Did you work 24h? Portugal should be ashamed.

“Dr. Philips woke up yesterday at 6:30 am. At 8 am he was in the hospital for a 24h shift in the emergency department (ER). He is a surgeon, and he was going to work 24h in a row without rest. During that afternoon two patients required an emergent surgery. During the night other two patients needed emergent care. He managed to take two hours of light sleep during the night, always waiting for the phone to ring. It was 8 am in the next morning. He had personally assisted 25 patients in the ER and operated 4 in the last 24h. He was now drinking a huge cup of coffee trying to decrease the exhaustion. Although he was feeling like he was hangover, he was going to operate 3 elective patients (one of them with cancer). Six hours of work were still to come. “How can I work 30 hours in a row and keep up with my skills?” …. Suddenly, Dr. Philips woke up thinking he was working in Portugal. It was just a nightmare!”

In July 2019 I read in the Mirror that the NHS (National Health Service of UK) had suspended a doctor for working 24h with no break. The reason for this suspension was misconduct by the doctor who was putting the patients’ safety at risk. For 5 times in a month, this doctor walked out early, to start a second shift in another hospital, working 24h in a row. He was suspended for four months. Great NHS!

At the present day, this suspension is unthinkable in Portugal.

Dr. Philips nightmare is the common day of many doctors in this “third world” country in a “first world” continent to what labor issues matters. In fact, there are laws that do not allow doctors to work more than 12 hours in a row in the ER. Additionally, if a doctor works during the night period he has the right to rest in the next day (see references). There is also an annual limit of extra hours: 200h or 100h whether you are unionized or not. (Extra hours would be another story). Impressive is the idea many people have that doctors take several days off after a 24h shift. WRONG. So, why do doctors work 24h and more in a row without a break? Why does Portugal allow this?

If a doctor works during the night period he has the right to rest in the next day.

Opposite to what some doctors in Portugal state, there is a serious lack of doctors available. In fact, I believe the total amount of specialists in Portugal is going to decline in the future. If the majority of medical services in the country require extra hours to keep working, this means there are not enough human resources. This is the main reason why doctors work more than 24h without rest, sometimes repeating this schedule several times in a week. What is being done? Do not ask…

Portugal has a serious lack of doctors available.

Every day there are patients scheduled for surgery. Every day there are several operation rooms working in the same hospital. Every day two or more surgeons are needed for each operation. However… There are not enough surgeons to occupy all operation rooms, and every day the Administration boards keep pressing with numbers. This is one reason why doctors operate after a 24h shift. If he (the doctor) does not operate, no one will. If the patient has a cancer… If the patient is waiting for surgery for 12 months or more… Neither the Government nor the Administration board can allow it.

In 2015 the “Diário de Notícias” newspaper published an article about several hospitals in Portugal (including in Lisbon, Oporto and Coimbra) where doctors were not allowed to rest and were working 30 hours in a row. The Administration boards of those hospitals and the Government were being sued on this charge. In the following year 2017, the Government published a note stating that doctors must rest and the law should be respected. Did something change?

Doctors feel the job as a mission and a duty they need to honor.

In “Diário da República” you can find the warning note 9745/2016 from the Government, which has two examples about how to apply the compensatory rest law for doctors. The first example uses a doctor who worked 12 hours in the night shift. Ok for now. In the second they use the example of a doctor who worked 24h. If the law dictates you cannot work more than 12 hours without rest (Law 266-D/2012), how can the Government use an example like this? This is non-sense. This is why nothing ever changes.

This feeling is the only reason that keeps the Portuguese National Health Service running, and this felling is being (rapidly) ruined…

However, doctors also have a cote of guilt. The majority of doctors feel the job as a mission and a duty they need to honor. The doctor wants to treat and heal each and every patient. The doctor will feel joy to do so, and this will sometimes masquerade the tiredness. To receive a “thank you” from the patient and his family is indescridable. In Portugal the National Health Service is still working because doctors (and other health care staff) still feel it as a mission. But make no mistake, this feeling is the only reason that keeps the Portuguese National Health Service running, and this felling is being (rapidly) ruined…