Going forward, looking back

Dr Anthony O'Connor | 17 Jan 2013 | 111 Comment(s)

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Suicide has been making headlines in recent weeks, but when we all move on to the next issue, the factors that contribute to the deaths of so many people persist, writes Dr Anthony O’Connor

In the last year, two doctors that I taught as undergraduates and subsequently worked with have died by suicide.

The story was picked up by the Sunday Independent newspaper on Sunday, 9 December. The hospital where the doctors had worked had organised memorial services and counselling for the friends and colleagues of the deceased, who the newspaper told us were medical and surgical senior house officers.

The hospital then sent those same colleagues back to work the 32- and 56-hour shifts that their fallen comrades had done at the coalface.

Business as usual.

The Sunday Independent carried another story about junior doctors the following week. Under the banner of “€266 million top-ups are paid out to HSE staff” it described “a bonanza in pay increases, top ups, on-call and overtime payments” and that “junior doctors will share a pot of €97 million in overtime payments”.

Business as usual.

Depression and suicide are a scourge of our times. I have long held the view that there is a silent epidemic of undiagnosed, untreated depression amongst our colleagues. This disadvantages patients in a very significant manner and is catastrophic for doctors and our families.

Rheumatologist and blogger Dr Ronan Kavanagh had the courage and eloquence to pen a wonderful piece on his own experiences with ‘the black dog’, a subject Dr Garrett FitzGerald of another parish has also broached with skill and insight. Ronan’s blogpost, which should be required reading for every aspiring doctor, argues that having lost empathy with patients during his first attack, his experience with overcoming depression made him a better doctor. The challenge is to equip doctors of all ages with the skills of empathy and self-care, without needing a depressive illness as a tutor.

I knew I needed help a couple of years ago when, in spite of an overwhelming sense of sadness, I was incapable of feeling anything enough to cry while driving to work to go on-call, having been up writing a paper until 3am that morning. Luckily I never felt suicidal, but I remember that morning thinking it might be nice if I was involved in a medium-sized accident where I broke a leg or an arm to get me out of call for a few weeks. I texted my team to say I was ill and would be late and sat in the hospital car park for nearly an hour just feeling numb and unhealthy, listening to the bleep going off and ringing back from my mobile. With the help of an amazing woman, a good GP, a great counsellor (which I am extremely grateful to my employer for providing) and some medication, I slowly got through it. I have no intention of ever going back there, although I know it could happen. I do everything I can to prevent it.

What cannot be avoided in evaluating depression in young doctors is the effect of long hours, burnout, the pressures of work, exams and research, public vilification, financial worries and dismal career prospects. Some of these are unsolvable, but we owe it to those who have died to create a set of working conditions

that are more conducive to good mental health. Unfortunately, the prevailing wisdom is ‘Well, it was worse in my day’. This argument, presumably equally popular among whichever chimney sweeps survived to their twenties in the 1840s, is not good enough on any level. I suspect those who propose it would not dare whisper it to the heartbroken families of those young doctors who did not live long enough (nor would they have anyway) to patronise their juniors with such claptrap.

This problem can be ended by two institutions – health service employers and training bodies. I call upon both to immediately enact policies to limit the hours worked by junior doctors to 24 in a consecutive sitting and 60 in a week, as of today, with a view to complying with relevant legislation within five years. There will be old ráiméis from those who erroneously think themselves well-served by the current system about “quality of training” and “continuity of care” that should be loudly and consistently ignored by all right-thinking people. If hospitals can’t provide good continuity of care while rostering doctors for shifts twice in excess of all other workers, then they are incapable of providing safe care to their patients. If training bodies can’t train people adequately in 60-hour weeks over eight to 10 years, then they are unfit for purpose as educators.

The deaths of these two young physicians are no less of a tragedy than that of Savita Halappanavar. The deaths are equally complex and multifaceted, with no one individual factor or institution to blame. They are comparable also in that they raise uncomfortable questions about how we do our healthcare business in this country, and the legal, moral and ethical framework that guides it. All three deaths may have been avoidable, all will inevitably happen again, but we have a responsibility to act to make them as infrequent as humanly possible. They all deserve equal political attention and scrutiny. Regrettably, my two former students appear to have been quickly forgotten by the powers that be and the public they served for all too brief a period. May they Rest in Peace.

Business as usual.

  • Comments

  • kushal kumar | 24 Sep 2014 15:09

    I would like readers to go through my article- " Reading suicide in the birth chart of actor Robin Williams" - scheduled for publication in the Fall Issue of The Astrologer's Notebook from North Port, Florida by Joseph Polansky. The quarterly issue is likely to be in the market by the end of September this year. Applying Vedic astrology, this writer has examined the aspect of actor Robin's suspected suicide and concluded : Yes, the operative planets in the month of August this year has confirmed the accuracy of general belief that actor Robin Williams died of suicide. I hope my analysis of the birth chart of actor Robin limited to the point of suicide would be found meaningful by readers. It may be emphasised that Vedic astrology which I employ in my analysis, can help identify potential of depression and suicide and thereafter suggest easy to go remedies as complementary to usual medical treatment . Also, readers may get valuable information for controlling mental stress in my masterpiece article - " Role of meditation in stress control" - published in Issue No.209 - October 2013 of Positive Health Online Magazine by Dr. Sandra Goodman from Kent, England atwww.positivehealth.com/

  • DLane | 01 May 2013 11:05

    Great article. Could not have said it better myself.

  • richard walsh | 01 Feb 2013 01:02

    As a non-medical person who worked 365/7 shifts for 25 years I have always been amazed at the length of duties worked by some doctors. It has always been incomprehensible to me that the medical profession, of all professions, should work should long shifts. Once in the entire period I worked 24hrs straight through because exceptional circumstances meant the other 2 shifts (3 shifts per 24hrs) could not get to work; I could barely function for the last 8 hours or so and yet doctors are being asked to do this, and more, day in day out. To me it is potentially criminally irresponsible for the HSE/Hospitals to force such working conditions on staff. I appreciate the point made in striving for a max of 24hrs at present but really you should be striving for a 12hr max shift. I have looked at the HSE web site seeking information on working conditions etc. There's a all sorts of documents on Risk Assessment , Clinical Governance etc etc but nothing on hours worked. I noticed that the IMO went to HIQA on Dec. 12th, 3 days after the Sunday Independent told of the suicides of the two young doctors. So much for the IMO; if they believe doctors are being coerced into working excessive hours and that the EWTD is being illegally circumvented why are they not pursuing the issue through the relevant EU authority and or through the court system? I am aware of some of the demarcation issues within the hospitals;e.g. junior doctors having to take blood samples and deliver them for testing etc while there are eminently qualified other staff there who are not allowed do the work for what reasons? Having to fill in O/T returns for salaries and separate attendance returns for HR because "they are two different units". The administrators should be doing everything possible to minimise the demands on operational staff but it seems that in more recent times they are making even more administrative demands. I'm sure you practitioners have many more instances of such wasteful administrative demands. Perhaps there is an area in which you could begin to say no - provided you can agree what to say know to and the majority do so (see following). It is obvious that NCHD's are being coerced on an individual basis and the answer has to be unified action. The availability of the social media provides you withe an opportunity to come together and support each other more easily once you have agreed on a course of action. Getting the public on your side would be a very useful asset. That process has started in recent weeks. You now need to build on that and keep it going. I, for my par,t will start by targeting all of the TD's in my own constituency (which has a number of hospitals in it) and seeking their views and responses to the issue of the inhumane hours. After all I'm getting to the stage where I am likely to become more dependent on the medical profession and I would like them to be in a fit condition when dealing with me and remembering my own experience of shift work, excessive hours are bad for patient and doctor.

  • | 27 Jan 2013 15:01

    Great article, and also praise for Joe Duffy for giving it media time. Very little coverage in mainstream press. I have completed my NCHD shifts now and am currently on fellowship where the conditions are much better. No job prospects at the moment as the career pathway is non existent. The junior docs have a chance to unite and make a difference and change these illegal work practices. (IMO is a very poorly performing union for these docs, as nothing has changed over the 12 years that I was an NCHD, just the usual spin you expect from politicians). Also there is some support among senior docs for this change.

  • | 27 Jan 2013 00:01

    Well done for speaking out. Am no longer a NCHD but remember well the soul destroying weekends on call on a 1 in 4 rota and the fleeting thoughts while driving that a little car crash would at least get me out of work and back into bed....back then at least we were being paid 4 the time we worked which was some solace whereas the guys now are working hours that management will refuse to pay them for.... What the public don't realise is that on top of all those hours NCHDs are also studying 4 exams and doing research which further impinges on their personal time.... Had a bad bout of depression as a result of bullying from a senior in my final year as an NCHD and got minimal support from the training scheme which is probably unfortunately the norm in our profession..

