Junior doctors are the workhorses – the backbone – of hospitals | The Secret Health Boss

In terms of running an acute hospital, junior doctors being on strike is much more serious – much more impactful – than the recent strikes by ambulance workers. On an ambulance strike day, if someone could get themselves to hospital there was a fully functioning emergency department, with fully functioning specialist medicine departments behind it able to provide the right care. But this time, although hospitals will be open, they’ll be running in a very different way to normal.

That’s because junior doctors are so vital to hospitals functioning properly. They are integral to the basic medical management of the medical services they work in. I think people misunderstand how important “junior” doctors are and also how skilled they are. They’re not just fresh out of medical school. They are often doctors with 10 years’ experience or more.

If you’re a relative in a hospital asking: “Can I speak to a doctor?”, the person you speak to will almost always be a junior doctor. If a patient needs tests ordering and chasing down, that’ll be a junior doctor. If someone needs medicines ordering, it’ll be via a junior doctor. If they need a referral to another speciality, such as cardiology, that’ll happen via a junior doctor. And if a patient deteriorates, especially at night, the person reviewing them will be a junior doctor.

Junior doctors are the workhorses – the backbone – of hospitals. There are 168 hours in a week. A consultant tends to be in the hospital for about 40 of them. But for the rest of those hours, it’s junior doctors who are running the show. But we won’t have them for the next three days. That will put hospitals under huge pressure because even with senior decision-makers still available – consultants – you won’t have the masses of rank-and-file medics who really do the hard work in terms of making the hospital run.

The strike does obviously pose some risks. We’ve had to cancel over 1,000 outpatient appointments and hundreds of surgical procedures. They’ll have to be rebooked.

But what worries me most is that there’ll be fewer medical rounds on the wards than usual and that one or two consultants will have a lot of beds to look after, and may also have to keep an eye on people in A&E, and so may not be able to see every patient every day the way we expect these days. Therefore patients whose health is deteriorating could get missed.

Patients could go days without being seen by medics, because doctors are concentrating on monitoring the sickest patients. So there’s the potential for slow, under-the-radar harm to patients to occur that is harder to spot.

I also worry that, with so many fewer doctors available, it might mean patients end up waiting longer in A&E because, for example, their tests and scans – usually ordered by a junior doctor – have taken longer to organise. And it could well mean that it takes longer to discharge patients or even that some patients are discharged but without the right medication or information for their GP.

I’m more worried about this strike than the ones by nurses and ambulance staff. I would rather it was for 24 or 48 hours, not 72. A three-day strike is about 10 times as hard to deal with as a one-day one. That’s because it will take a hospital like mine two weeks to recover – for example, by getting back in sync the rotas for consultants who have done extra and extra-long shifts this week, including overnights, covering for juniors.

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But do I think the strike is to any degree irresponsible? No, I fully support them striking. Junior doctors should be paid more because they do bloody hard jobs and do it under a lot of stress and pressure. They’re making a point. I do want to see the government pay them more.

As told to Denis Campbell

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