Parkinson’s

No, not the talk show host, not the disease, nor even the dirty joke about how old men in the old-folk’s home prefer old women with that disease, but this letter from the ST Forum today:


Dec 7, 2005
Review doctors' working hours, for safety's sake

I refer to the article, 'Checks in place to manage stress, fatigue' (ST, Dec 2), which stated that pilots are not allowed to fly more than 100 hours in any 28 consecutive days. This is to ensure that they fly with full concentration and deliver passengers safely to their destinations.

I wish to relate this to the plight of doctors here. Not long ago, an article in Time magazine reported that in the United States, around 98,000 deaths each year are the result of medical errors. Could some of these errors be due to fatigue or poor concentration?

I have friends who are junior doctors. They tell me their workday typically starts at around 7am, when they prepare to do ward rounds, after which the rest of the day is spent mostly in the wards carrying out instructions given by senior doctors. Their day theoretically ends at 5pm, but they do not usually leave before 6pm.

And when they have night duty, they work continuously from 5pm till the next morning. Thereafter, they continue the morning's duties like in any other day. They are allowed to leave only when they have completed the tasks for that morning. Many a time, it can be as late as mid-afternoon. That means they would have worked non-stop for close to 24 hours. And these night duties can occur up to six times a month.

These junior doctors are always stationed in the hospital wards and if their concentration and competence are affected by fatigue, are we not placing patients at risk?

Are we so short of doctors? Or are the hospitals swamped with too many patients? As with passenger safety, when there are patients' lives at stake, it makes sense for doctors' working hours to be reviewed.

Chris Tan


The opening analogy is interesting, not least because junior airline pilots earn more than junior doctors, and few patients are worth as much as aeroplanes. But the bit I would like to rant on is the last paragraph.

I believe that Parkinson’s First Law, which states that:

Work expands to fill the time available for its completion

also applies to subsidised healthcare.

The cost of unsubsidised healthcare is so high and hence the subsidy so attractive, that people will continue to seek subsidised healthcare and stretch it to its capacity unless one or both of two things happens:

1. It becomes so dangerous or unpalatable that people would rather spend the extra money than to receive it.

2. A system is in place to deny people of subsidised healthcare, based on whatever criteria as the case may be (e.g. means testing).

It seems that the author of the letter is arguing that we should do something about doctors’ work hours before 1. becomes a reality (some would argue that it already is a reality), without implying that 2. is the solution.

I don’t think anyone is actually perpetuating the current system of night-calls which really means six or more 36-hour shifts per month just to torture junior doctors. A simple calculation will tell you that to have separate night-shift doctors will mean a doubling of manpower requirement if after-hours are to be fully-staffed, or a 50% increase if it is on half-staff.

The current manpower shortage simply does not allow that, even if we had the money to employ the staff. Or is it a distribution problem? Can we increase the manpower pool by luring GPs in the private sector to work as junior doctors for a five-figure salary?

It might work, but that will drive healthcare costs up to an amount we are not willing to bear. Plus from Parkinson's Law, one can predict that people will continue to consume as much healthcare we can provide.

Something has to give.

I don't really wish to see 1. happen, so I guess I have to root for 2.

I'm not a fan of means testing as it stands though - it allows for a situation where a poor person may over-consume healthcare he does not need with impunity, while a rich person who needs it for a major illness can quickly become no-longer-rich from having to pay for it.

Even though this is theorectically a question of economics, as doctors we see this being played out so often you wonder if there is a fairer way of doing it.