  • | 26 Jan 2013 21:01

    Let me give you a consultants perspective (sort of). I’m going to use the “well in my day” phrase unfortunately but bear with me Anthony, your article brought back some memories. I worked as an NCHD in Ireland and the UK for many years. 3 day weekends in letterkenny were the worst. No sleep for that length of time is, literally, depressing. I made some mistakes then that were the result not of sleep deprivation but of the mood alteration that occurs when you know you are facing an on-call. Then, in later years, trying to explain to your kids why you are going to work on a Monday and won’t be back til after they’ve gone to bed the following night is not easy. The constant moving, heading abroad etc. is not easy either but doctors are not alone in that aspect of their work. At the end of it all you may or may not get a consultant post. It took me 5 years after I finished my training to finally get a job. It wasn’t worth it. I think most consultants would support NCHDs in their bid for change. I certainly would.

  • | 26 Jan 2013 15:01

    I feel lucky to be working in Australia in comparison to the UK or Ireland. Things here are still not great; there's plenty of depression, burnout and despair at the lack if ability to give our patients the care they deserve. We've sometimes joked about wearing traffic-light badges that say how many hours beyond 12 that we've been at work. What sane patient would choose a doctor who'd been at work for 24hours?!? We need to get the public on side in this fight! It's not about money, it's about quality of life.

  • | 26 Jan 2013 15:01

    I feel lucky to be working in Australia in comparison to the UK or Ireland. Things here are still not great; there's plenty of depression, burnout and despair at the lack if ability to give our patients the care they deserve. We've sometimes joked about wearing traffic-light badges that say how many hours beyond 12 that we've been at work. What sane patient would choose a doctor who'd been at work for 24hours?!? We need to get the public on side in this fight! It's not about money, it's about quality of life.

  • | 24 Jan 2013 22:01

    This article has been a real eye opener for me. As a dietitian in a large dublin teaching hospital I work with NCHDs on a daily basis, yet I didnt realise just how bad the conditions are that they are forced to work in every day. I can in a very tiny way relate to the bullying which is also rife in dietetics, a profession in which, lets be honest, it is extremely difficult to do any harm, so I guess if I multiply how I was made feel during my undergrad training by a million I might just grasp about 10% of what NCHDs go through. For what it's worth, knowing what I know now from this excellent piece I admire the NCHDs, in particular Interns and SHOs even more now. Any time I have requested a signature on a TPN prescription, suggested feeding tube placement, asked for phosphate/potassium/magnesium supplementation, etc it has always been met with a smile and a can-do attitude. All NCHDs should be proud of the work they do and tomorrow in work I'll be sure to make sure the ones I work with feel aware of my appreciation. I'm happy email the above politicians in support of my NCHD colleagues.

  • | 24 Jan 2013 21:01

    A brave piece of writing. I feel the time has come for 12hr shifts. All the game players need to agree on 12hr shifts. I have done part-time training and part-time work 40hr week. It is a solution. I have a family, a wonderful life. We need more flexible working arrangements. I feel that NCHDs lack a voice. Why has the new grade specialist been delayed? Thank god for Antony and Joe Duffy

  • | 24 Jan 2013 21:01

    This article has been a real eye opener for me. As a dietitian in a large dublin teaching hospital I work with NCHDs on a daily basis, yet I didnt realise just how bad the conditions are that they are forced to work in every day. I can in a very tiny way relate to the bullying which is also rife in dietetics, a profession in which, lets be honest, it is extremely difficult to do any harm, so I guess if I multiply how I was made feel during my undergrad training by a million I might just grasp about 10% of what NCHDs go through. For what it's worth, knowing what I know now from this excellent piece I admire the NCHDs, in particular Interns and SHOs even more now. Any time I have requested a signature on a TPN prescription, suggested feeding tube placement, asked for phosphate/potassium/magnesium supplementation, etc it has always been met with a smile and a can-do attitude. All NCHDs should be proud of the work they do and tomorrow in work I'll be sure to make sure the ones I work with feel aware of my appreciation. I'm happy email the above politicians in support of my NCHD colleagues.

  • | 24 Jan 2013 21:01

    As a Junior Doctor this article just made me cry...spent last night on call and got 25 mins of sitting down at 4 am and then was going the rest of the time. I'm in my last 6 months of hospital based posts for GP scheme and I have just been destroyed by this system. All the joy and happiness inside of me has over the past 5 years been drained out of me leaving an empty robotic shell. I have nothing but resentment towards my seniors and training body who stand idly by shrugging their shoulders saying that it was "the same in my day". My deepest condolences to the families involved in these tragic deaths, R.I.P.

  • | 24 Jan 2013 11:01

    Great article Anthony and some very moving responses. I came to Australia 18 months ago after my internship and cannot believe the difference in terms of quality of life - proof that it can be done differently with more humane hours. Where are the links to the FB group/petition?

  • | 24 Jan 2013 02:01

    Here is a list of email addresses for most of the current government ministers. Please consider emailing them a link to Anthony's outstanding article. It is time things changed. simon.coveney@oireachtas.ie; lucinda.creighton@oireachtas.ie; jimmy.deenihan@oireachtas.ie; frances.fitzgerald@oireachtas.ie; eamon.gilmore@oireachtas.ie; brian.hayes@oireachtas.ie; phil.hogan@oireachtas.ie; paul.kehoe@oireachtas.ie; alan.kelly@oireachtas.ie; kathleen.lynch@oireachtas.ie; dinny.mcginley@oireachtas.ie; michael.noonan@oireachtas.ie; ruairi.quinn@oireachtas.ie; pat.rabbitte@oireachtas.ie; james.reilly@oireachtas.ie; alan.shatter@oireachtas.ie; sean.sherlock@oireachtas.ie; leo.varadkar@oireachtas.ie

  • | 24 Jan 2013 02:01

    Brilliant piece Anthony! Hats off to you!

  • | 23 Jan 2013 22:01

    Thank you Anthony for your selfless actions in dealing with this problem. A problem which, to my mind, is going to destroy our healthservice. I got a little emotional reading your article and listening to Joe. I remember my first 56 hour intern shift in Cork. I can only describe the complex emotional journey during that first marathon sleepless shift as being akin to the stages of grieving. Perhaps without resolution at the end. At the time I did not realise I was grieving for my twenties and much more but I do now. Keep ploughing the furrow Anto. Sincerely Michael

  • | 23 Jan 2013 20:01

    Couldn't agree more with this article. Thanks for bringing this up- often the hospital culture makes people feel like failures for struggling to cope with the current rotas, when really is just a rotten system and nobody should be expected to do these hours.

  • | 23 Jan 2013 20:01

    Couldn't agree more with this article. Thanks for bringing this up- often the hospital culture makes people feel like failures for struggling to cope with the current rotas, when really is just a rotten system and nobody should be expected to do these hours.

  • | 23 Jan 2013 16:01

    I would like to thank you for highlighting this issue and for starting a movement.

  • Anna | 23 Jan 2013 11:01

    If you have a moment and feel compelled to do so please sign this petition. Thanks http://www.acti

  • GOC | 23 Jan 2013 00:01

    Anthony, well done on the article. My condolences to the family and friends of the juniors doctors concerned. I certainly can well remember my shock and grief when an NCHD colleague committed suicide in a hotel room a number of years ago. While this problem is not new, I think that it is definitely getting worse. I would like to see the figures from the training bodies on the number of NCHD suicides in the last two years. I suspect that it is in double figures. Working conditions in Ireland are certainly worsening with increasing complexity and acuity of medical care for a greying population. Added to these demands is an employer (HSE) who ignores our most basic contractual entitlements and a media-government who vilify doctors at every opportunity as an overpaid elite. (Witness the uproar about the nurses pay and the contrasting lack of public outcry when this happened to doctors). No wonder more and more NCHDs are leaving these shores for locations where they will be paid a basic salary commensurate with their professionalism and skills. Irish NCHDs are a much sought after commodity in the international medical manpower market. It's instructive that in other countries, there is not a culture of criticizing doctors for the salary which they command. They are valued as committed hard-working excellent professionals by these societies. Regarding the two recent tragedies, I hope that some of the indisputable facts and HR issues which were associated with these cases comes to public attention. Only then can we hope for real enduring change for the NCHDs of the future. Thankfully my decade as an NCHD with (routine) 70-120 hour weeks is coming to an end. I'm not sure that I would like my children to follow in my footsteps.

