Shadow doctors to end 'Black Wednesday'
A mentoring scheme could help the 7,000 new junior medics from making catastrophic errors on their first day in hospital this week
Abigail Downing, a 24-year-old junior doctor at Bristol Heart Institute, is pacing the floors of her ward. She checks on each and every one of her 24 patients, arduously writing down every minute detail in their exchange. She is responsible not only for documenting the ins-and-outs of each patient's illness and the happenings on her floor, but today, she is also showing me, how we can put an end to what has been dubbed the National Health Service's "Black Wednesday", once and for all.
In only three days' time, an estimated seven thousand new junior doctors will arrive in hospital wards to start their new jobs, fresh out of medical school. Research suggests death rates rise by on average six per cent on this day, with the most marked difference apparent in medical cases such as heart attacks and strokes, where they rise on average by eight per cent. Some have said it is the most dangerous day of the year to fall ill.
Ms Downing is just one of the many doctors now being relied on by the NHS to counter this phenomenon. Just as I am by her side today, thousands of young medics will have to shadow their predecessors for a minimum of four days before they take up their jobs on August 1, from next year. They will be paid for their induction days, at a cost of £1.6m.
It is hoped the initiative will reduce the number of errors made in the early stages of their careers. University Hospitals Bristol (UH Bristol), which has run a pilot scheme for four years, found that mistakes new doctors made in their first four months were reduced by 52 per cent after a week of shadowing and targeted teaching was made mandatory. While they recorded five incidents leading to permanent patient harm in 2008 – where patients ended up in intensive care – there was only one in the first four months of 2009.
Dr Rebecca Aspinall, consultant anaesthetist and programme director for doctors training at UH Bristol, said it was "common sense". Fresh from presenting to 39 of her incoming junior doctors on the "near misses" of last year's cohort – including taking blood from the wrong person, misprescribing patients, delaying care, and giving penicillin to those allergic to the antibiotic – she stressed first year doctors remained the hospital's "gateway to safety".
After saying the study, carried out by researchers from the Dr Foster unit and the department of acute medicine at Imperial College London, was a "little over dramatic", she added "something had to be done.
"There is a dramatic change between being a student and working as a doctor – it is a much bigger transition than a doctor will ever do again in their work life," she said.
"There was the argument that when we're seeing military reduction, the number of firemen reduced, and other public sector workers losing their jobs, how can we justify lengthening the contractual employment of new doctors? I say if we spend money now it will save money later by stopping patients going into intensive care."
Sir Bruce Keogh, medical director of the NHS, who was behind the national roll-out of the scheme, agreed. It was a "no-brainer", he said, adding: "I suspect the changeover does put patients at risk and a lot of people in the NHS would agree with that. This has been a problem in other countries too, like North America, when it happens around December and July [the 'July Phenomenon'], but the difference is, the NHS can deal with it."
Katy Day, a 26-year-old from Bristol, who will begin her career as a doctor this week, said she sees the shadowing as a "great opportunity". She has spent two days shadowing in Bristol so far, and said it was her first time in the hospital, where she would soon work. "It's quite a daunting prospect to start and there's massive responsibility working with the public. I'm glad I'm able to ease myself in." Her peer, John Frawley, 34, from County Mayo on Ireland's west coast, said his shadowing experience had left him feeling "prepared", adding that "no-one wants to make any mistakes".
Alastair Henderson, chief executive of the Academy of Medical Royal Colleges, said he was "very supportive" of the scheme and agreed the sector needed to do everything they could to "mitigate" risks to patient's health during the transfer period. He added, however, that the shadowing scheme only dealt with foundation doctors and not the estimated 50,000 doctors who transfer jobs in the NHS twice a year in August and February – around one third of the total work force.
"The other issues to be considered are the inductions given to all doctors who change and about the consultant presence at that time. We are also considering how easy it is to stagger the whole process, so all doctors in training don't transfer at the same time," he said.
As for Ms Downing, she recognises that "everyone feels scared" when they start. "I just try and give them tips, like how to fill out the medical forms, how to survive nights and being on call, and even where to find food and shortcuts around the hospital. It saves a lot of time, and in this job, you really have to be organised," she said.
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