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back to article Going under the knife? Avoid Fridays. Trust us, we asked a doctor

British readers who have an appointment with the sawbones are directed to this illuminating report in the British Medical Journal, which concludes that you're substantially more at risk of popping your clogs as a result of surgery if they open you up on a Friday or a weekend. That's the conclusion of a team led by Dr Paul Aylin …

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Anonymous Coward

I'd assumed that the increased risk at weekends was

because the eseential administrative staff, senior managers, Chief Executives, etc weren't around at weekends?

No?

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Coat

Re: I'd assumed that the increased risk at weekends was

> senior managers, Chief Executives, etc weren't around at weekends?

No, they were out on the golf course having heart attacks ready for the Monday slots :)

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Happy

Re: I'd assumed that the increased risk at weekends was

Well, I have such an experience, very few in fact about being cut at any hospital, but this woman doctor started by telling she was in a hurry. And everything she did went wrong and everything had to be corrected later. Who knows, perhaps Mondays are not better. Without claiming any statistical value, of course.

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Re: I'd assumed that the increased risk at weekends was

I wonder how many doctors are mentally already at their golf game or bar by then.

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Ah, statistics

I caught a discussion about this on Radio 4 this morning. One of the participants commented that, as a heart surgeon, he had often scheduled his more serious cases for a Friday. He knew that intensive care units were less busy over the weekends and he would be less likely to be in theatre, and so available on call if there was a crisis.

Obviously, though, this meant that the patients scheduled for a Friday op were the ones with less chance of making it anyway.

cause/correlation & all that

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Huh?

From the data in the report, it's not just that the risk is significantly higher on Fridays & weekends, it gradually increases from the lowest point on Monday.

The report lumps Saturday & Sunday together, which doesn't help, but if poorer care over the weekend was a significant cause, I'd expect Friday to be worse than Sunday, which doesn't seem to be the case.

Perhaps minor ops that happen toward the end of the week have a tendency to be pushed to the start of the following week, surgeons being unwilling to give up their weekends unless they have to, resulting in the figures being skewed by the percentage of serious/non-serious cases done on each day?

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Re: Huh?

Pick a surgeon and team who have just had 2 days rest.

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FAIL

No surprise

The rule is: if you're going to be sick, don't be sick on a weekend or Bank holiday.

Certainly, that's been my experience of the NHS.

It's the elephant in the room. The doctors know it, bureaucrats know it, the Govenment knows it. They just don't want to do anything about it.

Whenever I hear someone ranting about how 'great' the NHS is, I always ask them if they've ever been sick on a weekend or bank holiday. The response is always the same: they haven't.

All that money from Labour - er, actually, the taxpayer under Labour - and it's the same lack-lustre service for general admissions.

You can go private - and 'pay twice' - if you can afford it but why should I? The NHS is an expensive service that all taxpayers pay for whether they use it or not. I'm not sure what the alternative is, but if I had my time over again, I'd have been a doctor. The pay is great and the hours are even better.

NHS FAIL.

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Re: No surprise

"The pay is great and the hours are even better."

Glad you've not chosen to be a doctor. You clearly haven't the first clue what it's like.

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Anonymous Coward

Re: No surprise

"The pay is great and the hours are even better."

Glad you've not chosen to be a doctor. You clearly haven't the first clue what it's like.

Have a relative who's a GP .... full time job but hours are arranged so only works Monday to Thursday. Also regularily does night cover work and said last year that doing 3 nights between Christmas and New Year (where pay was 1.5-2x the normal amount) basically paid for their family's 1 week ski-ing holiday

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Re: No surprise

Andre Carneiro,

Senior doctors can end-up working pretty much any hours they choose, depending on what speciality they go for, and how much private work they take on. And the pay is very good. The same for GPs, once they get to be partners in a practise. The hours before you get their can be horrible. Although again, this depends somewhat on speciality and department.

Even in departments that do much less non-emergency work, such as neurology, it's very much the 'B Team' on at evenings and weekends. Admittedly they're still above average, as those kinds of departments are harder to get into. But while the best doctors are working normal 9-to-5s, the nurses are working shifts, because they've still got the same number of patients at 3am as 3pm.

Personally I'm in favour of something more like the systems in France, Germany and Belgium - which are more of a mix of public and private. They also tend to be set up a bit more for the convenience and well-being of the patients and a little less for those of the staff. The trick is to try and get the best of public sector commitment, and combine it with the best of private sector flexibility. Not to end up with a system with the worst of public sector bloody-mindedness with the worst of private sector price-gouging...

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Mushroom

Re: No surprise

I had a kidney transplant on the 26th November 2012. Due to complications (rejection) I was in and out of hospital between that date and the middle of January.

I was in Christmas Eve, I was out on Christmas Day so I could spend some time with my family, and I was back in on Boxing Day at 10am. I was also in over New Year. The care on the bank holiday / the weekend was just as good as on any other day.

