Malta’s public health system faces formidable challenges caused by wrong strategic decisions taken in the recent past, a growing and ageing population, workforce shortages and outdated working practices.
The consequences of all these factors are that patients' safety is at risk and taxpayers are not getting the value for the money they deserve.
A research paper by Alexander Clayman, a trainee psychiatrist, has exposed the fault lines in working practices that subject junior doctors to long hours of continuous work leading to excessive fatigue, burnout and escalating risks to patients’ safety.
It is generally acknowledged that the medical profession has a strong cultural association with intense, demanding work. This is partly because people can get sick at any time of the day and expect immediate professional attention.
However, Clayman’s report gives a worrying insight into a culture in which the punishing hours worked are an almost inextricable part of doctors’ professional identity.
The report claims that doctors in many departments work 30-32 hours at a stretch. Unsurprisingly, the author argues: “This has been proven to have a negative impact on staff’s mental and physical health as patients experience poor empathy as well as accidental and non-accidental medical errors.”
A condescending health ministry spokesperson blames doctors for their present unacceptable working conditions.
The spokesperson insists that “Doctors who opt to have 32 hours on-call periods usually do so in the interest of their training, in the interest of continuity of patient care or for financial reasons”.
Martin Balzan, president of the Medical Association of Malta, says that current work practices are acceptable and that any improvement could be achieved “if there were more doctors who could cover leave and sick leave”.
The European Working Time Directive has been enacted in many countries to combat overwork, with mixed results.
In many countries, 24-hour shifts are no longer common practice. Still, most public health hospitals in Europe remain understaffed and their doctors are overworked. The time is ripe for a serious discussion about the ethical implications of doctors working 24-hour shifts.
Some medical professionals argue that rethinking this system in favour of a maximum shift duration of 12 hours would be a bold step, even if it would not solve all the problems facing public health systems.
Of course, other medical experts may be reluctant to change the status quo and hold valid concerns about doing so.
Unfortunately, our public health system may have entered a vicious cycle of endemically poor working conditions for medical professionals, driving them out of the system, either from burnout or simply to seek employment elsewhere.
Public health policymakers must be honest about the investment needed to improve the working conditions of medical and paramedical workers.
Today’s junior doctors are tomorrow’s consultants and we must invest in the system and provide a good reason for them to stay.
The most crucial issue is the promotion of a cultural change within medicine. Working while exhausted should start to be seen as less than acceptable, the exception rather than a norm hardwired into current work practices.
In the interests of safety, patients and their families have a right to demand that their doctors have had enough rest before treating them.
They certainly do not want to be treated by doctors described in the study as excessively sleepy, emotionally exhausted, irritable, lacking in empathy, prone to error and even relieved if you were to pass away.
Doctors are ordinary people with ordinary limits. This study has exposed the urgent need to reform work systems that reflect these limits rather than ignore them.