Dr Dan Poulter and the 100-hour weeks

Could the new health minister please clear up his statement about his hours as a junior doctor?

With all the excitement over Jeremy Hunt's acceptance of the Poisoned Health Chalice, and the related stories about his pro-homeopathy and anti-abortion stances, you may have missed the news that former junior doctor Dan Poulter MP was appointed as Parliamentary Under-Secretary of State for Health.

Over the last couple of months I've been trying to get Dr Poulter, or "Dr Dan" as he prefers to be called, to clarify some statements he's made about the long hours he used to work as a junior doctor.

On Newsnight on Tuesday 19/06/2012 he said he "often used to do 100-hour weeks" (It's no longer on iPlayer but you can see the video here.

And he made a similar claim in a speech in the House Of Commons on 26/4/2012. I quote from Hansard:

"My hon. Friend said that we do not want to go back to the bad old days of 100-hour weeks. I worked those 100-hour weeks, and I am sure that the other medical doctors who are in Westminster Hall today did so, too. It was certainly not ideal to work 100-hour weeks; it was not good for patient care."

Now these comments have raised a few eyebrows in medical circles. Non-medics reading may wonder why; after all, everyone knows junior doctors work very long hours, right?

Well, kinda. As recently as the 1990s it was not uncommon for juniors to work very long continuous periods on call, and many older doctors can remember working a "one in two" rota (a regular working week, but staying up all night every second night, and working every second weekend continuously from Friday morning til Monday night - averaging 120 hour per week).

As Dr Dan says, "it was certainly not ideal", and that's why the BMA negotiated the New Deal for junior doctors, which was introduced around the time I qualified in 2000, and limited on call workers to 72 hours per week. Some hospitals didn't implement the terms of the New Deal until 2004, but were penalised by having to pay their doctors up to twice basic salary (that's how I managed to pay off my student loans). Hours were then limited further in 2004 with the introduction of the European Working Time Directive (EWTD) which specifies that no doctor should work more than 58 hours per week on average, and all workers were entitled to a period of 11 hours continuous rest a day. Many doctors are unhappy with the EWTD, as a lot of hospitals get around it with rotas containing weeks of up to 7 13-hour night shifts (91 hours per week for that week, but balanced out by random days off elsewhere). Having myself worked both the old "on-call" and new "shift" system, I can say that there are pros and cons to both, but the big pro is that new doctors no longer have to stay up all weekend without sleep.

Why am I telling you all this?

Well, Dr Dan only started work as a junior doctor in August 2006.

If Dr Dan was "often" doing 100-hour weeks in 2006-7, he (and, we must assume, his co-workers) would have been working in contravention of European employment law, and his hospital trust would be liable for fines of several thousand pounds for each breach.

This is where the raised medical eyebrows come in. The EWTD was enforced much more rigourously than the previous New Deal, because of the non-negotiable swingeing penalties threatened from Europe. As a result, I don't know of any 2006 graduate who's worked a 100-hour week, let alone on a regular basis. I'm not sure if it's even mathematically possible to squeeze 100 hours into the strict terms of the EWTD. The most I'm aware of is the 91-hour example above, but that would be an infrequent happening on a rota, maybe every 10-12 weeks; certainly nothing that could be described as "often". It's also worth noting that Dr Dan was elected as a councillor in Redhill on May 3rd 2007, and according to his website was Deputy Leader of Reigate and Banstead Council from 2008 until his election as an MP in 2010. When you factor in his hobbies, and the many good works he's undertaken in his spare time, I'm just struggling to see how the poor chap managed to fit it all in.

But, taking Dr Dan at his word, I felt it was important to find out where he was working, to avoid other junior doctors being exploited in the future. So, I emailed Dr Dan to see if he could shed some light on the matter. Unsurprisingly, I recieved a standardised reply: "Please note that there is a strict Parliamentary rule that MPs can only help their own constituents".

I'm not a constituent, but the Suffolk-based legal blogger @PME200 is. I understand he also contacted Dr Dan recently over his concerns that a local NHS trust may have been exploiting a junior doctor and breaching the law. It appears that Dr Dan point blank refused to confirm which trust employed him during the alleged 100-hour weeks. He effectively told his constiuent to mind his own business.