  • | 22 Jan 2013 23:01

  • Brian | 22 Jan 2013 23:01

    Broken hearted at more unnessecary loss of life. I am not a doctor but have worked in hospital lab all my life >30 yrs. We also have relentless on call , no backup, intolerable stress, Xmas ,weekends etc all ruined. Life = The Rota . Pre call tension is a very real thing starts fri for a 24 hr Sunday . Chronic lack of sleep, add in a blame culture and a dimunition of self worth and the mortuary does appeal. Others mention occup health and they must take a more active role to detect and alieviate this suffering. R.I.P to these young doctors and many others who suffered and made the same choice. More publicity is a must.

  • Dan S | 22 Jan 2013 22:01

    Great article Anthony. It's also heartening to see the beginnings of a campaign for change. Unfortunately, the IMO have never shown an interest in fighting this fight. Perhaps emailing Colm Burke would be worthwhile as he has tended to be sympathetic. The rcpi has seen a huge drop in applications for training schemes and are hopefully going to come to the obvious conclusion that the conditions are to blame.

  • Owen | 22 Jan 2013 22:01

    First of all my deepest sympathies to the families and friends of those SHOs mentioned. The emotional toll of working these hours is harrowing. While intern year is probably publicly perceived to be the “hell year” rite of passage before moving onto the endless splendor of half days, golf courses and fully-catered all expenses conferences etc., this could not be further from the truth. You will struggle to find more passionate, talented and dedicated doctors anywhere else than in the NCHD ranks of Irish medicine. Unfortunately, if you replace the adjectives in the previous sentence with “demoralised”, “disheartened” and “despondent” it reads equally true. I am utterly disgusted by the blatant disregard management - and often consultants - have for our working conditions. That is not to mention the obfuscation we are faced with when trying to take holidays, sick leave or even simply get paid for the physical and emotional torture we are illegally forced to endure. While it is difficult to remain on point, as there is so much wrong with how we are treated, I agree that it is vital to be pragmatic and to focus our concerted efforts on this one issue of abolishing the misery of these long shifts. Effective and safe implementation of the EWTD represents the keystone of reform of the antiquated training pathways in this country. Very few things appalled me more during my intern year than the sheer animosity I overheard two consultants speak with upon hearing that their incredibly hard-working SHO had taken a week of his holidays. He had given adequate notice, ensured that that the interns would be able to provide some cover, informed the secretaries so they could limit the number of patients at the outpatients’ clinics... he had ticked all the boxes essentially. Yet they spat bile at one another in disbelief for two minutes in a game of “training-austerity-In MY day-tennis” which I’m sure will ring a few bells. That is not to paint all consultants with the same brush and I know that this attitude is more the exception rather than the rule, but still it persists and casts a long shadow.

  • | 22 Jan 2013 10:01

    As requested on the FB group I have emailed all the TDs requesting them to read the above article. I have just recieved this reply from Michael Lowry... Good morning , I wish to confirm receipt of your email as sent to our office earlier today, regarding the above named issue. Thank you for taking the time to contact our office to express your concerns on this matter. Please be assured that I have, this morning, passed your email to Deputy Lowry for his consideration. Deputy Lowry has asked me to assure you that the gravity and seriousness of this matter has been brought to his attention by a number of concerned parties. He has asked me to inform you that he is looking into this matter at present and will be petitioning the Minister for Health on this matter. As soon as we receive any response from the Minister on this matter I will forward it to you for your direct attention. Kind Regards,

  • Dublin Intern | 22 Jan 2013 00:01

    Thank you so much for your article. I was shocked to learn of the two deaths of fellow NCHDs over the past few months, I was even more shocked when there was no mention of it by senior hospital staff in any of the other Dublin Hospitals where I or my colleagues work. This blatant lack of regard for a great problem is saddening and frustrating. The health of NCHDs, be it mental or physical, is the very last priority in the healthcare system. How can we call this a healthcare system when it seems to be damaging all the young doctors that are working within it. How much does it cost the government to subsidize the free university education of its NCHDs in Ireland? How many have gone to Australia, Canada, UK, US etc…? Who can blame them. Even if you want to stay the conditions and pressure you have to work in is just to much to endure for any length of time. I am halfway into my intern year and I have mentally given up. I have been forced to work shifts as long as 36 hours, at the end of which there was a major emergency that was left to me to manage single-handedly without any sleep. I have been abused and bullied by hospital administration,and other hospital staff. Many hospitals do not employ any phlebotomy service over the weekends and feel it is appropriate to leave dozens to hundreds of bloods to be taken by NCHD’s who are also responsible for reviewing and managing sick patients. I rarely hear thank you. I have worked many other jobs in my time and I know this system is not right, this system is not normal. On the drive home from work I often imagine just never going back. Unfortunately this is not an option……….as I have large student loans accrued from studying medicine (I paid my own fees, I didn’t get my education for free, and now I am working for free as I am not getting paid overtime hours I am forced to work) On my first day of my new job one of the porters said “Welcome to Hell”…..how apt.

  • Ciara | 22 Jan 2013 00:01

    TL I wish there was a similar supportive attitude among more Consultants, but it's encouraging to hear that from a Consultant and to have you enter the discussion. It's a great and necessary piece Anthony, thank you and it's struck a chord with me and any nchd who has read it. Something's got to give, let it not be anymore lives, let it be the system that relents to abolish these harrowing call shifts.

  • jeroen@vanrens.net | 21 Jan 2013 23:01

    Thank you for sharing this article. I too have written to the minister and local TD's plus joined online campaign. This practice has to end now.

  • C | 21 Jan 2013 19:01

    Thank you for the excellent article. My condolences to the families, friends and colleagues of the two doctors. The problem of excessive hours should have been tackled during the boom. Doctors and patients deserve better. During the last election I got a call from an Alan Shatter campaigner. It went something like this. Me- I have a problem with my son. He is being forced to work stupid hours, from 8am on Friday, all day Friday, all of Friday night with no sleep and all day Saturday until 6pm, for example. Him- Does this happen regularly or was that a once off? Me- It happens all the time, he usually works 70 to 80 hours a week. I think his longest shift was 56 hours over a bank holiday weekend, he got a couple of hours sleep in fits and starts during that period. Him- In this country? Me- Yes. Him- But that is illegal, there is legislation to do with that it is called the EWTD. Me- I know, but it is being ignored by his employers. Also, he often does not get told when he will be working until the last minute. He has missed a plane and his holiday because he had to cover for someone who was sick. Him- Does he get paid lots of money. Me- No, sometimes he gets paid for all his hours but that is unusual, he has worked out that got paid more per hour in a summer job he had in a cake shop when he was in college. He had to go to the bank to restructure a student loan because he didn't get paid what he was owed. He never knows what will be in his pay packet. Him- That is not on, you deserve to get paid for all the hours you work. Me- I sometimes think that they don't pay because that would be admitting the amount of hours he works. Him- By the way, what does he work at? Me- He's a doctor. Him- Hold on there, I will go and get Alan. He visible paled and took a step back in shock when I said that last bit. He returns a couple of minutes later with Alan Shatter who said that it was always like that, and it is just while they are junior doctors anyway. I tried to explain what the term 'junior doctor' meant, but he seemed to want to get away as quickly as possible. I am now going to email Dr. O'Reilly and all of the TD's in my area.

  • 24hrsisenough | 21 Jan 2013 19:01

    Please join our facebook group and lets put a stop to this once and for all http://www.facebook.com/groups/566600706700681/

  • Medical Student | 21 Jan 2013 18:01

    As final year medical students, many of us were shocked to hear of the recent deaths and expected uproar in the general media. But it seemed as if nobody cared. Thank you for a great article and eye opening comments, which really can't be ignored. Here's a petition: http://www.activism.com/e a medical student applying for work in the NHS...

  • EH | 21 Jan 2013 16:01

    For once in my life I have emailed all my local TDs and the minister for health. I urge you all to do the same. We need to start a petition on facebook where everyone can add their names. When it's up we'll put the link here. In the meantime the minister's email is james.reilly@oireachtas.ie. Add your voice.

  • DrB | 21 Jan 2013 12:01

    There was an uproar about this in the national press last July, radio and newspaper. There was also an article quoting the IMO NCHD Chair regarding emigration and highlighting the various issues pushing us overseas, that was in late November. Again the issue is growing legs but we need to unite on this ONE issue this time and not get sucked in by the usual headline grabbers (pay, emigration). They allow HSE/government distract from the fact that we are being pummelled into the ground. 24hoursisenough.

