns.

Dr Hilborne said: "Things are getting better, but there is still a lot of work to be done and progress to be made.

"The big concern is the effect it will have on training.

"If junior doctors are present in hospitals for less hours during the day, they are spending less time training and learning.

"I think it is important that reducing hours is done with an eye to the knock-on effects of exposure to training.

"Most junior doctors' goal is to become a consultant and you need as much training as possible to achieve this.

"You are junior doctor in training until you get your certificate to say you are a GP or a consultant."

Weekend blues

Dr Hilborne is three-and-a-half years away from becoming a consultant.

She started out as a junior doctor in the late 80s, but had a four-year break in the 90s when as she says, the working hours and the intensity of the job "finished her off".

She really was a victim of the old regime.

Her first house job was at Newcastle General Hospital in 1988 in general surgery.

She said: "My contracted hours were 92 a week, but I worked more than that.

"I was probably doing about 100 hours a week.

"It was horrendous. I can remember how awful I would feel on the Monday morning after a weekend on-call.

"You just didn't get any rest while on-call and we were on call two weekends out of every month.

"I had a feeling of dread when on-call weekends were approaching.

Things are getting better, but there is still a lot of work to be done and progress to be made
Jo Hilborne, specialist registrar
"I would have a weekend off and go back to work on the Monday morning, knowing I would be on-call the following weekend and it would just loom up on me from that Monday morning.

"Being on-call was like a prospective exam, but doing it twice a month.

"You got through it on camaraderie and the knowledge that it would not go on forever.

"Everyone else was doing the same thing and it was a case of togetherness in adversity.

"I remember spraining my ankle while I was doing that job and I am sure it was because I was so tired.

"I'm not aware of any grave errors I made at the time, but there must have been."

Dr Hilborne got married while she was a medical student. Her husband works in IT and he was also putting in long hours, which had a knock-on effect on their lifestyle.

She said: "We would both get home at about 6.30 in the evening and slump down and neither of us could be bothered to cook and we at out all the time."

She and her colleagues worked and played hard.

She said: "When you're working so hard, you have to do something when you stop, something very intense to counter-balance it.

"We regularly went out in the evening for something to eat, then off to the pub and then we'd go to a nightclub."

Resignation

After six months in this post she moved to a medical house job.

The hours were slightly better, but even though there was less weekend cover, the doctors were busier, which meant less sleep time.

She spent a further six months as a senior house officer in A&E and then moved to general surgery, during which time she went on maternity leave with her first child.

She was 26, pregnant and working long hours.

She said: "I didn't change my hours while I was pregnant, it didn't cross my mind, I just got on with it.

Junior doctors
Junior doctors are getting a better deal
She was back at work 18 weeks after having her baby boy, working in obstetrics and gynaecology, working days, nights and weekends.

She was regularly given the task of stitching patients after childbirth.

She said: "I was shattered and angry that I was having to do this and angry for the patients that I was doing this when I wasn't really in a fit state..

"I thought there was a high risk that I wasn't doing a good job."

She lasted three months before resigning.

The hours were so long that she was often only spending about 10 hours with her baby over a two-week period.

"It finished me off, it was so intense," she said.

It was four years before she returned to medicine, but not without considering other careers.

She now works part-time, 34 hours a week (including on-call work) in obstetrics and gynaecology.

She said: "Working part-time has kept me in the NHS workforce. If I'd had to go back full-time, to those hours I'd worked before, I would have left."




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