Hoong-Wei Gan: Strike on, strike off: why junior doctors are fighting for their patients

Striking is not integral to any doctor’s identity. As others have pointed out over the last few months, a doctor pledges, before anything to else, to “first do no harm.”

However, as doctors we no longer have to decide between amputating a gangrenous limb or leaving a patient to die. Our decision-making is becoming an ever more subtle balancing act of benefit versus risk—my neurosurgical colleagues for instance regularly have to choose between resecting as much brain tumour as possible to prevent recurrences and cutting out so much as to leave the patient severely disabled.

The junior doctors’ contract dispute and industrial action are perhaps no different. The cacophony of issues touted by the Department of Health, the BMA, and the press make for a confusing read, even for us within the profession. Prior to this, I knew few junior doctors who were political; my own social media profile described my own political views as “apathetic.”

What, then has led us to become so vocal over the preceding few months about these contract proposals? Why have so many of us taken to making television appearances, petitioning our MPs, and writing open letters and blogs? There is one thing this all distills down to, whether we realise it or not: our patients. The medical profession is generally a diverse one but we all quintessentially agree to give our patients the quality of care we would give our parents and children. Therefore, when the very quality of care we provide is threatened, you get an overwhelming mandate of 98% being in favour of taking industrial action.

The bottom line is this. Regardless of what has been said about reducing our working hours on paper or changing our pay structure, the underlying aim of providing a more comprehensive seven-day NHS on the weekend without increased investment (and consequently any more doctors) can only mean one thing—that the current workforce will be worked harder and stretched more thinly on the ground—and both will be bad for patients.

Coupled with this is the fact that we are facing a major workforce crisis—1 in 5 paediatric registrar jobs are vacant1 in every 10 doctors who graduated with me plan to leave the UK permanently, and only 52% of F2s continued on to specialty training in 2015. The issue of pay and working conditions is an issue of recruitment and retention, with a direct impact on the quality of care.

As a paediatric junior doctor, this new contract is not simply about working weekends, it is about working so many weekends and nights that my exhaustion will mean I can no longer safely intubate that 24-week premature infant at 3 am with a 2-mm-wide tube. As an NHS patient, this new contract is not simply about being able speak to a doctor on a Saturday, it is about the neurosurgical registrar who debrided my infected post-tumour excision wound not being so tired that she is at risk of causing life-changing paralysis, or worse.

You see, regardless of what the press will have you think, the battle for a safe and fair junior doctors’ contract isn’t really about junior doctors at all, it’s about our patients. So when Jeremy Hunt threatens to exhaust us until we cave in, let’s not forget who we are fighting for, because we should be treating our patients as one of our own.

Hoong-Wei Gan is a clinical research fellow and ST6 in paediatric endocrinology at the UCL Institute of Child Health and Great Ormond Street Hospital for Children. He is also an NHS neurosurgical patient.

Competing interests: None declared.