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August 09, 2004

The European Working Time Directive & the Sound-Bite Culture: why the latter makes arguing against the former impossible

Posted by Anthony Daniels

The European Working Time Directive will deprofessionalise medicine and turn it into a production-line - or proletarianised – job. This argument is however not made by doctors' representatives and cannot be heard on the airwaves. Anthony Daniels explains why the sound-bite culture embraced by the broadcast media makes putting this argument across impossible. Modern brevity is not only the guarantor of triviality: it is the handmaiden of unfreedom.

Anthony Daniels will be writing regularly for the Social Affairs Unit.

Anyone who has ever appeared on a radio discussion programme will know how frustrating the whole business is. The time allotted even for the most serious subjects is short: a BBC producer once invited me on to a 'long' discussion about the burning issue of the day, and when I asked what she meant by long, she replied with neither irony nor shame, but perfectly matter-of-factly, 'Six minutes'. Since there were to be three other guests on the programme, in-depth analysis was hardly the order of the day. Brevity these days is not the soul of wit: it is the guarantor of triviality.

It is difficult to develop an argument in a few seconds and some things cannot be expressed (at least by me) in so short a time. That is why I seem always to keep my best arguments until just after I come off the air. It is then that I annihilate my opponents – but alas, only in my head. The public is denied the benefit of my refutations.

It happened again the other day. We were discussing the effect of the European Working Time Directive on medical practice. The fact is that this directive will, as it is no doubt intended to do, further proletarianise the practice of medicine. It will turn medicine from a profession and vocation into a production-line job, with doctors watching the clock even as they examine their patients.

The BMA's representative for junior doctors was on the programme. He was in favour of the Directive because it meant less work for the same money. It also meant that they would be less tired and more efficient.

There is certainly some truth to the latter, though in my opinion it will be more than counterbalanced by the complete loss of continuity of care. This continuity is not only kind and decent, it is medically efficient. A doctor never knows other patients as well as those for whom he has special responsibility.

The BMA man then used two arguments that stunned me by their resort to the characteristic rhetorical devices of the sound-bite era, suppressio veri and suggestio falsi. He said first that there was nothing wrong with medical shift working (which the Directive will force on hospitals) because they had been used satisfactorily for many years in intensive care units, which after all looked after the sickest patients; and that most senior doctors wanted to retire as soon as they were able because of overwork.

Needless to say, I had to reply to these shameless assertions in ten seconds. In other words, they went by default.

It is obvious that intensive care units are not typical of hospital wards as a whole. Not only do they have an incomparably higher staff to patient ratio than anywhere else in the hospital, but their patients are of a special kind: they are virtually physiological preparations, such as one studies in a physiology laboratory. Indeed, one consultant of whom I know who works in such a unit insists on being called a 'clinical physiologist'. It is perfectly true that it is possible to pass on all the relevant information about an unconscious patient in renal failure and who is on a respirator to the next shift of doctors, but the vast majority of medical practice is not like this. It is rather alarming that a representative of the BMA should think – or at least claim – that it is.

As for senior doctors wishing to retire as soon as they are able, this is certainly true, but for reasons almost exactly the opposite of the ones the BMA's representative implied. Not only are senior doctors increasingly tortured – it is hardly too strong a word to use – by regulatory bodies and management interference in their day-to-day work, but they are having to do more routine tasks on the wards precisely because junior doctors do not work as many hours as they used. The end result of many years of education and training is to be treated like a skivvy, and a skivvy moreover who is treated as if suspected of being light-fingered.

The European Working Time Directive is typical of modern legislation, or perhaps I should say administrative fiat. It appears to confer benefits or rights on those who come under its purview (in this case, almost everyone). As such, it is seen by many of its supposed beneficiaries as benign. But the supposed benefits exert a profound and baleful influence of the character of the supposed beneficiaries, always in the direction of increased dependence upon the administrators. And a medical profession that is composed of clock-watching shift-workers will be far easier to control and order around than one that is both self-regulating and has a sense of vocation. The independence of citizens or professions is what the modern administrator fears more than anything else, for its strikes at the heart of his raison d'etre and threatens him with actual, rather than merely existential, redundancy.

