News from nowhere

Have you heard the one about the twins born at clocking-off time? It is a medical parable for the 1990s that makes trade unionists grind their teeth in rage and old fogies chortle with reactionary pleasure. Unfortunately it is true, and it goes like this.

A woman having twins in a gleaming new London teaching hospital reaches the second stage of labour somewhat late in the afternoon. Since twin births are potentially hazardous an obstetric registrar is on hand to deliver them. He dutifully delivers the first baby, without any problem. Then there is a pause—apparently not uncommon in twin births—before the second twin appears.

During this pause his shift ends, so he departs, handing over to a colleague whose shift is beginning. The colleague takes his place between the elevated legs of the labouring woman and duly delivers her second child, again without incident. Simple. A straightforward technical task efficiently performed, with no erosion of off-duty time for the workers. Who could complain? Only the woman giving birth feels that there is something, well, veterinary, about this approach and says so to the professor of obstetrics. The professor discusses this with the registrars, who can’t see a problem.

Obstetricians will be obstetricians, say the sceptics. Patient-centred care never was the strong point of that discipline, so the story tells us nothing that we did not already know.

But the sceptics are wrong. Wherever healthmatters goes the same story is repeated. Old hands from the campaigns to reduce junior doctors’ hours shake their heads ruefully about the behaviour of hospital doctors and young GPs alike. The day shift going off before the night shift has arrived is commonplace, as is the utter determination amongst junior doctors that they will not be exploited. The extreme case is not the twin birth at knocking-off time, but the junior doctor who told his boss that it was simply illegal to work past the shift’s end.

The certainty of the hours worked is matched by certainties about the job description, with ‘no ambiguities, please, we’re Maggie’s children’ the dominant slogan. Every aspect of the job is to be analysed and apportioned, in an exhausting process of job demarcation. And once the job is divided into component tasks, they can become commodities with prices, bringing the whole activity foursquare to market.

This is not surprising, but it is not what was intended. The campaign to reduce hospital doctors’ hours was born from 1970s radicalism and shaped by trade union perspectives, but it grew in the individualistic climate of medicine and the insecurities of the Thatcher years. Perhaps the ‘stakeholder society’ will stabilise medicine enough for a stronger sense of professionalism to emerge, so that the same pair of hands can deliver both twins.