The doctors and the Working Environment Act
Since the hospitals represent a 24-hour activity, the doctors have committed through their work contracts to cover the need for emergency assistance outside the specified working hours by using shift rosters. This was the bone of contention in the doctors’ strike. With limited daytime hours, 24-hour coverage by doctors gives rise to long shifts lasting from the end of the working day in the afternoon until the next morning, meaning that shifts often last for 19 hours with no scheduled breaks to eat or rest. To enable this, the doctors have been exempted from the provisions on working hours in the Working Environment Act, and as recently pointed out by medical editor Liv-Ellen Vangsnes, it seems odd that we as doctors, who are responsible for human life, should be exempted from the protection granted by the Working Environment Act (6). She believes that this has worked nevertheless, because there has been sufficient time for resting between shift periods. This is a truth with a number of modifications. As she points out, doctors are like most other people, and they are prone to make errors after working too many hours deprived of sleep. Many doctors also feel pressured by their colleagues to accept such strenuous shifts, even when they are ill (7).
Academic studies from a number of countries also show that treatment complications and deaths occur more frequently in patients who are admitted on evenings, nights and weekends, when compared to the daytime working hours on weekdays (8) – (10). This is because overworked and tired doctors more frequently make mistakes, for example by deviating from established procedures. During the shift periods, there are also significantly fewer doctors in attendance than on weekdays in the daytime, and this means that there is less competence available around the patient. In a population survey, nearly 70 % of the respondents stated that they were concerned that the workload on doctors might be a cause of malpractice (6).