Interview with Dr Kerryn Phelps, President, AMA: Discussion of the working conditions of junior doctors; and removal of organs during autopsies - 'Today on Saturday', Channel 9, 3 February 2001

With me now - AMA President Dr Kerryn Phelps.

Good morning.

Dr Phelps: Good morning Ali.

Compere: Well, this issue of junior doctors working long hours is not new. But were you surprised at just how widespread your survey showed the problem was?

Dr Phelps: We weren't surprised because, as you said, we've been hearing about the statistics at least anecdotally for many, many years. But what we're saying is that we have now done a national survey of junior doctors' hours and we've asked them specifically the hours they work, the time they have off, whether they have meal breaks, whether they have days off in between their shifts, whether they get time to sleep. And the results are very important because it actually shows that right across the country - metropolitan areas, country areas - we're seeing young doctors who are being expected to work hours which in any other industry would be considered impossible..

Compere: So there's no differentiation about where you are? Everyone is facing the same issue?

Dr Phelps: Yes. That's one of the interesting things, that wherever the junior doctors are working, they are expected to work excessively long and we consider unsafe hours.

Some specialties are worse than others. And it seems that the surgical registrars appear to be worse off than most.

Compere: How many hours are unsafe hours?

Dr Phelps: Well, it depends not just on the total number of hours, but whether you actually get time to sleep. We had one report, for example, from a doctor who'd been expected to work 64 hours straight, with some of those times on call, where he they thought, well, you know, you can get some sleep in that time. But, of course, you can't always get sleep because if an emergency comes in, if the sirens are going, you've got to be there.

Compere: Is there any documented evidence that these excessive hours are actually causing mistreatment of patients?

Dr Phelps: I don't think there's any documented evidence. But common sense would tell you that if people are absolutely exhausted and they've been up and about for 24, 36 hours, that it would be impossible for any human being to be working at their optimum. And when you're talking about sick patients in hospital who require very specific and careful care, you can't afford mistakes. And yet there is the potential for mistakes to happen when somebody is so tired.

Compere: Well, given it seems so logical that this shouldn't be happening, why is it still happening, and how do you stop it?

Dr Phelps: It's partly history. I think hospital managements have always thought, well, you know, we've got this workforce of junior doctors, and this is how all the pieces fit together to fill up our rosters.

Compere: This is so you should do it now.

Dr Phelps: Well, there's a little bit of that too, with the more senior doctors saying, 'well', you know, 'you need to get the experience' and, you know, 'we did it, and that's how we did it, and so it's okay for you to do it too'. But I think we know so much more now about things like sleep deprivation, and we're understanding now that junior doctors are supposed to be learning while they're working. And you can't learn effectively if you're terribly tired, and you also don't want to be, at that junior stage of your career, make a mistake that will perhaps effect somebody else's life. So it really is a situation that requires an urgent response.

Compere: What sort of response though? How do you change a culture?

Dr Phelps: Well, we want to see a change of culture. And I think the first stage is awareness. And that's partly what the release of our national audit was all about. But what we want to see is hospital managements really taking hold of this issue and saying 'we are going to implement safe rostering. We're going to make sure that doctors are actually rostered for time that they can sleep. That they get days off. That they are allowed to have meal breaks without feeling guilty about it.'

And we also want to see - if that doesn't happen as a voluntary code, we want to see the AMA's national code of practice implemented and therefore the State governments, if necessary, bringing in regulations or bringing in statutory law to make it mandatory for hospitals to have safe rostering practices.

It should be a requirement of accreditation of a hospital that their rostering practices are safe. It may require greater budget to put more people on to do those hours, but it may not require

a great deal more. For example, increased use of technology might ease the burden on some

of the junior doctors.

Compere: If we can just finish on another medical issue that's been making the headlines this week -

the removal of organs. How urgent is there a need for national guidelines?

Dr Phelps: I think that the latest case in the United Kingdom has really highlighted this as a problem.

There is a difference between the UK and Australia. In Australia you have to give consent for anything other than a coronial autopsy. And unless the relatives cannot be found, you have to get relatives' consent.

But we don't know exactly how many stored organs are in hospitals and medical research institutes and in universities around the country. And I think that first and foremost we would support the call for a national audit of stored tissues and organs.

And secondly, I think that we need to see national guidelines about what happens to organs that are removed from bodies for examination. One of the ways that we expand our knowledge about the cause of death and about disease is by studying tissues after death. And so we don't want to lose that great resource in terms of the intellectual capital that is gained from that exercise.

Compere: But people have a right to know what happens.

Dr Phelps: Families absolutely have a right. And what they often don't realise is that when they sign a consent for an autopsy, they are actually signing also a consent for the retention of organs. And I think families need to be able to understand that.

But, of course, the last thing you think of when you're grieving for a lost relative is what's actually going to happen in the nitty-gritty of an autopsy. But I think people need to be aware.

And also the College of Pathologists in Australia is looking at a national formulation of a consent form for autopsy. And we very much support that too.

Compere: All right. Thanks for talking to us this morning.

Dr Phelps: Thanks Ali.

Compere: Dr Kerryn Phelps, AMA President.