Give us a break
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l481 (Published 06 February 2019) Cite this as: BMJ 2019;364:l481
- Correspondence to: A Rimmer arimmer{at}bmj.com
Have you ever worked a whole shift without a toilet break? Or worked through your morning session into lunchtime and beyond without stopping to eat? Or got into your car at the end of a night shift and wondered how you were going to drive home safely?
The chances are that you have. These are not unusual scenarios for doctors working in the NHS or any other overstretched health system. Worryingly, for some staff these scenarios have become the norm. This is not acceptable. Missing essential breaks is bad for doctors and their patients.
The 2016 Royal College of Physicians’ report, Being a Junior Doctor, found that doctors were unable to take adequate breaks and described an absence of suitable rest areas.1 This was despite evidence that rest breaks contribute to the provision of safe care.1 The doctors spoken to also reported that lack of non-clinical spaces such as meeting rooms or seating areas where staff could share expertise with colleagues had contributed to “the loss of a sense of community among hospital workers.”
Two years on, little has changed. Nearly 20% of hospitals do not have a common room or doctors’ lounge according to data from the BMA. Doctors have repeatedly told us that these informal spaces are vital for learning and for building relationships with colleagues.23 But with year round pressures on services demanding beds and facilities,4 they are often not prioritised by trust management or when building new hospitals.
Rest facilities for use at night have also disappeared. In March 2018, the Association of Anaesthetists of Great Britain and Ireland (AAGBI), the Royal College of Anaesthetists, and the Faculty of Intensive Care Medicine called for action to reduce the effect of fatigue and shift working on the NHS workforce. These organisations found that the abolition of 24 hour resident on-calls had seen rest facilities removed from many hospitals: less than a third of anaesthetic trainees who responded to an AAGBI led survey had somewhere suitable to rest.5
Self care
Lack of facilities is not the only problem. A recent investigation by the Health Service Journal found that since August 2016, 63 309 exception reports—which allow junior doctors to report concerns about their working hours—have been made by nearly 36 000 doctors.6 Although these figures don’t tell the whole story, they show that junior members of the team are often not able to take the breaks that they need or to finish work when they should. Similar concerns have been raised in primary care, where workload pressures prevent GPs from taking the breaks that they need.7
Although workload and a lack of designated spaces make it hard for doctors to take breaks, doctors must also shoulder some of the responsibility. In its report on what could make a difference to the mental health of UK doctors, the Society of Occupational Medicine called on employers to consider the need for doctors to take regular breaks. However, it also stressed that doctors were responsible for prioritising self care.
Call for change
In response to the rising prevalence of burnout,8 in support of the work done by many other organisations, and following discussions with our wellbeing advisory board, The BMJ is launching a campaign calling for doctors to be able to take the breaks that they need for their wellbeing and for patient safety.
In secondary care we will campaign for doctors to have access to a doctors’ lounge or staff room, and to properly equipped and maintained on-call rooms. In 2018, the BMA published its fatigue and facilities charter which, among other things, calls for the provision of appropriate rest areas.9 We will monitor and report progress towards this aim in trusts across the UK.
We will seek out senior staff who have prompted members of their team to take regular breaks to eat, drink, and rest and ask them to share their expertise. In general practice we will explore how teams have found ways to get together for a coffee break or lunch. We will promote a culture that encourages doctors to take a few minutes out of their day to pause and regroup.
This isn’t a new idea. Medical organisations, trade unions, and royal colleges have campaigned on this issue in the past and continue to do so. However, the problem persists and may be getting worse. We will bring these organisations together, along with other stakeholders such as employer and patient organisations, in a united effort to change systems, working practices, and culture to ensure that doctors get the breaks they need.
You can follow our work at https://www.bmj.com/wellbeing and take part in the campaign by sharing your examples of where things are changing for the better or where more work needs to be done through social media using #giveusabreak.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.