This is not, of course, an argument that can easily be developed in a few seconds. Neither it is the kind of four legs good, two legs bad kind of argument that sound-bite culture both loves and requires. Our mental world is increasingly Manichean, thanks to this culture, and irony is allowed existence neither in word or fact. For the sake of discussion programmes, goods – such as shorter working hours - must be wholly good, and harms – such as fatigue caused by long working hours - must be wholly bad.

So the sound-bite culture itself favours the extension of the totally-administered state, because every new regulation can be presented as unequivocally rational and beneficial. Modern brevity, therefore, is not only the guarantor of triviality: it is the handmaiden of unfreedom.

Anthony Daniels is a doctor and writer.


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Why will no-one broach the real reason that doctors and nurses are overworked and underpaid, socialist medicine.

If all hospitals were totally independent, able to choose how much they paid their employees and how long they worked, the market would make sure that everyone was actually paid what they are worth.

The idea that in order to protect doctors from working very long hours, we need government regulations is laughable. Its a state run monolithic institution that is slave driving them in the first place.

Only state workers have little or no choice as to who they are employed by (Teachers, Nurses, Policemen etc.) If they wish to continue in their chosen professions choices are extremely limited. Everyone else has so much freedom that protection is totally unnecessary. Its funny how rules to protect the proletariat from the robber barons are only actually needed in the state sector. No state sector, no need for regulations.

Posted by: Jon at August 11, 2004 12:21 PM
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Every hospital doctor reading Dr Daniels's article will no doubt claim that his or her specialty is the one in which the European Working Time Directive (EWTD) has its most iniquitous effects, so might I be the first. Continuity of care is essential, not even merely desirable, in the field of psychiatry. The hospital in which I work was about to fall foul of the EWTD and so adopted a full shift system in order to comply. This means that rather than seeing and supervising our junior doctors every weekday, consultants now have no contact whatsoever with them for two full weeks, while they are working a week of nights and then given a week off to obtain compensatory rest. As Dr Daniels correctly states, we are now having to take over much of the daily ward work formerly carried out by our juniors. The patients are utterly confused by these arrangements, and the comfort they derived before from knowing exactly what they could expect from any particular member of staff is being steadily eroded.

It's not just junior doctors who are subject to governmental strictures on working time, of course. A consultant colleague of mine has until recently started work at 8.30 each morning because this fits in with the school run. The management have now instructed him that, in accordance with the notorious 'job planning', he is not to be at work before 9 am. Rather than sit in his car outside for half an hour, he naturally ignores this craziness and is at his desk or on the ward by 8.30, hoping that he will be called to task on this as it would be the start of a crucial test case.

Posted by: Tim at August 17, 2004 08:44 PM
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There are few things the EU cannot make worse with a directive and Britain's already dismal 'envy of the world' healthcare system is certainly no exception. Of course Britain is entirely capable of buggering up things without the EU's assistance but what the EU can add is to lock-in errors at an even more bureaucratically remote level to ensure that we will have several generations of whatever joy our political masters inflict on us regardless of who gets voted for in Westminster.

Posted by: Perry de Havilland at August 19, 2004 12:18 AM
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It's important to distinguish the application of the working time directive to State employees from its application to the private sector. The working time directive as applied to the NHS is basically just a pay rise at the expense of the tax payer. Whether it is good or bad for patients is a moot point but I don't see that freedom has much or anything to do with it; except for the tiny minority of doctors who might wish to work longer hours for the same pay.

In the private sector it is of course a different story. The idea that the State has the right to tell private hospitals and doctors how to run their businesses and practices is odious.

Posted by: Cydonia at August 19, 2004 05:44 PM
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I think medicine has become a racket and is no longer about healing as much as it is about being a business and about profit. It has become this way, because more people know what’s going on under the hood of their cars than what is going on in their own bodies. We’ve ceased to take responsibility for our own health…yeah, yeah - you’re on the latest diet craze, you exercise and don’t smoke…but tomorrow you’re jogging down the street and drop dead of a heart attack. Why? Because you missed the signs, and you missed it because you didn’t know what the signs were. You don’t pay attention to your body until it screams at you with pain

Posted by: Susan R at January 26, 2006 08:50 AM
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