  • Ronan Kavanagh | 21 Jan 2013 12:01

    Well done Anthony. I was very moved by your brave piece and delighted to see that it has generated so much discussion about mental health in doctors.

  • R | 21 Jan 2013 11:01

    I asked the IMJ to commission an article looking at what elements of international training models could be incorporated into the Irish system to reduce stress and provide support to NCHDs. Even after they finally realised commissioning an article doesnt involve paying the authors fees, they proved to be a complete brick wall. Unsurprising considering they are aligned with the IMO. I wont ever submit anything to the IMJ in future. Good luck trying to get this into mainstream media when Ireland's primary medical journal won't listen despite the nature of its readership. Very disappointing, somehow doctors will have to look out for themselves- that will only happen when the attitude of the majority of consultants reflects that of the NCHDs they have a responsibility towards.

  • shocked and saddened | 21 Jan 2013 11:01

    The 7th entry from the bottom in the comments section by 'intern' has me close to tears. Im not a Doctor, i followed this from an article on journal.ie. You always hear doctors work hard etc but this is barbaric. All of you need to keep at the government and TDs until you at least have a statement on the issue, adressing that there is a problem - on record. Ill be following your progres. Dont give up. Keep at it.

  • Jane | 21 Jan 2013 10:01

    A little coverage from thejournal.ie below: a well written article that doesn't highlight all the abuses and contractual breaks that go on, but does bring some home truths about the ridiculous outdated and dangerous work practices here: http://www.thejournal

  • Aidan Murray | 21 Jan 2013 10:01

    Thank you Anthony for a very brave piece. It's been four years since I moved to New Zealand and I don't regret it one bit. While i dont regret my time in Ireland, i can see now that the working conditions there are not designed to protect, nourish or train Irish doctors. They only act to demoralise and dehumanise. As an intern I too remember being told by a prominent ED Consultant to be thankful for my one in four call with 56 hour weekends because in their day it was one in two. I only wish my Irish colleagues could see the strength of the NZ doctors union firsthand. Not only do we have rigorously protected working hours, fully subsided training/Medical council registration/indemnity costs but also easy access to leave and fully subsidised meals. The system here is actually geared towards quality of life. The IMO should be ashamed of themselves.

  • H | 21 Jan 2013 10:01

    The night is always darkest before the dawn. Lets focus on one issue, hours. Nothing else for the time being. We cant allow ourselves to be drawn into discussion/ arguments regarding pay and training length. While they are totally legitimate argumemts in a wider European/international context, they serve to detract from the public sympathy we so desperately need to achieve more humane conditions. For the time being the latter two wont damage our lives in the manner our shifts have been. Anthony has captured the essence of a very bleak and harrowing existence which none of us truly believed we would have to live with. Thank you Anthony. May our departed colleagues know that we think of them often and miss them dearly. We have strong voices among us. The health minister and former HS executive are not unaware of our situation, nor is the health columnist of the Irish Times as we see below. I beg all of them for help. I like so many of my colleagues am on my knees. As a collective it is very difficult to know how to proceed. I have no interest in whipping our trade union, we cant let that mess detract attention from this crisis either. I would ask any IMO hierarchy / Representatives reading this article to formulate a strategy to guide us to a safer place. Outsource to a strategic management company if you must. For many it would spell your redemption. Our working conditions are likely to spill into the national media in the coming days. This was the case a number of last summer as well. Somehow our plight still went ignored and who knows what might have been avoided. We must be calm and assertive on this issue and we cannot lie down until there is a change. As it stands we dont even have promised change. The campaign has started and it does not stop until we get 24 hour maximum shifts.

  • EH | 21 Jan 2013 09:01

    What a great article. It articulates all that is wrong with the system. It is unbearable. I'm in research this year and my blood runs cold when I think of the life I will be going back to. I left surgery once because the conditions were so intolerable. I trained as a gp and i cannot tell you how differently you are treated and how great your quality of life is in comparison. I didn't care that I was paid less - most nchds would swap salary for reasonable hours though they shouldn't have to. If the public think that doctors want to earn a lot then why is it so difficult to get someone to cover a call? Because no amount of money is worth the stress of it. And how many uncounted doctors leaves schemes like surgery purely because the hours and working conditions are impossible? They go into gp and pathology and public health and they could have been great surgeons. The system is barbaric and favours those who can put up with the most punishment while allowing those who struggle to flounder and even take their own lives on occasion. I worked with one of the nchds who died and when he had to take time off for his depression as well as another nchd who was off sick, the hospital did nothing and provided no despite repeated pleas and requests. We were all told we had to cover or colleagues or else. I almost quit again then. And by the time my sick colleagues returned they came back to an exhausted, resentful set of coworkers who were desperate for them to cover the Rota again, whether or not they were really ready to come back. It was terrible for everyone.

  • MC | 21 Jan 2013 08:01

    I was an Irish NCHD for 6 years in the 80's and endured the same abuse and bullying. We used to say "they have you by the testimonials". I too remember colleagues who succumbed to suicide, alcoholism and drug addiction, and some who became bullies themselves. It was not until I moved to the US for a fellowship that I felt respected at work. That is not to say that there was no abuse of residents in the US, because there were and are some sadomasochistic programs. But the abuse in the US is not pervasive as it is in Ireland, and in Canada, where I live now, residents have an excellent quality of life and good job prospects. If I had the gumption as an NCHD that I have now, I would have protested. But I was a young intern at 22 and had a sheltered youth and a lot to lose. The Irish NCHD is at the bottom of a steep power gradient and has already invested many years in education. Hence the tendency is to just endure it for the duration and hope for a better life afterwards. Clearly the IMO is a toothless organization and is not helping NCHDs. Maybe what is needed here is a human rights challenge. I'd be willing to donate a few Euros. And I would advise you all to leave if you can.

  • LS | 21 Jan 2013 01:01

    Going home? and who looks after the patients ? In many cases there is no one whatsoever. Irish hospitals are run with skeletal amounts of medical staff who are run ragged trying to do their jobs ( and often the jobs of nurses/porters/admin too) Know exactly what you mean about wishing you broke your leg. Many times I thought the same.But a colleague of mine was forced to work on a broken ankle - he was threatened with being reported to the medical council and his contract cancelled if he complained. I have been threatened many times forced to cover 72 hour straight shifts at no notice. I left Ireland completely destroyed, I was abusing prescription meds and drinking heavily. Got a new life in OZ, so thankful for the new start. If anyone is feeling suicidal or cant cope please walk away from the mess. Start afresh somewhere else. Somewhere they dont abuse bully and exploit you.

  • Niall | 21 Jan 2013 01:01

    Im not a doctor, but I sympathise hugely with all the sentiments and emotions expressed above. As an outsider looking in I'd like to ask the question, why don't individual doctors do the hours they are required / restricted to do by the EU working directive, rather then the ones they are rostered to do? Literally dont come in and leave around the working directive. Inform the "boss" thats what you are going to do, and do it! Be collective about it. They cant fire everyone. But they can hire more. Just a thought and genuinely interested in answers / comments.

  • MarieO'N | 21 Jan 2013 00:01

    Being an NCHD in Ireland is ruining my life. I cant cope anymore. A few weeks ago after working 38 hours with no sleep I drove home (another sleep deprived decision). I drove through a red/amber light without even realising. When I slowed down I was physically dragged out of my car by an enraged man who started shaking me and roaring at me in the street for being so careless. I broke down in front of him. I haven't been right since. We are all at breaking point. I'm moving to NZ next year and leaving my scheme. Enough is enough

  • InExile | 20 Jan 2013 22:01

    My sincere condolences to the families of these young doctors. I spent ten years working in the Irish system. I've moved to the NHS now. It has been a complete eye opener. When I describe the hours and conditions back home they are incredulous. They simply cannot believe that we put up with this. I expect things will get a lot worse over the next few years. NCHDs need to take a stand now for safer conditions, better training and towards a consultant rather than NCHD led service. If they won't make the changes vote with your feet, conditions are way better outside Ireland.

  • Anthony | 20 Jan 2013 22:01

    Thanks again everyone Just to clarify, the reason I am asking for 24 hour max shifts, 60 hour max weeks NOW is not because I think they are okay, but with planning they are deliverable IMMEDIATELY. Anything else may not be achieveable right now under current circumstances given state of national finances and current configuration of hospitals.

