Back in June last year I decided to resign from my job as a doctor in Emergency Medicine at the Spanish hospital where I’ve been working for the last eight years. My contract was precarious and the working conditions treacherous. I had complained several times about the unsafe long hours without any organized rest and the incredibly busy shifts. Nothing worked so I just left.
Poor working conditions, with lack of stability, temporal and badly paid contracts and generally undignified jobs are common in the Spanish NHS where only less than 40% of doctors have job security and they are mostly over 50 years old. So, five weeks after leaving my job I decided to write about it here in my blog Medicoacuadros. This is a blog that I have been writing since they closed the blogs section at the national newspaper El Mundo. I tend to comment on medical professionalism, medical ethics, humanism, patient dignity and all those things that I feel are important to Medicine. So, I wrote, in general terms, about the suffering and precariousness of medical staff and all the things that shouldn’t be happening and that I had decided to leave behind. Here is what I said:
Dear working exploitation: this is it, I am leaving you
I have left my job as a doctor.
I have given up my on-call hours contract with the Spanish Health Service.
I have left behind a merciless working exploitation.
I have abandoned the slavery of a health system that treats its staff as if they were just rubbish.
I have given up to being pushed around by a head of department that manages his staff as if he owns them, a boss that uses tyranny rather than leadership. A boss who is just like so many others in our national health service. No better and no worse.
I have left a system where there are first and second class doctors and some live at the others’ expense.
I have resigned from working 24 hours shifts, with no rest. Such long hours are a risk to my own health but more importantly, they are a hazard to my patients’ safety.
I cannot take any more of this lack of job stability.
I have resigned from working with excellent colleagues who, like thousand of them in Spain, have finally forgotten their professional pride, their dignity and they just live in fear.
I give up a summer timetable that would make me work up to 60 hours per week, for three months non stop, at peak busy time just because this year, it’s not my turn to have any breaks
I leave behind the only working contract that allows me to work part time. You are either a full time worker or you are nothing.
I’ve fled from the “this is the way we’ve always done things here”.
I give up to the overwhelming feeling of being different because I dare to write and I dare to doodle cartoons or because I dare to stand up to injustice or to give my opinion when nobody asks.
I give up to the indignity, the abuse, the tiredness, the stupidity, the despotism, the poor organization, the lack of mid and long term plans, the lack of solidarity and professionalism that the Spanish National Health Service inflicts on us workers
I have always wanted to be a doctor since I can remember, I graduated 25 years ago, I spent five years training and twelve more as an A&E doctor in the UK and the last eight years in Spain. I am just a doctor, only a doctor, a doctor from head to toe but I have had enough.
This is it, I give up, I am out.
This letter was received with an immense and roaring welcome in the Spanish medical social media where thousands of doctors were pleased to see a colleague making our general situation visible to society (many people still think that doctors have great salaries and fantastic jobs), there over 80.000 visits to Medicoacuadros, many thousand of tweets and so on. The Spanish General Medical council (OMC) were also enthusiastic about it and helped to spread its popularity.
Unfortunately some of my former colleagues at the local A&E department (led by their head of department) took it personally and felt offended about it and they made a complain to the local medical council (Spain has a general medical council but also 51 independent local councils that are fully autonomous). The council looked into it and decided five months later to take disciplinary action against me following a review by the local deontology committee. Apparently they found that I could be guilty of missing the adequate attitude of brotherhood and fraternity towards my former colleagues.
I am now undergoing disciplinary procedure for this; if the board finds I am guilty, I could have my license to practice medicine removed for up to a year.
I am happy to count on an incredible (and virtually noisy) backup from doctors, nurses, organizations and even patients associations who are giving me their support in an unprecedented explosion in SoMe that has been completely overwhelming. Some of it may be followed by the #ExpedienteMonica My @mlalanda was mentioned over 10.000 times in less than 48 hours, I have received over 100.000 visits to the entry with over 100 comments and more than 50 bloggers have written entries and so on. In only two days it has managed to make it to local and national newspapers too
I am sharing it all in english( in a very concise way) since I am sure that there are many doctors around the world who are also suffering for speaking up and whistle blowing. In this XXI century I feel that a situation like the one I am suffering needs to be made public. Maybe we have been taking freedom of speech for granted but it’s not really there. Something is not quite right.
I feel that I am fighting now not only for myself but for better working conditions for the medical profession in Spain. I am hoping to encourage my colleagues to fight for our jobs to become more dignified. If we are permanently exhausted and concerned about the needs of our families, the stability of our homes, we will not be able to provide the quality and safety of medicine that our patients need and deserve.
Now I can only cross fingers and hope that I’ll be found innocent.
UPDATE: Due to the uproar, the case was moved to the national GMC for mediation. My lawyer attended on my behalf. I was asked to sign a joint paper where with the head of the A&E department I had resigned from (my ex-boss), describing that what I had written was not against him and that I was ver sorry. The case was then closed at the end of March without any form of punishment
I signed it. Luckily nobody asked me to remove the entries to the blog. Needless to say, it was never intended to offend anyone but to bring to the attention of the society the situation we are at.