“Doctors are less competent now than they used to be”

“Doctors are less competent now than they used to be”

Lung specialist and professor Geertjan Wesseling says farewell

19-04-2023 · Interview

Workload, stress, burnout. It is the order of the day now, while assistant physicians used to work twice as many hours. How is that possible? It is one of the subjects that Geertjan Wesseling, professor of lung diseases, will touch upon in his farewell speech.

At the beginning of the nineteen-eighties, working weeks of 90 hours were not unusual, says Geertjan Wesseling, lung specialist and head of the lung diseases department at the MUMC. “If I was on duty at the weekend – I worked in a hospital in Haarlem at the time – I would start on Friday morning at 8:15 and stop on Monday evening. All those days, you slept at the hospital, but never for a whole stretch. You were called upon every couple of hours by nurses or the emergency department. You would be completely broken by Monday evening and fall asleep on the sofa at home. The rest of the week followed with four working days of ten hours each. Nobody spoke about something like the balance of work and private life.”

Wesseling remembers that nurses knew all too well when assistant physicians were completely exhausted. “Let me do that, they would say, and at that time would take over getting a blood sample.”

Those kinds of working hours are a thing of the past, although the workload and stress are greater than ever. It is one of the themes that Wesseling will touch upon in his farewell speech on 26 April. He will also mention the achievements in his field, the CT scans and PET scans that have provided spectacular progress. Also, should we be giving those over 90 expensive medicines, or do these patients benefit more from care and attention from a district nurse?

Much suffering

Back to the crazy rosters of a 90-hour week. They play a main role in a court case in New York in 1984. A young woman was brought to the hospital in that city in a confused state; she is given two types of medicine by the assistant physicians which lead to her death a couple of hours later. The young doctors defend themselves by referring to the excessive working weeks.

After that court case, the attitude towards extreme working hours wavers, says Wesseling. When he came to Maastricht in 1986, he even started the discussion himself. Since the nineteen-nineties there was legislation and inspections, and working days have become shorter and shorter. “Assistant physicians now work 48 hours per week, 10 hours of which are for training.”

And still stress and burnouts are more widespread than ever. “Very sad to see how young doctors crash, break down and quit. It is accompanied by a great deal of suffering.”

Trip to Bangkok

The key question is, how is it possible, seeing as the number of working hours has been reduced significantly? There is more at play than just the working hours, says Wesseling. “Control mania, for example. Doctors have to tick things off much more than before. It is intended to improve the quality of care, but we didn’t become doctors to tick things off. That doesn’t give us any satisfaction.”

In addition, a lot of stress is created by making the wrong choices in one’s private life, says Wesseling. “If you work 48 hours a week, it would be clever to rest in your spare time. I, however, know assistant physicians who – in a manner of speaking – fly to Bangkok for a long weekend. That looks great on Instagram, but you are not getting any rest at all.”

When there is a lot of stress and dissatisfaction about the balance between work and private life, the first reflex of managers is to lighten the workload, says Wesseling. “But that is not always wise, because young doctors need to have sufficient ‘flying hours’ to excel in their field of specialisation. A surgeon needs to operate on an X number of knees in order to get the experience. I feel that the past years, too much water has been added to the wine, resulting in doctors not always meeting those minimum professional requirements. You have to gain experience, deal with complications, speak to patients during your training.”

Are doctors less competent than in the nineteen-eighties? “Yes, I see that some are less skilled in case histories, finding out what exactly is wrong with a patient, or with an operation. We now talk about patients with the whole team, in a multidisciplinary discussion. Very instructive and great progress. But it is different from having that talk yourself and performing that operation. We see more and more of our colleagues and fewer and fewer patients, so to speak.”

Doing something extra

Wesseling’s advice to assistant physicians: focus all your attention on your study for six years. “Use that time to become really good in your profession. Put the trip to Thailand on hold, and maybe also the desire to become a parent. Make sure to rest well in your spare time. Think about the fact that the government invests 140 thousand euro per year in your education. Also, that colleagues in the hospital invest a lot of time in you.”

But what is actually really good? “It is not possible to define that in detail. You must have mastered all competences in seven areas, but it is also in the urge to do something extra, such as PhD research or learning a new technique. It is not a guarantee that someone will be really good, but it does show dedication.” 

Sacrificing income

Maybe the study programme needs to be set up differently too, says Wesseling. “In addition to their training, assistant physicians also partly keep the place running, which means that they work shifts at weekends, in the evenings, and at night. See it as chores. They take care of patients upon arrival, prescribe medication, or reattach a drip that has come loose, the kind of thing that every young doctor can do no matter what their field of specialisation is. Every night, there are some fifteen assistant physicians present in a hospital, three of whom are working at any given time. The others are present just in case. They hang around, wait, or do some administration work. Those are lost hours.”

You could prevent this by creating a “pool of generalists”, says Wesseling. Which could mean that all assistant physicians first work at the hospital as a generalist for a year, before they start their training. After that, they start their training, to which they can devote themselves entirely without being disturbed. But of course, that costs money. Where will that come from? “We have to think about that. If you were to suggest that young doctors should sacrifice some of their salary, the Third World War would break out. That is not an option.”

Photo: MUMC+

Categories: news_top, People
Tags: farewell speech,workload, stress, burnout,assistant physicians,geertjan wesseling,professor of lung diseases

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