  • Catherine | 20 Jan 2013 21:01

    Thank you Anthony for a very brave and clear analysis. It is awful to read people's experiences in the comments section. Particularly, it seems that even when people have made difficulties known to occupational health/HR, the differing levels of sympathy and management of the problem makes it clear there is probably no HSE policy in place to support doctors mental health. I think anyone who has not worked under these conditions cannot understand the crushing physical tiredness we all endure on a regular basis. I work in psychiatry, and in my experience, 24hour shifts are quite bad enough. It's difficult to be empathetic and take all the time necessary to build rapport at the end of a 24 hour shift, when part of your mind is clamouring for sleep and just wants to go down a 'checklist' style of assessment. In the UK there are no more 24hour calls, and I think this is what we should be asking the HSE for. If it works there, with adequate handover times, why not here? I think the public genuinely think that the long calls are a thing of the past. After my first intern call I recall being so tired I couldn't manage public transport, so got into a taxi. I explained to the taxi driver why I was so tired I couldn't make polite conversation, his shocked response was "Jaysus, love, a horse wouldn't do it".

  • Shane C | 20 Jan 2013 21:01

    Can I urge everyone reading this to post it to Facebook pages, email it to politicians and organisations and tweet it with the hashtag #24hoursisenough . The only way things will change is to get this seen by as many people as possible. We all need to take on some of Anthony's courage and speak out.

  • Anna | 20 Jan 2013 21:01

    As a Reg at SJH, I am constantly amazed at the calibre of our SHOs and disgusted at the criminal working hours and conditions and the unconcerned attitude not only of mangement but Consultant colleagues. Thank you Anthony for your wonderfully written piece. The intolerable working conditions have been well laid out in the article and subsequent comments. However, I feel the additional stressor of the 'teach yourself' postgraduate medicine has not been highlighted. The lack of teaching and training provided to those undergoing postgraduate medical examinations by training bodies responsible of even informally by the much lauded Consultants and Professors astounds me. Provision of adequate teaching sessions is something

  • SHO | 20 Jan 2013 20:01

    Since the recent loss of our late colleague, I have become so angry at our healthcare "system". I feel angry every single day at work. Nothing has changed. And what's worse, it's too late for change now, because we have permanently lost a wonderful person who was failed by the Irish healthcare system. I continue to work 32+ hour shifts, which prove challenging to my own mental health on a 1 in 9 day basis, and that is with no history of depression. We ourselves are even too tired to fight, and so desperately need some kind of actual representation from a real union. The issue obviously concerns not only doctors but the patients we treat. It is a disrespect to her memory to continue to undermine us and allow us all to struggle on as before. Her parents are so admirable to comment with such positivity and hope for change. My thoughts are with them always. Let's not let this happen again, ever.

  • Shane C | 20 Jan 2013 19:01

    Can I urge everyone reading this to post it to Facebook pages, email it to politicians and organisations and tweet it with the hashtag #24hoursisenough . The only way things will change is to get this seen by as many people as possible. We all need to take on some of Anthony's courage and speak out.

  • Muiris Houston | 20 Jan 2013 18:01

    An absolutely superb piece of writing. I take my hat off to you. Muiris

  • Surgery SHO | 20 Jan 2013 15:01

    Excellent article . . . Was 30hrs into my 36hr shift yesterday while chatting to my consultant about this subject, he chortled and delivered the classic "in my day we were glad of being on call, what are you complaining about?". As I silently continued scrubbing I bit my tongue, and pondered how I can physically drag myself through this for the next 8+ years . . . Lets change this

  • | 20 Jan 2013 15:01

    The toothless IMO should take a good look at this forum and hold another EGM to discuss the crisis that has occurred on their watch. This would be a much more useful use of their time than finding a location for their next AGM that is reflective of the economic mood. Yes the hubris of hotel Europe is over, trying to find a more optically pleasing venue is more of a priority than their grass roots members. Their CEO checks out with a bankers pension and our regulatory body asleep at the helm. Business as usual.

  • | 20 Jan 2013 13:01

    Reducing single shift lengths to 24hours would be a huge improvement and I encourage everyone to fight for it. However, as someone working in a specialty where this is already the case, I would like to point out that it is still far from a perfect situation. In my last 6 months, at least once a month, I worked in excess of 90 hrs per week. Other weeks weren't quite as bad but still well above EWTD. That was with post-call days off. So despite limiting shifts to 24hrs, it is still possible to work nearly double the EWTD in one week. And it is still possible for this to take its toll on mental health. Frequency of call is part of the problem along with the lack of understanding of colleagues, public etc as mentioned by others. I hobble home after 24hrs on call due to back pain. Occupational health referred me to physio, however, I cannot take half an hour out of my working day to go to the physio dept - which is in the same hospital. The only time I can make it is on those post call days when I am too sore and haven't the energy to cooperate with exercises designed to prevent the problem. I admire those of you who manage to carry on working through the next day but it is not right. Neither is my situation. We can start with 24hrs but ultimately we need to look at fortnightly averages and 14hour limits.

  • SHO | 20 Jan 2013 13:01

    I really hope every person who reads this great article and feels some sort of emotion contacts their local TDs. Nothing will change if we don't ask/demand change. I refuse to allow these untimely deaths and the crisis we are in go unnoticed. We should stand up in their memory.

  • | 20 Jan 2013 12:01

    I was reading this the other day while filling out an application for a scheme at home next year having spent the last few years in australia. It has me wondering wether Im crazy to be going back at all when there are so many reasons to stay away. The sad fact is that most people who leave are doing so out of desperation as it seems like our only chance at a decent quality of life. Great article Anthony, thanks for again highlighting issues that need to be addressed but also paying tribute to 2 people who deserve to be remembered, one of whom I am lucky enough to be able to call one of the greatest friend I'll ever have.

  • Tallaght Intern | 20 Jan 2013 11:01

    Fantastic article! The week after the tragic death of Jess NCHDs in Tallaght thought this is what it has come to is this what had to happen for something to be done? They have to wake up now? Almost two months has passed since the loss of a terrific doctor and it certainly is business as usual nothing has changed. I have cried on the way in to work a Sunday call, I have had a colleague admit to me they cried several times during a weekend call. College friends have been transformed in six months into exhausted, frustrated people who well up when you ask them how their day is going. We all laugh it off after put it down to a bad day and got on with it like every other doctor in the country we dry our tears and get back to work because we don't have a choice. It's only looking back after reading this article I realize crying on the way to work isn't something that should be laughed off! I have spoken to interns who have decided medicine isn't for them after six months they have seen enough. Although I can't imagine doing anything else there is a part of me that is jealous that they are escaping. I can't guarantee I will be a doctor for life which is something the medical student me would have been appalled to hear. You just can't help but think there is more to life and if this job can lead you down such a dark path as to end your own life is that a job I want?

  • Edel | 20 Jan 2013 10:01

    Jess was a friend of mine and an amazing Doctor i think about her everyday and the positive impact she had on my life. This is a great article and should definitely be in mainstream media.Things need to change.

  • TL | 20 Jan 2013 10:01

    Very well written article. Recently crossed over to the dark side and became a consultant. I myself am happy to share the pain, facilitate 24 hour or less shifts and discontinue this rubbish of a consultant doing the ward round with a trail of junior doctors in close pursuit. Send the guy with the red eyes home and if I have to see twenty in clinic as a consequence so be it. That's what I'm paid for!

  • HOL | 20 Jan 2013 08:01

    What a tragedy that there is such a culture of self-serving among those in power in the HSE. NCHDs, stand up for yourselves. Be professional. Be respectful. But you are totally within your rights to stand up for yourselves to HR and to your consultants. No, I will not be able to do that extra call. I need to ensure I get the rest I need to work safely on my next shift. No, I will not tolerate your bullying. If you choose to threaten me with a poor reference, that is your choice. The quality of my work speaks for itself. What Irish medical training lacks is assertiveness training for NCHDs. And management skills, which should be taught from the very beginning. Not the year before one becomes a consultant. That's too late. The requisite skills need practice. Think about it. I'm sure the majority of junior doctors reading this (including myself, although I am working on these skills) wouldn't dream of standing up for themselves like I suggest. This just proves my point. RIP to the loss of precious lives. For these, we must stand firm

  • J | 20 Jan 2013 03:01

    Thanks Anthony for describing what its like. Medicine in Ireland nearly wrecked my life. Was absolutely destroyed as an SHO left to fend for myself with 70 very sick patients, no team and no support. Working all day every day, not paid, no sick leave, holidays cancelled. I remember calling the IMO who told me I should go to Australia. Always wondered what they did with the money I gave them to try and improve the lot of NCHDs. Now we know - it went straight into their pockets. Throwing money at each other as we were ignored, marginalised and exploited.

