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24-hour labour ward consultants

December 9, 2012

Another lost debate

Last week I debated with my friend Nigel Simpson from Leeds.

“The time has come for 24-hour consultant resident labour ward cover.”

I was for the motion, and I really thought that this time I would win. There haven’t been any randomised trials, and it’s tricky to prove that consultants do a better job than senior trainees. But I’ve never heard of anyone asking if they could have their forceps or Caesarean done by someone in training.  I was able to quote loads of observational evidence that consultants generally provide better care, faster and more cheaply that doctors in training.

My opponent put up some smoke and made lots of good jokes, but couldn’t really provide much more of a reason than that it would be expensive, tough on senior doctors and that it was good to learn from experience.

The expensive argument has less validity than might first appear.  If senior doctors genuinely prioritised labour ward work, instead of giving it up as soon as every new colleague was appointed, the number of extra consultants required nationally to provide 24-hour cover in the larger maternity units would be about 300.  There have been an additional 1000 since 1997 and the government plans for only slightly slower consultant expansion over the next 15 years.

I was sad. Not because I lost the debate, but because I failed to get across how much the quality of obstetrician’s lives would be enhanced.  If each individual did say 12 hours on the floor per week, alongside a modest daytime clinical and administrative load they could drop the 16 hours on call from home they currently do. Most obstetricians would love that.

Jim Thornton

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