Plasmapheresis and fulminant acute pancreatitis?

I hope that Dr Simon Durnford's editorial (15 October, p 931) on junior doctors' working hours is an indication that more attention will be paid to this. The issue is one not only of resources and training but also of complacency and lack of imagination. While working an alternate night system in 1971 I and colleagues reduced our hours of work when in danger of sleep deprivation-that is, after 24 hours' continuous duty-from 42 hours a week to eight by simply changing duty times with no change in total hours of duty.' The experience made clear two attitudes that are likely still to be obstacles to improvement: that of some senior doctors, to whom the house job is more an initiation than a training process, and that of management, to whom only financial considerations were relevant and thus working hours of technicians were important but those of doctors were not.