{"id":35568,"date":"2015-10-29T16:14:17","date_gmt":"2015-10-29T15:14:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=35568"},"modified":"2015-10-29T17:42:33","modified_gmt":"2015-10-29T16:42:33","slug":"richard-smith-the-catch-22-of-health-strikes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/10\/29\/richard-smith-the-catch-22-of-health-strikes\/","title":{"rendered":"Richard Smith: The Catch 22 of health strikes"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-33037\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014-150x150.jpg\" alt=\"richard_smith_2014\" width=\"150\" height=\"150\" \/><\/a>Junior doctors are clearly extremely angry. Some 15 000 junior doctors\u00a0recently protested against changes in their contract. As there are about\u00a055 000 junior doctors in England, that\u2019s the equivalent of about 16m\u00a0of the general population protesting a change. That would be a\u00a0revolution. But why are junior doctors so angry and what should they do\u00a0about their anger?<\/p>\n<p>The standard line is that doctors are protecting &#8220;<a href=\"http:\/\/careers.bmj.com\/careers\/advice\/%E2%80%9CYes%E2%80%9D_vote_predicted_for_junior_doctors%E2%80%99_ballot_on_industrial_action\" target=\"_blank\">patient safety, the\u00a0wellbeing of doctors, and the future of the NHS<\/a>.&#8221;\u00a0That seems to me spin.<!--more--><\/p>\n<p>Hospital care is dangerous. We\u2019ve known that for 30 years, but nothing\u00a0happened until the <a href=\"https:\/\/iom.nationalacademies.org\/Reports\/1999\/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" target=\"_blank\">Institute of Medicine published its report<\/a> in 1999, and\u00a0nothing moved in the UK until the new century with the creation of the\u00a0<a href=\"http:\/\/www.npsa.nhs.uk\/\" target=\"_blank\">National Patient Safety Agency<\/a>. Hospitals are probably safer now than\u00a030 years ago, but no doctors were inspired to march through the streets\u00a0protesting lack of safety until the contract of junior doctors was\u00a0threatened. Tiredness in doctors is a safety problem, but it\u2019s by no\u00a0means the main one\u2014and it\u2019s a matter of dispute whether junior doctors\u00a0will be working longer hours.<\/p>\n<p>Junior doctors are, of course, smart enough to realise that the public are\u00a0much more likely to respond to threats to patient safety than to doctors\u00a0having to work Saturday evenings.<\/p>\n<p>Similarly the public will be concerned by threats to the future of the NHS.\u00a0And the NHS is threatened, but not by changes to the junior doctor\u00a0contract. It\u2019s threatened primarily by the rising cost of healthcare\u00a0because so much more can be done\u2014albeit, much of it, like keeping\u00a0people with cancer alive another six weeks with expensive drugs, of\u00a0minimal public (as opposed to individual) benefit.<\/p>\n<p>The wellbeing of doctors\u2014which can sound like spin for how much they\u00a0are paid\u2014is a real issue, but is it primarily about hours of work and pay?\u00a0I think that it may be something much deeper.<\/p>\n<p>Schoolchildren and young people aspire to become doctors because\u00a0they expect to have meaningful work that will do good, be interesting,\u00a0attract a reasonable salary (maybe even a high one if they take up\u00a0private practice), offer lots of opportunities, and command respect and\u00a0status. Is there a sense that being a doctor no longer delivers these\u00a0aspirations? I won\u2019t analyse them one by one, but as a junior doctor you\u00a0can feel like an unloved, even unnoticed, stressed cog in a vast machine\u00a0and being a doctor is not what it once was. You are anxious too about\u00a0what\u2019s going to happen with the NHS, and Jeremy Hunt being so\u00a0dismissive is hardly helpful.<\/p>\n<p>So perhaps the protests are about more than hours and money. They\u00a0reflect a deep frustration, a feeling of being undervalued.\u00a0But what to do? Protest and talk and talk, yes, but take industrial action?<\/p>\n<p>There\u2019s a Catch 22 inherent in health workers taking industrial action.\u00a0The point is to disrupt services and cause pain, and a handful of tube\u00a0drivers can achieve huge impact by striking. People may be furious, but\u00a0nobody dies. Most of the people affected are far from vulnerable, and\u00a0walking home probably does them more good than harm. But with a\u00a0strike by health workers you either cause harm to vulnerable people,\u00a0even perhaps kill them, or nobody notices that you\u2019ve been on strike.\u00a0Either way you lose.<\/p>\n<p>Then, there\u2019s the seeming paradox that doctors going on strike leads to\u00a0a <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18849101\" target=\"_blank\">drop in mortality<\/a>.<\/p>\n<p>People guffaw when told this well established fact, but it\u2019s not surprising\u00a0because emergency care continues and elective care, which inevitably\u00a0causes some deaths, ceases. So maybe a strike will lead some pundits\u00a0to ask if we really need 55 000 junior doctors.<\/p>\n<p>This blog will not make me popular, but I\u2019m not arguing that we should\u00a0ignore the anger and distress of junior doctors. We simply need to think\u00a0more deeply about the causes of their distress and how to respond\u2014and\u00a0most of the response needs to come not from politicians but from\u00a0doctors themselves. Doctors should never see themselves as victims.<\/p>\n<p><em><strong>Richard Smith<\/strong> was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.<\/em><\/p>\n<p>Competing interests: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Junior doctors are clearly extremely angry. Some 15 000 junior doctors\u00a0recently protested against changes in their contract. As there are about\u00a055 000 junior doctors in England, that\u2019s the equivalent of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/10\/29\/richard-smith-the-catch-22-of-health-strikes\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[165,955],"tags":[],"class_list":["post-35568","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-junior-doctors","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: The Catch 22 of health strikes - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/10\/29\/richard-smith-the-catch-22-of-health-strikes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: The Catch 22 of health strikes - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Junior doctors are clearly extremely angry. Some 15 000 junior doctors\u00a0recently protested against changes in their contract. 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