• management
• emergency care systems, efficiency
• ethics

Angry Tax Payer (ATP): I see that your lot have found yet another excuse to avoid increasing the number of doctors who have to work at weekends.

Militant Doctor (MD): I presume that you are referring to the paper by Metcalfe et al in this journal which shows that admission to an English Major Trauma Centre at a weekend is not associated with any increase in mortality.1

ATP: Yes, but only because these well-funded specialist units are staffed around the clock with consultants and have 24-hour access to appropriate investigations. A plethora of other studies from both the NHS and other healthcare systems around the world have shown that patients admitted to hospitals at weekends have higher mortality and worse outcomes.1 This is true for most of the common emergency conditions and also for elective patients!

MD: Nobody is denying that the weekend changes the behaviour of the whole of society and that there is a consequent effect on health but it is certainly not clear that the lack of doctors—and also supporting staff—at weekends is the only, or even the main, cause of increased mortality in hospitals. It may be due to the case mix of the presenting patients, clinical coding or many other aspects of healthcare delivery.2

ATP: Well that is not what the Secretary of State for Health, the Royal College of Nursing and the Royal College of Physicians think.3 ,4 They regard better staffing at the weekend as essential for reducing the differential outcomes of patients throughout the week. And …