As for the hours - I was in hospital for the best part of 2 months, and doctors earn every penny, the nurses & auxilliary care workers even more so. The hours they do and the amount of work they get done is astonishing.

Private health care is fine for minor ops, or for the cosmetic options, but for the big things, in my (sadly extensive) experience, the NHS does it very very well. Have an op done in a private hospital, what do they do when things go wrong? Turf the patient to the local NHS hospital for them to fix.

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FAIL

Re: No surprise

My young daughter was sick on (bank holiday) Monday and spent most of it in Southampton General and I still think the NHS is great. Perfect, no, but great, yes.

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I would imagine

Part of that, at least in major hospitals, is due to the drunk and beligerant you get in on friday and saturday after drinking just that bit too much.

10 surgeons for 10 schedualed cases, sure not that much of a problem.

10 surgeons for 10 schedualed cases, and a nurse popping in every few mintues. "We have another stab victim" can probably put you off your game. And even if they aren't actively bothering you it must be in the back of your mind, "the moment I get out of here, I'm gonna have to stitch up some drunk guy who got in a fight with a car window"

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Re: I would imagine

I fear that may not be quite right.

It is well known that staffing levels decrease at night and weekends. It would appear from this study that what many in the NHS have felt, actually is true: reduced staffing levels lead to increased morbidity and mortality,

I believe the medical royal colleges have tried to impress this upon the "powers that be" for years: we need more staffing round the clock, 24/7. Hospitals should never run on "skeleton staff", regardless of the time of days or day of the year.

But, of course, this comes at a price. And when hospitals are struggling to keep the staff they already have or are considering redundancies, increasing staffing levels is clearly not happening any time soon.

I think it's important, however, to get a grip on reality: Healthcare in the NHS is of very high quality even if individual patients experiences may not always be so. It's good that these "deficiencies" are brought to light, though. The NHS strives to always improve. My opinion anyway.

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Good news

Shorter waiting lists on Thursdays and Fridays for people that can put risk into perspective.

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Anonymous Coward

Re: Good news

Preparing for the Friday Night drunks in A & E

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You forgot to mention that they also reported that a similar increase in risk was seen in the US health system (amongst others).

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Is there generally the same level of experience/skill in surgical staff working on different days?

Is seniority positively correlated with ability, and if so, do there tend to be fewer senior surgeons around at weekends?

Is there bias in terms of patients (certain types of people being more likely to opt for weekend surgery for elective operations?)

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Paris Hilton

How about ops on a Thursday?

If these correlate closer to Mon - Wed results rather than Friday results maybe that provides an evidential basis for first 24 hours post op care?

If not, well ermm cough-cough, innocent whistle...

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No mention of some important facts

Like the hard cases are seen on the Thursday and Fridays as their surgeons would not then be tied up in operations over the Saturday/Sunday.

This report should be taken like most reports, with the full knowledge that the figures have been compiled in order to prove whatever points the writers want.

The figures in this report are comparable to those in the US, which should tell you that its not as simple as people say.

From personal experience of both working for the NHS in multiple hospitals and from being a cancer patient that involved chemo and surgery I would always go private for the nice clean hospital beds and better looking nurses, but there is no equivalent of a "Friday afternoon car" in the NHS.

Massive waste, corruption and cheap labor employed for massive margins yes, but no lack of care to those who need it post operations.

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Anonymous Coward

Re: No mention of some important facts

"their surgeons would not then be tied up in operations over the Saturday/Sunday."

You seriously expect readers to believe that the relevant medics are routinely going to be on call over the weekend in case of emergency?

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Re: No mention of some important facts

Who said anything about routinely?

But yes, there is more chance of the surgeon being available in the case of an emergency if they are not tied up on other ops.

Its not perfect, but it increases the chances of someone being contactable.

It also increases the amount of deaths over those two days because the operations are generally those that can result in death rather than in ingrown toenail.

While its pretty fashionable to bash the NHS, they are people and tend to not like their patients dying on them.

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Note To Self

if having a heart attack, please make sure its a Monday, Tuesday at the latest.

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Headmaster

Re: Note To Self

You missed the part where it said elective operations. AFAIK the operation post heart attack would be classed as emergency...

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Duh

Maybe it's because so much of my family is in the medical profession, but I've known this since I was a kid. If you're scheduling a surgery that can wait, you schedule it for Tuesday at 10am or 1pm. Stay the hell away from Monday (doctors are just as susceptible to bad attitudes on Monday as anyone else). 10am is late enough that they've had their coffee but early enough that they're not yet thinking about lunch and 1pm is just after lunch so they're not hungry and not yet rushing through things at the end of the day. Never, ever schedule anything after noon on Thursday or anytime on Friday if you can help it. If you do then they won't be around if/when you have complications so you'll be stuck with whatever the nurses can do (which is a hell of a lot, but they can't make certain key, potentially life-saving decisions legally).

