Did anyone notice the thunderstorms and rain, and general dreariness that began on the first Wed of August and continues today?
Some may explain the meteorological reasons for this phenomenon, or put it down to the British weather. I myself blame Black Wednesday.
For those non-medics reading this article, Black Wednesday is in reference to doctor change over day. This is the day when a fresh batch of newly qualified doctors flood the hospitals and primary care, eager to test their knowledge and wits on the general population, while secretly praying to whichever deity they believe or don’t believe in, that they get through that first day OK and not kill anyone. Though now with the changing nature of the profession there are multiple change over days, the true Black Wednesday is the first Wednesday of August. The day that almost every junior doctor will start or change jobs on.
You may scoff at this, but it is a true reality. One to such a degree that some consultants will deliberately plan to be on leave on this particular day, while most trust doctors and nurses will beg and plead not to be working that fearful Wednesday night shift.
However most worrying is the effect this day has on patient care. There is evidence to suggest that health outcomes for patients are worse on this particular day (Jen et al, 2009).
Why is this allowed to happen? Simply it is down to money. To have doctors used to a job before they start it, you need to pay for it. Not just in wages, but in training, and in time. Inductions take admin and clinical staff out of the loop and these people will then need to be covered as well.
I myself went through this very same prospect. I can promise you I felt all of the above.
My first day as a doctor was spent on-call on a medical assessment ward after driving to the hospital in the rain. The ward had a regular influx of sick patients all needing to be seen and sorted into the tight bowels of the hospital. In a 8 hour shift comprising of ward rounds and a crash call, I clerked a sum total of 4 patients! A paltry number that I now find ludicrous to even contemplate to be real, but a number that on that particular day I felt pride and relief in, particular as none of my patients died, became worse or complained about me.
I was however fortunate to have been through a shadowing period before starting my first day as a ward doctor, and to be supported by some amazing colleagues, both nursing and doctor based.
And I remembered that fact 2 years later when changing from my job as a FY2 again in a medical admissions unit, I had the ‘pleasure’ of a split transfer. This meant I finished on the Wednesday morning after a night shift on the MAU, and so finished my contract with the trust, only to start a new contract with another trust that same morning. The conundrum was finishing a 12 hour night shift at 9am in one trust, only to be as I was told numerous times, contractually obligated to attend my new job at 9am in another some 20 miles away. A pleasant journey this was not I can assure you, especially yet again in the rain. What was worse, was the human resource bods repeatedly telling me that they knew my shifts and claiming I was sick or not able to turn up was not an acceptable reason for missing my induction at the new hospital, despite the obvious risk a significantly tired doctor would pose to patients and staff. I eventually had to leave after my induction, refusing to go onto the wards to see patients in the state I was in, with the thankful support of my new consultant.
My most recent experience was last year starting as a GP, and having to break new ground again, this time now working as a Locum GP in a new practice. I must admit, while refreshed and raring to go, the apprehension, and the rain was still there. Would I get to the practice on time, what would the patients be like, would I be able to refer them properly if I needed to, is my car going to get stolen (the practice was not in a great area of town to say the least), and yet again that age old nagging worry, am I going to mess up and cause some harm?
The doubt and the worry is always there, I would say it needs to be, without it, you become complacent and that is when the real trouble begins.
I know some will read this thinking, what a pansy , ‘I did 36 hour shifts back in my day’, while others will be horrified that this practice ever existed. Others may relate to these events and I hope you feel you can share them as well. In truth it is here to highlight what Black Wednesday can do to people. To highlight its pain, and its highs.
Black Wednesday is here and I cant see that it will ever leave us any time soon, but I hope it does. Until then, next August, on that first Wednesday of the month, just check and see if it is another dark and dreary day in the middle of summer.
Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS One 2009;4:e7103