When Junior National Health Service doctors in England voted to strike last week over pay and hours, there emerged the predictable response from opponents that strikes are unsafe for patients. A new analysis, however, suggests such fears are misplaced: Mortality rates stay about the same during strikes—if anything, they decline—as long as emergency departments stay open.
Any labor strike is a burden on somebody—that’s kind of the point—but, in theory, lives hang in the balance when doctors strike. Earlier this month, conservative member of Parliament and former general practitioner Sarah Wollaston told the Telegraph a strike would be “highly unsafe for patients…. When you think of procedures that might not be emergencies but are extremely urgent, to have three days including two of them a full walkout, will be putting patients in significant harm.” A 2011 nurse’s strike in California raised similar concerns after a replacement nurse’s error took one patient’s life.
“Doctors in high-income countries can be reassured by the consistent evidence that patients do not come to serious harm.”
But do doctor’s strikes actually put people in danger? According to Harvard Medical School researchers David Metcalfe, Ritam Chowdhury, and Ali Salim, the answer is a clear “no,” as long as patients have access to emergency care. The team reviewed seven strikes around the world (previously discussed here, here, and here), and found they typically had no effect on patient deaths. In fact, mortality rates went down when Los Angeles County doctors withheld non-urgent care for five weeks in 1976, and the same appears true of a 1983 strike in Jerusalem, during which burial rates in the city declined.
The one exception was a 2010 South African strike that halted emergency services at all but one hospital for 20 days—in a region serving 5.5 million people. Data from the one open hospital suggest emergency admissions fell but deaths increased during the strike, perhaps because patients, deterred by the strike, delayed seeking care until it was too late, Metcalfe, Chowdbury, and Salim write.
In fact, emergency care may have something to do with the flat or declining death rates: Six of the seven strikes the Harvard team cites guaranteed emergency care, and some doctors during a 2012 United Kingdom strike continued seeing patients as usual, making it “sometimes difficult to determine which doctors were actually taking action,” the team writes. Care might even improve in emergency departments if junior doctors strike—their replacements, after all, are likely to be their more-seasoned elders.
“It would, nevertheless, be naive to imagine that [strikes] can be undertaken without causing harm to patients,” the team writes, noting the South African example and the fact that, at some level, strikes work by discomfiting consumers—in this case, patients. “However, in balancing their competing priorities, doctors in high-income countries can be reassured by the consistent evidence that patients do not come to serious harm … provided that provisions are made for emergency care.”
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