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Meh

I had an op on the weekend...

Non-emergency knee operation and everything went according to schedule.

What was interesting was what happened when i came out of anesthesia. One of the things they do is offer you food/water as you can not eat/drink that day. In my case there were no "helpers" ( i forget the actual term) on the ward and so i had a fully qualified nurse make me toast. I was also in a different ward then i would have usually been placed in (again staffing issues).

This is what might be contributing to this stat, trained staff being stretched thin plugging various holes rather than less quality staff botching things. I would imagine the situation is even worse if you cross over into the evening shifts on fri/sat where the medics are having to sort out idiots who can't handle there drug of choice (or others injured by said idiots)

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Stats in context

In summary your chance of dying from elective surgery ranges from 0.6 % to just over 1%. Still pretty good odds once you eliminate the 44% and 82% headline grabbers.

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Happy

black wednesday

Fridays are bad but death rates rise 6% in one day on Black Wednesday - in June, when the new crop of junior doctors are unleashed. Still, you can't moan too much, it is free after all.

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Pirate

Its down to

the staffing levels on the weekend. and the fact the staffing levels are kept to an utter minimum because it cuts into the amount of execs and bean counters that can be employed.

A lot of the staff are highly dedicated professionals who do an excellent job over and above what their terms of contract say, I should know... lying in a heart surgery unit , you got to know the good ones, there are some who just do their jobs, then theres the agency staff who get called in when 1 of the 4 ward nurses goes sick when the nursing assisant has a day off.

Pray to god that your post-op care does'nt fall on the shoulders of the agency staff......

30 mins to do the obs on 4 patients when the full timers could do it in 8 mins and not need the patient to tell them which monitering device goes where on the patient.

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Meh

So now they've found the effect is real.

Lets find out why

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Windows

Prevention is better than cure.

Without the NHS keeping our sorry asses alive we would have a much worse life expectancy in the UK. Before WW 2 anyone too poor to afford a doctor either suffered and died or threw themselves at the mercy of charitable institutions who struggled manfully to keep them alive with a far higher failure rate than would be acceptable today. In 1930 a British citizen expected to live to 60 on average, 20 years less than today and if they were going under the knife they made a will.

We are currently 27th (between Belgium and Germany) for longevity and only 2 years behind the leaders Japan using a "free" state health service that everyone seems to attack for not being perfect.

Much like our ancestors our chances of survival are much more likely if we don't have need for elective surgery and the process of educating the whole population to avoid the need for it is an expense that the NHS knowingly shoulders to reduce the need for expensive operations and after care.

Don't smoke, don't drink and drive, don't shag strangers without a condom, eat veggies and get off your lazy arse to do some exercise so we don't have to treat your cancer, liver failure, heart disease, RTA injuries or STDs. That is the real way to reduce the need to cut folks open and potentially kill them by doing so.

Might reduce the strain on the system too, maybe.

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Flame

Re: Prevention is better than cure.

Go boil your head.

I had emergency heart surgery last year after a routine trip to the docs showed something was wrong, then had a heart test which showed something extremely fatally wrong when everyone(inc the hospital) was expecting something minor.

95% artery blockage close to the aorta.

I walked 20 miles a week + to work and back, limited my drinking to maybe 1 or 2 beers, did'nt smoke, and ate my veggies like a good little smurf

The doc told me that 50% of heart disease cases are like me with no readily indentfiable cause, anyway old Sir R. Fiennes came back from one of his expeditions, oh I've just walked across the north pole on 1/2 a cup of brown rice sort of thing and he needed a double bypass....

Damnit now my BP has soared back up again, the pain has come back andddddddd...arrrghgghhhghhgh

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Windows

Re: Prevention is better than cure.

I appreciate that not every heart attack is caused by nurture but is just as likely to be nature. My Dad died in 2002 aged 58 after 3 heart attack in 90 minutes. When the post mortem stated premature ageing of the heart I asked the cause.

Poor diet in early life, excessive drinking and a sedate pace of life were all prime suspects but ultimately the most likely trigger was inherited.

I don't claim that brown rice will save you (or me for that matter) but causality doesn't ignore the fact that taking excessive health risks certainly won't increase your chances of survival. Good luck with your circulatory system, I hope it sees you well into your retirement.

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The interesting question is how do Japanese men not get lung cancer regardless of how much they smoke ?

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Windows

Suck, squeeze, bang, blow.

I was wondering that too, current reasoning includes lower alcohol and fat consumption in Japanese males, higher efficiency of Japanese cigarette filters, less carcinogens in Japanese tobacco and later uptake in smoking age within Japanese society. Diet including high levels of fish oils and different exercise levels are possible components as well.

There may be a genetic link to lung cancer resistance too but this has not been proved yet. Certainly worth studying I reckon.

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