  • C | 20 Jan 2013 02:01

    It's heartbreaking when you leave college and everyone is so proud of you, then you arrive in a system that piles on stress and guilt, and makes you feel like a criminal when you ask for your leave or your pay. I know NCHDs who had booked time off for sibling's weddings and were blackmailed into working at the last minute without a word of thanks. If you don't play along you don't get your reference/funding/interview. I've been handed back my timesheet of almost 100 hours with 50 of them tipp-exed out by the consultant because it was "unapproved" overtime... which the consultant told me to do! I had an awful couple of years of clinical depression and only for the joint efforts of a fantastic consultant who mentored me, my friends who told me their own battles with the black dog, and my very patient family I would probably not be here, let alone in medicine. Now on the other side of it (for now), it has made me a much more assertive person and I hope a more compassionate doctor. That said, I am leaving Ireland this summer with no plans to return. Most of my friends are long gone and several more are in the process. The IMO and the HSE may claim they are working for us in the background but it feels like a long, slow turning of the screw to me. Thanks for shining a light on this.

  • Tallaght Doctor | 20 Jan 2013 01:01

    Thank you Anthony for such a heartfelt and honest article. Unfortunately you could wallpaper the human resources department with these comments and they would be in vain. As far as the Department of Health, HSE and middle management are concerned we have taken the strain and they are willing to load on more as long as we take it. For example, the current interns have taken a 22% pay cut this year compared to their peers only 12 months ago - was there a shred of media attention- not a sausage. Queue the comparison to the new nursing graduates, a similar pay cut - mass outcry at the rampant sexism rife in the HSE and cheap shots at junior staff. What’s the difference; we have a lame duck representative body. The IMO should protect doctors, it has failed. Doctors are dying in the Irish healthcare system and this forum while commendable is only singing to the choir. It is time that doctors went on strike to protect our rights, protect our mental health and to protect each other. It’s about time the IMO balloted for strike action.

  • Caroline Larkin | 20 Jan 2013 00:01

    Thank you for this article Anthony. I thought when I was an intern that the whole problem of excessive working hours would be sorted out very sharpishly. Many years later nothing seems to have changed. In fact I find that physically I am much less able to cope with on-call than I was as an intern or SHO. That coupled with the additional responsibility you get as you "climb the ladder" means that for many people working in the hospital it gets worse over time, not better. It's a completely broken system that passes for the norm every single day...and we're all only human after all, there's only so much one can take.

  • Anthony | 20 Jan 2013 00:01

    Thanks for all your comments and responses. It's very moving and a little overwhelming. I don't want to address individuals but it's harrowing knowing what people who work alongside us day in day out are going through. If we can achieve anything by having this discussion it's letting those colleagues know they are not alone, now or ever. Would anyone who's been kind enough to read or comment on my recent blog take a minute to contact their TDs? If you're on twitter use this hashtag #24hoursisenough

  • John | 20 Jan 2013 00:01

    Why hasn't the IMO brought the HSE to the European Court of Human Rights to get a legally binding judgement on the European working time directive? Surely someone's human right is being violated if that they are working inhuman illegal working hours causing detriment to their physical and mental health. Our current servile government run scared everytime the troika arrive from Europe and implement everything they say without question so surely they only need to be frightened by the big boys in Europe? Plus it could mean a helpful financial compensation for the IMO...

  • GMK | 20 Jan 2013 00:01

    Congratulations, Anthony, on an excellent article highlighting this medical 'sore'. Ask any medical student why they want to study medicine and you will learn of desires to help rather than harm, to ease rather than inflict, to cure rather than cause, to heal rather than disrupt, to restore rather than destroy a healthy exisence for one's fellow travellers along the challenging highway of Life. Yet, some of these highly idealistic and positively motivated individuals find themselved exposed, in the name of 'training' to a type of endurance test which has more in common with the excesses of a brutal regime than with a 'caring' profession. while one could ask why this is deemed necessary, perhaps a more troubling question is why members of the same 'caring' profession preside over this treatment of their junior medical colleagues.

  • intern | 19 Jan 2013 22:01

    I could have been with them. I wrote a letter to my parents and James Reilly on November 21st asking them not to let my loss of life be wasted as I did not have the energy to stay alive o try to change it. I was saved. Saved.. To return to the same toil that drove me to that dark place in the first place. Occupational health met with me, I wanted to get back to work, so I had one suggestion to help, would it be possible for several weeks to not do call but to work the other 10-12 hour days without proper breaks as usual. I was told I'd have to ask my colleagues to cover it all. And also told by my intern coordinator that I may not be signed off a having 'completed' my internship if I did not do my call. My consultant gave me a 'poor' assessment of my ability to handle stress on my review form. I was told they had it way worse, that we have it easy now. 'And what does an intern do all day anyways?' And so i work hard at keeping myself safe every day. And my parents and partner worry about whether the next low that comes will tip me over completely, or whether I can survive until I get on a GP scheme and get out of the hospital system in 2 years. Its my ony hope.

  • Hazem | 19 Jan 2013 22:01

    Thank you Anthony for a wonderful article. Well put. I left Ireland a few years ago, and it's sad to see the system hasn't evolved in managing appropriate working hours for all doctors. After moving to Australia, I've realized that health systems can effectively implement rostered hours and shift work that can provide: 1) adequate healthcare 2) adequate training (postgrad training bodies need reform too for this to work) Both Australia and NZ operate with hours under 45 per week (most specialties, not all), with exceptional pay. There is no reason why Ireland cannot reform. You need political will though, and that has to come from NCHDs pushing the envelope. Public awareness and a public inquiry into the tragic suicides would be crucial. Our thoughts are with you all.

  • SC | 19 Jan 2013 19:01

    Thank you for articulating the despair we have all felt at some point in this job- that it is impossible to go to work every morning and care for others in a system that cares so little for us.

  • Nuala Quinn | 19 Jan 2013 18:01

    The pressure, hours and relentless negative media debases and dehumanises our profession and it has to stop. The effects are clearly visible in the many tired, weary and strained faces of NCHDS in hospitals all over Ireland. Excellent article Anthony, well done.

  • Stephen | 19 Jan 2013 17:01

    Well said Anthony. I left medicine about a year ago, its amazing how much better you feel. The mental and physical destruction involved in the job is unreal. It took me 6 months just to feel normal again. The worst thing is how ignored and marginalised we all are. The IMO, the training bodies, the HSE , the Government - they just dont care. Business as usual as you said. Ive lost 2 classmates to suicide, will probably lose more. Depression , Alcoholism , Self medication are rife. Hell is the impossibility of change as they say. No change is coming or even contemplated. The system just grinds along spitting out victims and sucking in fresh bodies at the other end.

  • Annette Neary | 19 Jan 2013 16:01

    Great article, and humbling feedback. A junior colleague was asked in an interview "What are the best and worst things about being a doctor?" Her answer was "other doctors". I have been lucky, and been supported through grief and loss by a majority of colleagues at all grades. However, I have been bullied (as a consultant in the UK); and worse, I saw some of my peer group become the type of consultant they themselves would have despised as NCHDs. Consultants especially have a duty to set a good example, that caring for staff is as much a part of the job as caring for patients.

  • Caroline Larkin | 19 Jan 2013 16:01

    Thank you for this article Anthony. I thought when I was an intern that the whole problem of excessive working hours would be sorted out very sharpishly. Many years later nothing seems to have changed. In fact I find that physically I am much less able to cope with on-call than I was as an intern or SHO. That coupled with the additional responsibility you get as you "climb the ladder" means that for many people working in the hospital it gets worse over time, not better. It's a completely broken system that passes for the norm every single day...and we're all only human after all, there's only so much one can take.

  • S | 19 Jan 2013 15:01

    As a junior doctor at the beginning of my much anticipated career, your words echo what I am starting to feel - absolutely deflated. Sleep deprivation matched with stress, the never ending barrage of demands from the incessant bleep, plus blatant disrespect from certain colleagues - doctors and non doctors alike, makes for a dangerous combination in a 14 hour day. There's a sense of "man up" and "just get on with it" that prevails and that serves just to heighten any self depreciating tendency that's underlying an already tenuous situation. It is not true of all jobs and I have also had senior team members that have looked out for me and supported me this year and made me love my job - but this is just a lottery of human kindness, rather than a result of any safeguards put in place to make my working day humane, fair, or even achievable. Do I remain loyal, stay and hope for change - or just exit stage left for a country that provides quality health care without affecting my own health in the process? I can't decide. As evident by your article and subsequent posts there are viable solutions to ending this. My condolences to the families of these doctors, I had the pleasure of working with Jess, she was always so kind, helpful and approachable and someone that has made a positive and lasting impact on me. May they rest in peace.

