"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

The Guardian has discovered that dozens of hospitals are struggling to recruit doctors to fill gaps in their rota. They are sending out urgent emails and text messages, often hours before a shift needs covering, asking for medics to come in. They are also offering increased hourly rates – of up to £95 an hour – in an attempt to encourage staff to cover.

But, despite this, doctors say many shifts are going unfilled, putting patient safety at risk. Doctors are being spread too thinly, they say, often having to leave other departments to offer help where its needed. They are also missing out on training due to staff shortages and being asked to work long hours back to back as a result.

We heard from dozens of NHS doctors about this. Here are a selection of responses.

Michael, a trainee surgeon: ‘We often have to cancel our emergency clinic because of a lack of staff’

We’ve had a rota gap for well over half a year now in my department. It has a knock-on effect. First, it means that my colleagues and I are constantly asked to cover extra 12-hour on-call shifts, despite already working long hours. Second, it affects services. We often have to cancel our emergency clinic because of lack of staff. But most importantly as a trainee surgeon in the past, I have not been able to attend theatre sessions to get training. This is worrying because when I am asked to perform certain life-saving procedure I may not be confident doing them on my own.

All junior doctors needs training to progress. When there are long-term rota gaps, this falls by the wayside and covering the services become the priority. Without adequate training, the service we provide will inevitably get worse as years go on.

It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people

Brian

Jack, A&E locum: ‘One hospital had just two doctors for their A&E department – they called an emergency meeting’

I am working as a junior doctor in A&E. Since the tax rule changes (known as IR35) the gaps in A&E rotas in hospitals in the Midlands have got bigger. They were present before but not as visible.

One hospital I was in had only two doctors for a large A&E department overnight. They had to call emergency meetings and take doctors from other areas of the hospital. It meant patients needing treatment had to wait longer. Doctors stayed on for hours to try to bridge the gap. I stayed for as long as I could but in the end I was so tired I wasn’t safe. On the drive home I rolled the windows down and played music loudly just to try and stay on the road.

I work in three hospitals across the Midlands and the majority of the time there is not a full rota of doctors. When I arrive in the morning for handover, I have been told someone needs to go home and come back for the night shift as there isn’t enough cover. One consultant who was on call for 72 hours was in the hospital for the majority of that time trying to see patients and find more staff. A&E is the worst hit. This is because it has the lowest percentage of filled posts in training schemes and is most heavily reliant on locums. Its training schemes are underfilled because it has difficult hours, difficult time pressures, and it is one of only two ways into the NHS system. The GPs close, but the emergency department never closes so it’s always on the frontline.

Brian, a foundation doctor: ‘It’s terrifying when staffing gaps leave you responsible for loads of people’

Night cover is almost permanently short-staffed. It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people. I am also seeing the effects on the more senior members of the team. They are sometimes expected to be in two or three places at once (somehow simultaneously covering the ward and clinic). I don’t understand how the problem seems to be taken so lightly. It’s a threat to patient safety.

Tensions run high as ridiculous last-minute rota changes result in people getting angry that a staff member they were planning on using has now been seconded elsewhere. The government capped rates for locums, the doctors who cover when staff members are ill or on holiday. Given that we sometimes already do 70-hour weeks (yes, that’s legal too somehow) our free time is very precious. The extra work is heavy enough as it’s short staffed, so the pain and risk just isn’t worth what we’re being offered.

Mandy, middle grade doctor: ‘Remaining staff take up the slack – teaching falls away and morale drops as a result’

Every rota has rota gaps. Obstetrics and gynaecology requires seven registrars; we have 1.8 doctors at our hospital. In intensive care, they are at least six registrars short. Every day we receive messages requesting staff to work extra shifts. Today working on renal the issue wasn’t a rota gap with doctors but with nurses: patients who needed dialysis couldn’t receive it due to not enough nurses to care for them on it.

The issue is the remaining staff take up the slack and go above and beyond every day to ensure patients remain safe. This makes our lives fairly miserable: teaching falls away, morale drops and tensions rise.

