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Tue, 31 Dec 2002 14:59:13 +1300

Dear John,

Sadly I must agree with your comments on the knowledge of young doctors about their contracts vis a vis medicine/surgery.

One cannot help but think that the practice of medicine in 20 years time will be very different from what it is today.

It seems to me (while not wishing to make a "k" like prediction) that the by-word(s) will be itinerant care. These young doctors will have lots of wizz-bang diagnostic and therapeutic toys to play with and undoubtedly will get very good at them. They will employ them "itinerantly" very well but will the patients be well cared for?? I am less convinced. Itinerant surgery is a well known anathema but what else can you do on 40 hours per week. This pattern of practice (acknowledging the difficulties in the acquisition of skills and knowledge) may work adequately in Emergency Medicine, where the problems are by definition unplanned and the expectation that the conditions will be treated or transferred within a relatively short time frame, but will not work in most other branches of medicine. The public will probably seek another type of prefessional to be their medical advisor and get episodes of care from current day medical graduates.

Personally, I still like to visit my GP and know that I can expect care without having to regurgitate my entire medical, family and social history each time, but in 20 years, perhaps we will have developed different expectations from a medical practitioner.

Ian Civil
Director of Trauma Services
Auckland Hospital
> 
> From: Holmes John <John_Holmes@mater.org.au>
> Date: 2002/12/30 Mon AM 11:56:47 GMT+13:00
> To: "'trauma-list@trauma.org'" <trauma-list@trauma.org>
> CC: "Ken MATTOX (E-mail)" <KMATTOX@aol.com>
> Subject: RE: Projections for 2003
> 
> Ken Mattox said:      ............  If one is offended by a threat to
> non-professional status, as I am with the 80 hour work week, then we should
> do something about it and change our status from being tradesmen.   I for
> one plan to do what I can to show that this move was not a good
> one...............    
> 
> In Australia we are threatened by further encroachments into the
> professional development of our young doctors.  We now have an industrial
> award that specifies a 40 Hour working week !!!!     The cost implications
> of this are obvious if we try to have our registrars and residents work
> "overtime".  But worse than this is a not so subtle change in the
> professional culture of our young doctors who are frequently more
> knowledgeable of the fine print of their award conditions than they are of
> the fundamentals of medicine.  Many  no longer seem prepared to put in the
> hard effort that it takes to become a decent medical practitioner.  Those of
> us who came up through the hard school of 100 plus hours per week  feel that
> we have paid our dues - we feel we have a right to count ourselves amongst
> this honourable old profession.  But now the juniors seem more concerned
> when their holidays are, how they can avoid weekends and night shift and how
> quickly they can leave the hospital after a shift - irrespective of whether
> their duties are done or not.  The further implication is for training - in
> a 40 hour week they learn very little - and from a practical sense they also
> do very little now independently.  I must admit to feeling that something is
> not right in a system where I still work at least 50% more hours than my
> juniors.
>  
> Or perhaps I'm just getting old(er) and crusty.
>  
> Happy New Year.
>  
> John
>  
>  
> 
> Dr John L Holmes 
> Director Emergency Medicine 
> Mater Public Hospitals, Brisbane, Australia 
> 
>  
> 
>  
> 
> 
> 
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Projections for 2003