  • JE | 19 Jan 2013 14:01

    Well done Anthony.....I take my hat off to you for firstly having the courage to put your thoughts in print...and secondly having the skill to express so eloquently what many of us feel....but no one outside the world of an Irish NCHD will ever understand....I have shared your feelings many times during my training....& not sure if I am going to continue on my present scheme. Any chance of getting this published in the mainstream media....public lack of awareness / misperceptions of the glamorous overpaid jobs we have never cease to amaze me........Thanks again...

  • S | 19 Jan 2013 13:01

    Thank you Anthony for writing this piece. I commend you on taking the step of articulating what we are all feeling. I was lucky enough to work with one of these doctors, who is deeply missed by her colleagues. The next step is to broadcast these issues on a broader national stage. This excellent article should be forwarded to managers in all hospitals, training bodies and the HSE who are ultimately responsible for the provision of a health service that is not only safe for patients, but also safe for the service providers. Not only this, the mainstream media and the public at large need to be made aware of these issues. The hospital involved touted the counselling services they offered. However, no one working in the hospital at the time was aware of their existence or indeed how to access these services. While a service like this would indeed have been commendable, it does not absolve them of their responsibilities. It is the health system and specific hospitals that have failed and continue to fail those who work in the high stress, high responsibility environment that medicine is. This is the issue which should be front page of every major newspaper in the country. Not the spin and responsibility dodging of PR departments. We have lost colleagues, friends and family as a result of current work practices in this country, which continue to violate not only specific contracts, but also European law. Business as usual cannot continue...

  • R | 19 Jan 2013 13:01

    Firstly just to compliment the article- it is very well written and makes some salient points. While the EU working time directive is a crucial issue, I would like to see the relevant parties in Tallaght (eg clinical director and training programme director) conduct a thorough review of -local- services that may have put a strain on these doctors. And perhaps report back on any changes they have made in a public forum (eg here) and serve as an example to other hospitals. A thorough review could include asking previous shos/sprs if they experienced any strain while working for the relevant services. I know this has not occurred as I worked on one of these services- I would have comments for improvement. Consistent views from good doctors about a service make factors contributing to individual vulnerability (eg history of depression which is v common in general population anyway) slightly less of an acute issue. This should be borne in mind. I now work in the NHS and I would like to see local and national bodies look across the sea where the training programmes (while involving a bit more paperwork unfortunately) are much more supportive. We have educational supervisors, consultants who support us through all jobs on the scheme. We can use them as a current reference if there is any clash with a clinical consultant. We can speak up about bullying when we see it without jeopardising our careers. There are also mentorships where an sho/spr who has worked in similar jobs and 'has seen it all' directly supports another sho/spr in strict confidence. If an unsupportive service is identified in the UK, the service loses its sho +- spr immediately. The service has to cope without and any return of the juniors occurs in a staged, graded, highly monitored fashion. I looked to those in authority in Tallaght to interrogate themselves about this and confront any local issues. I deeply sympathise with the families and hope they will feel supported by those in the hospital who move the necessary mountains.

  • C | 19 Jan 2013 12:01

    Back during my first clinical placement as a student, my consultant recommended I read Samuel Shems' House of God which, for those who haven't read it, is a story of a group of interns who under gruelling working conditions and indifference from self-centred superiors end up destroyed either mentally like the narrator or physically like his old college friend. In all it shows the then US system take in bright promising doctors and leave them utterly destroyed and jaded. It is introduced by reviewers online as a historical piece of fiction describing what junior medicine was like in the US during the early 1970s yet much of it could be used to describe what I see today in Ireland. Thanks for your piece and thanks to other commenters for sharing their stories as well.

  • joe | 19 Jan 2013 12:01

    very good article. My advice to anyone really struggling in the current system, is to get out. don't listen to scare mongerers who try tell you it doesn't look good on your cv if you've left. i just don't believe this anymore, I dont think consultants etc are in a position to put these stipulations in place. Its not that big a leap, you have the chance to work in so many other countries, we have massive options.

  • Aoibhlinn | 19 Jan 2013 10:01

    Another wonderful piece Anthony, I have forwarded it to the registrar of RCPI, could docs from other training bodies do the same ? In adddition I think the CEO in every hospital should be emailed a copy.

  • JW | 19 Jan 2013 10:01

    Thank you very much for your piece. Sometimes when you go through a tough time like that you feel like you are the only one. I have always been a happy-ish person. That was until I became an intern. I was quickly made aware that " a good intern is seen and not heard". My consultant did rounds only twice a week, and I was informed I was not to speak. My registrar and SHO conducted the ward round in their native language. If you factor in the weekend fri am to mon pm on-site on-calls, I easily worked over 100 hours a week. I had many, many MANY days I wanted to end it all. The only thing that stopped me was that I became pregnant. When I became an SHO the weeks became about getting the most out of the 4 hours per week, some weeks, I actually was home with my 10 monthh old child. My husband was rotated 300+ km away from us and the RCSI refused to put him in the same region as us. This after we wrote letters pleading with the head of the allocations and the BST program. They point blank refused - take it or leave it. I don't know any marriage that could survive an indefinite Letterkenny - Mallow separation. I am still trying to find public transportation crazy enough to link the two. Lord knows, with that many hours under our belts, we are in no fit state for a hair cut never mind a drive. If the long hours, the constant bullying & public humiliation is not enough - it was a constant battle to get your entitled leave. Oh, and you dont get paid, but you pay the childcare and babysitter. The patients suffer the most. Everyone is overworked, everyone is angry, everyone is stressed. The simplest things get turned into Waterloo. And before you know it, an intern somewhere in Ireland, is taking the heat for some thing. Everyone dumps on the intern. The intern in so low on the totem pole that only only person who the intern can complain to without repercussions is the floor. I have since left Ireland and it is the smartest thing I ever did. All that hogwash about "continuity of care" and "reduced exposure to training" is just that - hogwash. Get out of the dark ages before things snowball out of control.

  • Shane | 19 Jan 2013 09:01

    I personally know two doctors who quit because of the amount of bullying that they received from their consultants or from senior doctors in public hospitals. Always in front of other staff and sometimes in front of the public, just to add to the humiliation. I'm glad they quit for their health. I also know other doctors who were trained in Ireland, saw what our hospitals were like, and fled to foreign countries with proper working conditions. Some doctors actually do enter the profession to help people. For many, it is a dream that they have pursued for years. To have that dream snuffed out by cowards on power trips, forcing them to extreme measures is appalling. The leaves our hospitals bereft of these caring healers. The culprits rarely seem to be taken to task even though many other members of staff are aware of the problem. There needs to be better solidarity among staff to get these people suspended. I don't care how technically good a doctor or surgeon is - if they are responsible for this level of misery then they have broken their oath and should be punished accordingly. No other decent profession* in the EU allows this type of behaviour, rampant verbal abuse, and physical strain to the point of fatigue. *Decent. It does happen in banking.

  • A | 19 Jan 2013 08:01

    I'm so glad you've written this piece! I've recently changed from a very demanding training scheme to a far more family friendly one, in no small part due to the fact that the demands of my job were putting my relationship and family under enormous strain. Not to mention I could barely hold a conversation with exhaustion. I had a stack of letters/ bills etc untended to from pure exhaustion and lack of free time. I think I was completely not coping with my real life but maintaining everything at work. Everyone except my family was shocked at my decision, but it was writhed change job or I was heading for a bad spiral. Thankfully a wonderfully husband helped me realise that it's only a job and being treated like shit for >60 hours a week and unpaid for a lot of it is just stress no one needs. Rip to those 2 wonderful nchds

  • Joey Byrne | 19 Jan 2013 05:01

    Fantastic article Anthony....however you omitted the other causes of depression amongst NCHDs....BULLYING! From certain greater than though consultants or senior NCHDs who's only interest is what serves their political agenda or gets them to the golf course in the quickest time. Not to mention the grief and hassle laid upon NCHDs by medical manpower when someone gets ill for whatever reason. Depression prevelance is nearly 1 in 5 of the normal working joe soap....now double his hours give him responsibility for other people's lives bully him daily and give him grief when he gets ill....I think NCHDs must be either immune to depression or the HSE and training bodies are ignorant to the issue! Again great writing Anthony

  • SES | 19 Jan 2013 03:01

    Thank you Anthony. I have always tried to be open about my experiences with depression and attempting suicide, in the hopes that one day somehow this might make a difference to someone's life. So far it has a few times. I took a year out to contemplate my future in the HSE, and have recently come to the conclusion that I cannot go back. In some ways those that have left feel like survivors - we may have run away, but only to preserve ourselves. I think of Jess daily, and I remember the fun times we had together, and how she laughed. I hope no one else should have to lose - yet another - colleague, student, friend.