‘Rota gaps are ubiquitous, a daily occurrence. As a junior doctor you become desensitised to them.’ Photograph: Peter Byrne/PA

Al, a core medical trainee: ‘Not a day goes by where we don’t get emailed about a need for cover’

Rota gaps are ubiquitous, a daily occurrence. As a junior doctor, you become desensitised to them, which is a scary thing to say. Not a day goes by where we don’t get emailed about a need for cover. Sometimes phone calls are made to all the employed staff asking of they can work an evening shift or a weekend shift.

You become desensitised to gaps in the rota, which is a scary thing to say

Al

If this fails, then the vacancy is put out to the preferred locum agency dealing with the hospital who then have thousands of doctors at hand. Often these medics have not worked at the hospital before and although they agree to step in, they are nowhere near as efficient or diligent as the staff doctors.

My trust are also employing long-term locums to fill these gaps in the rota. This a positive step as these doctors become well acquainted with the hospital policies and procedures

Iman, consultant physician: ‘Highly-skilled surgeons are sometimes pulled out of theatre’

I have been given the thankless task of coordinating the junior doctor rota, a role which no one wants, but is almost forced on you. The reason people are reluctant to take it on is the almost daily severe shortage of staff which means that you are firefighting all the time.

I have rota gaps more often than not. The number of junior doctors allocated to the hospital by deanery is less than what we are supposed to have. We try to cover the rest by recruiting locums, which is often unsuccessful partly due to locum pay caps.

The remaining juniors are often under a lot of stress due to manpower shortages and consequently the sickness rates are high. On several occasions some of the wards have no juniors at all, which then requires senior staff to act down. This is a waste of resources as it means a highly-skilled surgeons or physicians are pulled out of the operating theatre or clinic to do these jobs.

On several occasions some of the wards have no juniors at all, which then requires senior staff to act down.

Iman

It’s hugely concerning. I have raised these repeatedly with the trust board, but they are powerless to do anything. We do not have enough junior doctors full stop. Deanery cannot recruit enough in specialities such as medicine and A&E due to onerous on-calls. The 1% pay caps have eroded pay and the imposition of contract has resulted in many juniors leaving the country, depleting the pool further.

Tom, general surgery registrar: ‘Increasing rota gaps is one of the factors driving doctors out of the profession’

Most hospital doctors are extremely worried about the impact of rota gaps on patient care. Clearly, having doctors who have stayed on for up to an additional 12 hours beyond a normal 12-hour shift means they are far too tired to make reliable clinical decisions, especially for the sickest emergency patients. Beyond fatigue, the routine reassignment of doctors from their ward duties to the emergency department leaves vast numbers of patients with too few doctors to look after them. It is often the most junior doctors who are left caring for large numbers of vulnerable post-operative and/or elderly patients without quick recourse to or support from more experienced colleagues.

In the 10 years since I qualified, I have seen nothing but a relentless increase in the demands put upon hospital staff. Increasing rota gaps have compounded the pressure on staff and is one of the factors driving doctors out of the profession and into mental health problems.

• All names have been changed.

"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

Tomorrow I Was Always a Lion review – ingenious journey inside mental illness

Just over a decade ago, Belarus Free Theatre began its extraordinary existence with a production of Sarah Kane’s 4.48 Psychosis. Now it returns to the subject of mental health with Vladimir Shcherban’s adaptation and staging of a memoir by a Norwegian psychologist, Arnhild Lauveng, recording her own experience of schizophrenia. It is performed with the company’s usual physical expressiveness, yet it also left me wondering if theatre is the ideal medium for recapturing a prolonged curative process.

Five actors sit in a circle and take turns in embodying Lauveng’s experiences. As a schoolgirl, she shows all the symptoms of mental disturbance: she imagines jumping off tall towers, sees wolves in the hallway, suffers a crisis of identity and hears voices. In one of the most telling passages, she records the presence of another self she calls “The Captain”, who rebukes her for her failings, physically attacks her and squats on her back as she tries to go about her daily life.

