Formulación de hipótesis

6.1. Reflections

Prior to the increased national focus on the health and well-being of Trinidad and Tobago (T&T) doctors and calls by the local medical trade union for improvements in on-call working arrangements, I was motivated to conduct research on how being on-call is experienced by doctors in their everyday lives. This was because of my own experiences of having a mother whose professional duties sometimes required her to be on distal call. Due to the paucity of research on the experiences of distal on-call workers, including the impact this working arrangement had on their social well-being, I had initially sought to gain an understanding of the experiences within this group of doctors only.

However, after having had informal conversations with proximal doctors during one of my visits to a major hospital prior to the start of the study, it became apparent that the experience of being on-call held different meanings for proximal versus distal doctors. I realised that no research had explored the differences and/or commonalities between and among these groups. This led to the development of new research questions with the aim of isolating proximal and distal doctors’ perceptions of being on-call and understanding the meaning being on-call had for their family and social lives. Furthermore, I believed that different individuals in the on-call workers’ social network might have had different perspectives of what having a partner, parent or friend who worked on-call meant to them. There were a few studies which explored the realities of spouses of on-call workers and as argued in chapter two, of those which did, there were

several limitations. Therefore, an additional aim became to explore the experiences of SOs when their partners were on-call. The literature also suggested that the on-call experience might be different for men and women and thus, attention was given to how gender was constructed and perpetuated within systems.

Consistent with previous research, the study found that the on-call doctors and SOs of on-call doctors’ experiences of being on-call were more ambivalent than definitive. Distal and proximal doctors had generally accepted that their on-call duties were a required component of their medical careers and welcomed the opportunity it afforded them to provide adequate patient care. However, where this study contributed to the existing literature was in the rich insights it offered into the multi-faceted nature of the on-call experience that was often hidden behind the statistical approaches of past research. Specifically, the results showed that in their evaluations of their experiences of being on-call, there were some nuances between and within proximal and distal on- call systems and between the realities of men and women doctors and SOs overall. The study also contributed to knowledge about the meaning being on-call had for the family and social lives of both proximal and distal doctors and their SOs. Specifically, the results showed that it impacted the quantity and quality of time participants spent with their partners, how they negotiated their childcare duties and the extent to which they engaged in non-work activities.

6.2. Strengths and limitations

The study’s strengths related to its contribution to; on-call research in the Caribbean, qualitative work in the area which could be used to inform future quantitative research, a cross-analysis of the experiences of proximal and distal on-call doctors, research on the family and social impact of being on-call and a gender-focused perspective of the on-call experience.

Notwithstanding the above strengths, one limitation of the study was that the composition of the distal on-call sample (i.e. mostly District Medical Officers [DMOs]), meant that the realities of this group might have been mostly applicable to DMOs and therefore, not reflective of the realities of distal hospital doctors. As stated in chapter four, the DMO on-call experience was perceived as less hectic than the distal hospital on-call experience. Therefore, it is not known if the recruitment of more distal hospital doctors might have revealed more intense lived experiences. Additionally, while the recruitment of SOs allowed access to another set of realities, a more ideal scenario would have been the recruitment of SOs who were matched to the doctors in the sample to allow for comparisons between the two groups. Future research should explore the experience of being on-call using dyads of on-call doctors and their SOs as more recent research is needed in this area. Furthermore, it is not known for certain if there might have been some degree of self-selection, since it seemed that the couples represented in the two samples either adjusted to having to manage their relationships around their partners’ on-call or they did not and separated. Nevertheless, it was not the intent to generalise the participants’ experiences to other on-call doctors and SOs.

6.3. Implications for practice

It is unlikely that the requirement to be on-call within the medical field and especially within a doctor’s junior years will cease. Thus, systemic and individual methods of coping with the challenges of being on-call are needed. Apart from the development of appropriate strategies to improve what on-call doctors and SOs perceive to be the favourable aspects of the on-call experience and to minimise the unfavourable, systemic or organisational on-call strategies should take into consideration where on-call doctors’ needs diverge and converge per on-call category and within on-call categories.

Proximal on-call policies could entail the implementation of lengthier recovery periods between on-call shifts or between on-call shifts and regular working hours. Meanwhile, distal on-call policies could involve the recruitment of more middle-range doctors or registrars to reduce the likelihood that senior doctors would be called out. Counselling should be made more accessible to DMOs in particular, and they should be encouraged to access these services given the trauma they are exposed to in their line of work. The lack of psychological detachment outside the on-call period experienced by both proximal and distal on-call doctors could be addressed by training doctors to use individual strategies such as relaxation and meditation techniques at home. In essence, systemic methods should support individual approaches. While some of these recommendations may have been voiced, they have not all been adopted. It is hoped that the evidence provided in this study will serve as an impetus for implementation going forward.

The prioritisation of work over family by men on-call doctors, the desire by women on- call doctors to dedicate more time to their families and the sacrificing of careers by women SOs, imply that broader national ideological changes about the role of men and women in the home and at work are needed. However, while it is acknowledged that this is by no means an easy feat, more immediate and realistic strategies could begin with managerial attitudes which encourage a better balance between work and life among men and women doctors on-call. This would entail a redefinition of what it means to be an ideal or invincible doctor. Acknowledging the differences in the social role expectations of men and women and the need for greater equality as pertains to these roles, can contribute to the development of more appropriate strategies for each gender. For instance, opportunities for part-time working within various medical specialties, having a choice between compensatory days off-duty and on-call allowances and lengthier vacation and/or leave periods (particularly paternity leave where offered), may go a long way towards attracting and retaining women doctors and facilitating greater involvement by men doctors in the home.