  • ETN | 19 Jan 2013 02:01

    In light of the recent tragic death of the young doctor above named, a psychiatrist was brought in to give a talk to the St James' interns about dealing with stress. He raised the twin issues of sleep deprivation and the completely inappropriate demands placed on the junior grades, and asked if we had any suggestions on how to ameliorate this in our lives. I piped up that the single most effective thing that could be done to reduce the dangerous levels of stress imposed would be to implement the most basic legal working conditions set out in the EWT. No-one had anything to say on this. As Dr O'Connor points out, this entirely unsafe situation is the status quo, and barely on the radar for those who have the power to do something about it.

  • Cathy | 19 Jan 2013 01:01

    Agree entirely with the sentiment of this article. Thank you Anthony for highlighting this forgotten tragedy with occurs too often within the HSE. Hopefully changes will be made before anymore of the young talent of Ireland give their lives to the sinking ship that is the HSE

  • R | 19 Jan 2013 01:01

    Well said. I couldn't agree more.

  • K | 19 Jan 2013 00:01

    Well done on commenting on such an important problem, this is a very well written and important article that merits nationwide exposure.

  • SK | 19 Jan 2013 00:01

    Thanks for writing this. I'm looking at numerous 80-straight hour shifts inhouse on call over the next 6 months, Friday mornings till Monday evenings. This is built into the system, it requires it to function. And it's obscene. I intend to emigrate to a country that treats its doctors humanely at the earliest opportunity.

  • R | 19 Jan 2013 00:01

    Beautiful piece, beautifully written, with wonderful insight in contrast to the ill-informed articles about junior doctors so often published in the media. As a group, we, the junior doctors of Ireland, owe it to the memory of those doctors to make certain that our working conditions no longer remain a risk factor for suicide. It's time for change.

  • K | 18 Jan 2013 23:01

    A thoughtful article with familiar overtones for many of us working in Irish hospitals at present. On multiple occasions I wished to be knocked off my bicycle en route to work rather than deal with another 36 hour shift/short staffing levels/endless toiling in non clinical tasks left for NCHDs to sort as no one else will fill the gaps. After these recent tragedies and yet no willingness on HSE/hospital (in)human(e) resource departments what will need to happen before safe and sound working practices are the norm? I shudder to think...

  • Michael | 18 Jan 2013 23:01

    Thanks for writing this Anthony. It needs to be said in as many different ways as possible as frequently as possible. I`ve been out and back through a major depressive episode and was lucky enough to have great support from higher trainees and my friends and colleagues who recognized what was going on, even when I had lost all insight and perspective. What else is there to do but talk, and keep talking?

  • A | 18 Jan 2013 23:01

    I was heartbroken to hear about the loss of a second colleague in less than six months. I had the privilege of knowing and working with both of these doctors and count myself lucky to have known them. They were brilliant young physicians who worked tirelessly for their patients and their passing is a huge loss to medicine. May they rest in peace. I too have battled with depression, not helped by hours and hours of on call and overtime and endless post call jobs that can never wait until tomorrow. I often felt overwhelmed with nowhere to turn but thanks to an amazing family and super GP I am now back on track. It's high time we started looking after each other, enough is enough. I can't bear to contemplate the loss of another friend.

  • Rory | 18 Jan 2013 23:01

    One of the most important and well written articles I've read in a long time.

  • Donal | 18 Jan 2013 22:01

    Thank you for writing this Anthony.

  • Kate | 18 Jan 2013 22:01

    Difficult to express how much I agree with this article. Well done Anthony for articulating it.

  • Anthony | 18 Jan 2013 21:01

    Hi Marian and Matt Thanks for your comment which is very moving. I knew Jess as a student and intern at Tallaght where I was her tutor in final med. She was beautiful and talented and she cared deeply for her patients and would go the extra mile for them. I have many memories of her pursuing me tenaciously for consults and endoscopies for her patients in my last year there! She really was one of the good ones and her passing shocked and moved us all. One of my motivations for writing this and highlighting it (I'm finished as a junior doctor in a few months) was if my daughter ever followed me into medicine I don't want her to have to go through what doctors like Jess did. And I can't even imagine the grief you are going through as parents. If I can help in any way my email is jpanthonyoconnor@hotmail.com Anthony

  • Marian and Matt Murphy | 18 Jan 2013 21:01

    We are the parents of one of the junior doctors you mention. We thank you most sincerely for articulating our feelings in a way that acknowledges the complex factors leading to the death of our beloved Jess.She had suffered from depression for many years and had been treated by three GPs, two in Ireland and one in Australia where she had worked for eight months last year.However, we are convinced that the pressures she experienced during the five months of her SHO scheme contributed in no small way to her final bout of depression.She loved being a doctor but had come to feel that she could not continue to work the hours required by the Irish hospital system to care adequately for patients.She also found it impossible to contemplate a future outside of medecine.Would Health Service managers condider consulting with their Australian counterparts to discover a way to run hospital services which would allow doctors to work a normal 40-50 hour week? If not to prevent other families from suffering our horrendous loss and pain, then for the safety of doctors and patients?

  • Dave | 18 Jan 2013 21:01

    Thanks for writing this Anthony. Great piece, deserves more exposure.

  • S | 18 Jan 2013 20:01

    "Luckily I never felt suicidal, but I remember that morning thinking it might be nice if I was involved in a medium-sized accident where I broke a leg or an arm to get me out of call for a few weeks." This really struck a chord with me - I've had the exact same thoughts, thinking on my way into work that it would good to fall over and break my leg because at least I wouldn't have to work for a little while. And this was after getting through depression! I've never gone as far to have been suicidal, but without the support of my wonderful boyfriend, or even if I had been in a slightly busier, more high pressure rotation, it could have been so easily different. Thank you for being brave enough to talk about this - I never have been. I hope any Irish doctor who is feeling this way reads this article and realises that they are very much not alone. I've left Ireland and am now working abroad, and though I miss people hugely, I know I can never go back to work there unless there is a radical overhaul of the system. To go back would mean taking a big paycut, working hours which are so far in breach of the EWTD it's almost ridiculous, being treated like dirt by management, being so busy that I know that I am not giving my patients the care I want to, being expected to work dozens of hours per week for free (or in the case of one hospital I worked for having my overtime sheet illegally tampered with), and working in a culture where being shouted at and belittled by your seniors is all too commonplace (I have been lucky to work with some wonderful consultants, but lets face it, this is happening in probably every hospital in Ireland at multiple levels of seniority) When I look back at my class, probably the majority of them have left hospital medicine in Ireland, mainly via immigration, GP, or sadly in one case suicide. Ireland's hospitals have lost some wonderful doctors, and this will keep happening unless the HSE wake and and change things dramatically.

  • Alison | 18 Jan 2013 20:01

    I'm so glad you have spoken out about this. It's unacceptable and inhumane the hours doctors work in Ireland. It leads to a loss of a social life, excessive stress and great difficulties. For the sake of doctors and patients this needs to be changed.

  • | 18 Jan 2013 14:01

    Great piece. I am currently in the process of moving, and will be gone come July. Many of my friends are also moving, with very few having applied for Irish HST schemes.

  • Nigel SR | 18 Jan 2013 13:01

    Great piece Anthony. Having the pleasure of working with two of the doctors, I can say they will be missed and their place never be replaced. Again, you speak up for us the same way you did when I was still in Dublin, fearless and with simple common sense. As for working in Ireland... I could not wait for the powers that be to come to a decision about our lifestyle and our lives. I made a decision to move, one I have not regretted til this day. I miss Ireland, and I wish things would have worked for our generation. There might still be hope but I didn't want to live like that anymore. May they rest in peace.

  • Ruth-Anne | 18 Jan 2013 12:01

    You are, as always,a powerful voice for us Anthony when we have none.In our parents' time there was no emphasis on self-care yet I am now on a GP training scheme(north inner city)that has a whole module on it. If only the HSE could catch up and implement the change that is so badly needed..

  • Jane | 18 Jan 2013 11:01

    I was on call with an SHO who, having done Friday am to Monday pm, in house on call straight with no break, killed themselves immediately afterwards. Good on you for speaking up. More of us need to.

  • Darren | 18 Jan 2013 01:01

    Heartily agree with the sentiment of this article. I have seen work induced depression in another profession do horrendous things to decent people and make them go places in the human mind no person healthy of body mind and soul should ever go. Yet it is still viewed as a taboo and something people should just snap out of and go back to business as usual. I do hope this changes.

  • | 17 Jan 2013 23:01

    fair play anto

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