All doctors have a personal horror story

Most doctors have at some time borne the broken look of Marlon Brando's Colonel Kurtz in Apocalypse Now, dehumanised by the Vietnam War. For me, “the horror” was over 10 years ago as a preregistration doctor in surgery at St James's Hospital, Leeds, about the time the European Working Time Directive was conceived by people with time to think. I began a weekend shift at 8 am on Saturday morning, an endless ward round of patients I'd never seen before with illnesses I little understood. I finished at 9 pm on Monday after non-stop calls—mostly straightforward but many bewilderingly complex—a couple of cheese sandwiches, a few cans of soft drinks, and three hours of broken sleep on a two seater sofa.

At some point on Sunday evening my fellow junior doctors and I cracked. Overworked, sleepless in surgery, every incident and comment greeted with unstoppable mirth, professionalism replaced by inane amusement at our predicament. By Monday evening we were catatonic Brandos. Sharing this rite of passage with senior colleagues attracted little sympathy: “In my day we had it much worse; whole weeks on call without a break.” “The experience will be good for you.” But was the experience any good for patients? Was it really any good for any of the doctors who lived it then and live it now? Too much mistreatment of doctors and patients has been excused by what is deemed good for us.

This week, the working time directive should mean fewer doctors in training work more than 58 hours a week (p 310). Rhona MacDonald describes how organisers of health care have had to innovate by rethinking out of hours cover and switching to competency based training (p 301). New medical schools have opened in England to supply enough doctors to compensate some far off day for this reduction in working hours (p 327). What hope that doctors in training will see real benefit? MacDonald, a passionate Scot, argues that those already exploited—doctors from poorer countries and non career grades—will be further exploited for doctors in training to benefit. This well meaning legislation—legislation that doctors know to be inapplicable without major reform of the medical workforce and medical training—is proving hard to implement, as our European round up shows (p 310).

Richard Smith, another passionate Scot—by choice, not by birth—left the BMJ last week (p 309). He devoted 25 years of inexhaustible energy to this publication—13 years as one of its greatest editors—one eye on blue skies the other on fine detail, working at full tilt to the end as he promised, in defiance of any working time directive. He leaves behind a young team—plus some wise heads—dedicated to building on his considerable achievements. The BMJ will miss his genius and his gusto. But as he once told me: “Nobody is bigger than the BMJ, not even me.”