Emily Houghton in Tomorrow I Was Always a Lion. Photograph: Tristram Kenton for the Guardian

When Lauveng talks of the fog that surrounds her, the actors blow smoke rings that slowly envelop her

One advantage of theatre is that it can make Lauveng’s experiences manifest: when she talks of the fog that surrounds her, the actors blow smoke rings that slowly envelop her, and the images that fill her head are ingeniously projected on to a screen through a copy of the very memoir she has written. When Lauveng is institutionalised, we also get a vivid idea of her initial resistance to much of the treatment: the morning workouts, the confinement to an isolation ward, the meaningless tasks that, at one point, involve her in routinely rolling earplugs.

All this is graphically and imaginatively shown. But the production also raises several questions. The story has a positive note in that Lauveng eventually overcomes the illness (today describing herself as a “former schizophrenic”) and fulfils her dream of becoming a psychologist. But in an 80-minute show it is difficult to record every stage of the curative treatment and Lauveng’s leap from afflicted patient to qualified expert is sudden and only partly explained. The production also seems intended to stir us into action on patients’ rights. At the end we are invited to sign postcards protesting at the increased use of physical restraints against mental health patients. That seems entirely just. But, since Lauveng explicitly says she wouldn’t be alive today if force had not been used to prevent her from harming herself, it is difficult for the layman to know at what point restraint is appropriate.

Symptoms … Grace Andrews in Tomorrow I Was Always a Lion. Photograph: Tristram Kenton for the Guardian

This is the first Belarus Free Theatre production to use an all-British cast and the five actors involved perform with exemplary lack of inhibition. Emily Houghton, Grace Andrews, Samantha Pearl, Oliver Bennett and Alex Robertson all switch easily from representing Lauveng herself to the doctors and staff who attend her. But, while the show enhances our awareness and understanding of schizophrenia, it also disturbs one in another sense. By condensing the treatment into a limited time, can theatre ever convey the arduousness of treating mental illness? And, as spectators, are we equipped to make instant ethical judgments on practical issues? Vibrant as this show is, I remain deeply unsure.

Tomorrow I Was Always a Lion review – ingenious journey inside mental illness

Teenage girls talk about anxiety: "It"s always linked to failure" – video

One in three teenage girls in England and Wales suffers from anxiety, according to a survey of 14-year-olds for the Department for Education. Orli, a 17-year-old girl from north London, talks to her friends about her anxiety, how she plans to beat it and stop the stigma surrounding it

Teenage girls talk about anxiety: "It"s always linked to failure" – video

Skeptics will always face an uphill struggle against pseudoscience | Michael Marshall

If the scientific skepticism motion have been to decide on a mascot, we could do a good deal worse than Sisyphus: the figure from Greek mythology doomed by the gods to devote eternity pushing a boulder uphill, only to watch it roll back down yet again the moment he rests. Few other analogies actually capture the frustrations and seeming futility of counteracting a extensively held pseudoscientific belief.

Possibly worse, it is not ample for us simply to push back against the outrageous claims of pseudoscience, and those who capitalise on the bereaved and the vulnerable (whether knowingly or unknowingly) – we also have to do so responsibly. We can’t afford to use the dirty tricks employed by some of these we criticise, lest we lose our very own integrity and with it no matter what persuasive energy we might have had.

Equally, we can’t afford to advocate rationalism with the identical brashness and rudeness displayed by some pseudoscientists, because our truths are sadly significantly less welcome than their comforting untruths. It is effortless to persuade an individual of a falsehood if it is anything they desperately want to hear. They will even spend you for the privilege, and defend you to the hilt.

This is the Greek tragedy of the contemporary skeptical motion. If we’re cursed to play the function of Sisyphus and forever push our boulder up the mountain, we’re also fated to do so with a single hand tied behind our back. Rest assured, these advocating explanation will forever encounter an uphill battle, and any victories will be slow and challenging – and the minute we stop pushing, the boulder will inexorably roll back.

So why do we bother? If each and every victory only holds back the tide for a whilst, what’s the level? It is a question I’ve been taking into consideration a great deal of late, and I feel the answer lies in social duty, humility and an awareness of our own susceptibility. It is as well simple to see ourselves as getting beyond belief, or above belief: “There but for the grace of a god I don’t believe in go not I, for I am smarter than that, and I are not able to be fooled.”

Personally, I don’t buy that mentality for a second. Intelligence is no guard against pseudoscience – wise individuals basically find smarter methods to justify their belief in the unjustifiable. Rather, the genuine defence towards succumbing to seductive nonsense is an awareness of our own intellectual limitations and the cognitive flaws to which we are all prey. Or, in short, skepticism.

Skepticism is an anti-virus system for the brain: it merely supplies the resources to examine suggestions, combined with the knowledge that can get the weight out of undesirable concepts. Realizing that psychics have distinct techniques of asking concerns that make it sound as though they’re supplying data implies you are alive to the trick when you hear it. Awareness of regression to the suggest and confirmation bias may possibly quit you attributing your recovery to the copper band on your wrist or the sugar pill on your tongue. Knowing that President Kennedy’s seat in his car was raised to make him far more visible to the crowd will take the mystique out of the trajectory of that magic bullet.

But the anti-virus application analogy isn’t ideal, since after you have been infected with a “logic virus” it is hard to uncover and delete it, due to the fact it covers its tracks so well. Folks who fall for the seductive claims of psychics do so not simply because they’re wilfully flouting reality, but because there’s a phenomenal emotional sway that goes with the mystical. We have all misplaced a person near to us, and we have all felt the pain of bereavement. As skeptics, we have no magical solution to that soreness.

At their lowest ebb, at their most vulnerable, that is when folks are most at threat of taking a logical misstep that, when made, is extremely hard to reverse. And that applies not just to the “illogical handful of”, but to every a single of us, due to the fact we are all prone to moments of weakness. It is portion of the human problem, and it will take an act of near-perverse will to break that pattern, since it’s so deeply ingrained in our cultural and evolutionary psyche.

But that’s why it’s so crucial that we as skeptics and rationalists phase up: when someone is in a negative area, it’s the obligation of everybody who is aware of them – and even folks who really do not know them – to view their back. Because when I’m in that place myself, when I’m at my lowest ebb and feel as although actuality offers no hope, I want there to be men and women who end me walking – blinded by vulnerability – into an open manhole.

Michael Marshall is the project director for the Good Considering Society and vice president of the Merseyside Skeptics Society. He tweets as @MrMMarsh.

Skeptics will always face an uphill struggle against pseudoscience | Michael Marshall

The New York Occasions Meals Author Who Is Always Out To Lunch

Does New York Occasions meals writer Mark Bittman get anything right?  I doubt it.  I after tried his recipe for challenging-boiled eggs and the yolks have been runny.

I ate the eggs anyway, but Bittman’s pronouncements about policy are significantly less palatable, and I’m afraid that some credulous readers really swallow them.  His latest commentary, “Leave Natural Out of It,” is yet another hash of uninformed opinions and misinformation.

It is tedious to deconstruct a Bittman column simply because there is constantly so much incorrect with it, but let’s deal with a number of misapprehensions and misrepresentations.

O  Bittman does seem to be to have backed down from his rabid antagonism toward crops genetically engineered with the most present day, precise and predictable tactics.  He now concedes grudgingly that they “are probably harmless” and that “the engineering itself is not even a little bit nervous making.”  (This building, from a skilled wordsmith?)  In reality, right after far more than four billion acres planted around the world and far more than 3 trillion meals containing genetically engineered substances consumed in North America alone, there has not been a single ecosystem disrupted or a tummy ache confirmed.  (Couldn’t we get rid of the probably, Mark?)

Leading: Lesser cornstalk borer larvae extensively damaged the leaves of this unprotected peanut plant. (Picture Number K8664-2)-Photograph by Herb Pilcher. Bottom: Following only a number of bites of peanut leaves of this genetically engineered plant (containing the genes of the Bacillus thuringiensis (Bt) bacteria), this lesser cornstalk borer larva crawled off the leaf and died. (Picture Quantity K8664-1)-Photo by Herb Pilcher. (Photograph credit score: Wikipedia)

O  “[T]o date G.M.O.’s [genetically modified organisms] have been utilized by companies like Monsanto to maximize revenue and more getting rid of [sic] the accumulated knowledge of generations of farmers from agriculture.”  And how, specifically, is this distinct from the organizations that make implements like tractors, combines and farm-management software, that have modernized farming practices and produced them a lot more worthwhile?

O  Large agribusiness companies using the new methods “have not been effective in moving sustainable agriculture forward (which is related since that was their claim).”  The evidence argues otherwise.  By enhancing weed manage and decreasing the want for plowing, genetically engineered herbicide-tolerant crops allow a lot of farmers to adopt and maintain no- or reduced-tillage manufacturing programs, which final results in important reductions in greenhouse gasoline emissions.

According to a current complete examination, “Based on cost savings arising from the quick adoption of no-till/reduced tillage farming systems in North and South America, an further six,706 million kg of soil carbon is estimated to have been sequestered in 2012 (equivalent to 24,613 million tonnes of carbon dioxide that has not been launched into the global atmosphere).”

Equally essential, the higher yields and drought resistance of some genetically engineered crops make them a lot more sustainable than standard crops and, particularly, than organically grown ones.  As discussed under, natural agriculture is the scourge of sustainability.

O  Bittman retreats into the deepest, darkest recesses of his parallel universe with his allusion to the “intensive and nearly unregulated use of…agricultural chemical compounds.”  In reality, agricultural chemical substances are subject to some of the most stultifying, burdensome, expansive and high-priced regulation on the planet, courtesy of the relentlessly risk-averse Environmental Safety Agency.  (Isn’t there an editor who reads Bittman’s copy prior to it’s published?)

Lastly, we come to Bittman’s continuing slavish and uncritical devotion to natural agriculture: “Eating natural meals is unquestionably a greater choice than consuming nonorganic foods at this point, even so, it’s a privilege” [italics in unique].  That is unquestionably nothing at all a lot more than silly, sentimental twaddle, specifically in see of a 2012 research by researchers at Stanford University’s Center for Health Policy published in the Annals of Internal Medication.  They carried out a meta-examination in which outcomes from the scientific literature had been combined.  Data from 237 studies were aggregated and analyzed to figure out whether or not organic foods are safer or more healthy than non-organic meals.  The researchers concluded that fruits and veggies that met the criteria for “organic” have been on regular no much more nutritious than their far less costly traditional counterparts, nor had been people meals much less most likely to be contaminated by pathogenic bacteria like E. coli or Salmonella.  In addition, even though non-natural fruits and veggies did have higher pesticide residues, a lot more than 99 % of the time the amounts were beneath the permissible, extremely conservative safety limits set by federal regulators.

Bittman’s phobia about chemical pesticides in agriculture is so, well, jejune.  The huge bulk of pesticidal substances that we consume occur in our diet plans “naturally,” and they are existing in natural foods as nicely as conventional ones.  In a landmark investigation post published in the Proceedings of the Nationwide Academy of Sciences, University of California, Berkeley, biochemist Bruce Ames and his colleagues discovered that “99.99 % (by excess weight) of the pesticides in the American diet regime are chemical compounds that plants make to defend themselves.  Only 52 natural pesticides have been examined in substantial-dose animal cancer exams, and about half (27) are rodent carcinogens these 27 are shown to be current in many widespread food items.”

The bottom line of Ames’ experiments: “Natural and synthetic chemical compounds are equally very likely to be positive in animal cancer exams.  We also conclude that at the reduced doses of most human exposures the comparative hazards of synthetic pesticide residues are insignificant.”

In other phrases, consumers who purchase overpriced natural meals in buy to steer clear of pesticide publicity are focusing their focus on .01% of the pesticides they consume.

Contrary to Bittman’s views, if you care about the atmosphere, eating organic food is much more of a sacrilege than a privilege.  Natural farms generate far much less foods per unit of land and water than conventional ones.  The reduced yields of organic agriculture — normally 20%-50% lower than conventional agriculture — impose different stresses on farmland and especially on water consumption.

The New York Occasions Meals Author Who Is Always Out To Lunch

US data shows autism costs up thirty%, but disease not always "more common"

The US government’s estimate of autism has moved up yet again to one in 68 US young children, a thirty% enhance in two years.

But wellness officials say the new number may not indicate autism is much more typical. Much of the boost is believed to be from a cultural and health-related shift, with medical doctors diagnosing autism more often, particularly in kids with milder problems.

“We cannot dismiss the numbers. But we can’t interpret it to mean more folks are acquiring the disorder,” explained Marisela Huerta, a psychologist at the New York-Presbyterian Center for Autism and the Building Brain in suburban White Plains, New York.

The Centers for Condition Control and Prevention (CDC) launched the most recent estimate Thursday. The Atlanta-primarily based company said its calculation implies autism affects approximately one.2 million Americans under 21. Two years in the past, the CDC put the estimate at one in 88 kids, or about 1 million.

The trigger or leads to of autism are still not recognized. Without having any blood check or other healthcare exams for autism, diagnosis is not an precise science. It is identified by creating judgments about a child’s habits.

Thursday’s report is regarded as the most comprehensive on the frequency of autism. Researchers gathered information in 2010 from places in 11 states – Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Utah and Wisconsin.

The report targeted on 8-yr-olds due to the fact most autism is diagnosed by that age. The researchers checked overall health and school records to see which children met the criteria for autism, even if they hadn’t been formally diagnosed. Then, the researchers calculated how frequent autism was in each spot and total.

The CDC began using this approach in 2007 when it came up with an estimate of one in 150 children. Two many years later, it went to one in 110. In 2012, it went to 1 in 88.

Final 12 months, the CDC released benefits of a much less trustworthy calculation – from a survey of mothers and fathers – which recommended as several as one in 50 youngsters have autism.

Specialists aren’t stunned by the developing numbers, and some say all it reflects is that physicians, teachers and dad and mom are more and more most likely to say a youngster with learning and habits troubles is autistic. Some CDC experts say screening and diagnosis are obviously significant drivers, but that they cannot rule out some actual improve as nicely.

“We can’t say what portion is from greater diagnosis and enhanced understanding versus if there is a true alter,” said Coleen Boyle, the CDC official overseeing analysis into children’s developmental disabilities.

For decades, autism meant kids with severe language, intellectual and social impairments and uncommon, repetitious behaviors. But the definition has slowly expanded and now includes milder, associated conditions.

A single signal of that: In the most recent examine, almost half of autistic youngsters had typical or over common IQs. That is up from a third a decade ago and can be taken as an indication that the autism label is more typically provided to increased-working young children, CDC officials acknowledged.

Aside from that, a lot in the newest CDC report echoes earlier findings. Autism and connected disorders proceed to be diagnosed far more frequently in boys than women, and in whites than blacks or Hispanics. The racial and ethnic differences probably reflects white communities’ greater concentrate on hunting for autism and white parents’ access to medical professionals, due to the fact there is no biological purpose to believe whites get autism much more than other individuals, CDC officials mentioned at a press briefing Thursday.

One particular alter CDC officials had hoped to see, but didn’t, was a drop in the age of diagnosis. Professionals say a diagnosis can now be created at age two or even earlier. But the new report stated the vast majority of youngsters proceed to be diagnosed soon after they flip 4.

“We know the earlier a kid is identified and linked with solutions, the better,” Boyle said.

The American Academy of Pediatrics issued a statement Thursday, saying the nation demands to phase up screening for the situation and study into autism’s brings about.

“It’s vital that we as a society do not turn out to be numb to these numbers,” explained Dr Susan Hyman, head of the group’s autism subcommittee.

US data shows autism costs up thirty%, but disease not always "more common"