Why is Dr Dan so coy with the details of his 100-hour weeks? We can only assume that Dr Dan (unlike any junior doctor I've ever met or heard of) was genuinely "often" doing 100-hour weeks in 2006-10, but is so protective of his erstwhile employers he cannot bear the thought of revealing that they were serially breaking European Law.

Of course, there is an alternative explanation. It is possible that Dr Dan (like every other junior doctor I've ever met or heard of) actually WASN'T "often" doing 100-hour-weeks in 2006-10, but has chosen to pretend that he was, perhaps to try and carry some of that junior doctor kudos into his new role in one of the nation's least favourite professions.

If this was the case (and of course I'm not for one second suggesting that it is, merely enjoying a thought experiment while we await confirmation from Dr Dan of the names of the law-breaking hospital trusts concerned), would it really matter? After all, we accept that our politicians will somteimes give a different version of events to suit their own agenda.

Here's why I think it would matter:

1. Dr Dan isn't just an MP, he's a registered medical doctor like me, and society holds its doctors to a higher standard of probity than it holds its politicans. Specifically, the General Medical Council states in Good Medical Practice that:

"64. You must always be honest about your experience, qualifications and position, particularly when applying for posts."

If, (and again, I'm not saying this is the case, merely that it is one possible explanation of the facts we have while we await clarification from Dr Dan), if Dr Dan could be shown to have persistently and deliberately misrepresented his clinical experience in order to improve his standing as an MP, this would transcend politics and hurtle toward the realms of professional misconduct.

2. There's a thing called misleading Parliament. I'm not too familiar with this (hence the Wikipedia link), but apparently if you're making a speech in the House Of Commons, it's frowned upon if you start making shit up.

3. Whatever his many failings as Secretary of State for Health, Andrew Lansley was an absolute master when it came to completely alienating the medical profession. At the last election most doctors I know voted for one of the two coalition parties. With the twin pitchforks of NHS privatisation and pension cuts, Lansley has completely destroyed that support. One can imagine that Dr Dan was elevated to his ministerial position with at least a partial hope that having a doctor in government might go some way to winning back medical hearts and minds. Now, a doctor who could do such a thing would have to show themselves to be of impeccable character. They certainly wouldn't gain any friends if they appeared to be claiming experience they didn't have, or posturing to try and appear older and more battle-hardened than their CV could account for. If a shadow were to fall over Dr Dan's credibility and probity as both an MP and a doctor, it is hard to see how his addition to the government would be beneficial.

Why am I blogging about this now? My exchange of emails with Dr Dan was a couple of months ago, and while he remained a back bencher it seemed somewhat churlish to push the issue. Though I strongly oppose his government's privatisation agenda, I have no beef with him personally, and in fact admire his stance on expenses and his statements in favour of plain packaging for tobacco.

But now that he is a Health Minister, I'd like to know that he can be trusted.

Dr Dan can clear up the situation now by answering three simple questions:

  1. Which Trust did you work for, for which consultant, and at which grade, duing the period when you "often used to do 100-hour weeks"?
     
  2. Can you provide a copy of the rota so we can ensure future generations of doctors aren't exploited in this way?
     
  3. What sanctions if any were taken against the employing Trusts for these breaches of employment law, and if none were taken, what steps will you take as Health Minister to amend this?
     

I hope Dr Dan comes up with the answers soon. I'd also be keen to hear from any medics who think they did work a 100-hour week rota as a junior doctor in 2006, particularly those who worked with Dr Dan himself! If Dr Dan doesn't respond, I suppose it might be possible for a journalist to apply under the Freedom Of Information act. Let's hope it doesn't come to that.

This post first appeared on Pete Deveson's blog here. You can follow him on Twitter as @PeteDeveson

Update, 21/09/2012: You can read Dr Dan Poulter's response, and Pete Deveson's commentary on it, here.  

Dan Poulter appearing on BBC News.
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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear