Distal on-call doctors.

Distal on-call doctors were primarily senior doctors who were relatively older than proximal doctors (i.e. their ages ranged from 37-60 years old), usually had more than 10 years’ on-call experience and had partners and/or children. In this study, these doctors were either registrars or consultants at public hospitals or were DMOs at primary healthcare centres and clinics. The DMOs’ on-call duties came from their work as medical legal officers providing clinical support to the Trinidad and Tobago (T&T) Police Service.

The hospital doctors were considered second or third-call officers and were only called in if proximal doctors were unable to manage the patient/s. First, second and third call officers in the DMO system did not hold the same meaning as at the hospital. First DMO on-call meant that they were the first one called by the police in the case of an emergency. In the event the DMO first on-call was unreachable, then the DMO second

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on-call was contacted and so on. Nevertheless, all distal doctors waited off-site to be called during the on-call period.

On-call rotas for distal doctors ranged from every day on-call to one in six days. This large variation was due to DMO calls which were determined by the level of staffing and DMO supply in each region. The on-call period for both DMOs and hospital distal doctors lasted 24 hours (i.e. from 8 am one day to 8 am the next day). They were also on-call on weekends.

While distal doctors were not required to be at the hospital or health centre during the on-call period, it was expected that they would stay within a distance that would allow them to respond within a reasonable time to emergency call-outs. Therefore, they were to avoid activities which were not in proximity to the hospital or within the relevant region or that would require them to be in transit during peak traffic hours. It was also expected that they would not engage in activities that would hinder their ability to perform their job if called out. For instance, the consumption of alcohol was prohibited.

When compared with DMO calls, distal hospital calls were generally described as more hectic. Since hospital distal doctors were relatively senior doctors, in most cases they were called out for emergencies (e.g. surgery) or situations requiring high demands on their time and skill. DMO calls, however, entailed responding to call-outs from the police within the region for which they were responsible primarily to: view bodies resulting from sudden death, homicide and suicide and to examine medical legal cases such as rapes and incest. The work of the DMO in the Trinbagonian setting can be likened to the work of coroners or forensic pathologists in other settings. The table

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below identifies the doctors by their pseudonyms and categorises them per their demographics including whether they provided proximal or distal on-call. It is worth noting that the on-call categories were mutually exclusive. That is, no doctor provided both types of on-call.

Table 1: Showing doctors identified by pseudonyms and characterised per demographic data

Doctor Gender Age Category Relationship status Child status Type of on-call Rank Specialty No. of years on-call based on a 10-year marker

Barbara Woman 31-40 Partner Child/Children Distal Registrar Surgical More than 10

Billy Man 21-30 No partner (divorced) Childless Proximal House Officer Surgical Less than 10

Carl Man 41-50 No partner (separated) Child/Children Proximal House Officer Surgical More than 10

Carol Woman 41-50 Partner Child/Children Distal Consultant Surgical More than 10

Drew Man 41-50 No partner (divorced) Child/Children Distal DMO Primary Care/Medical Legal Care More than 10

Earl Man Over 50 Partner Child/Children Distal DMO Primary Care/Medical Legal Care More than 10

Harry Man 21-30 Partner Childless Proximal House Officer Surgical Less than 10

Hazel Woman 31-40 Partner Child/Children Distal DMO Primary Care/Medical Legal Care Less than 10

Jill Woman 31-40 Partner Pregnant Proximal House Officer Medical Less than 10

Jon Man 21-30 Partner Childless Proximal House Officer Medical Less than 10

Kate Woman 31-40 Partner Child/Children Distal DMO Primary Care/Medical Legal Care Less than 10

Lilly Woman 21-30 No Partner Childless Proximal Intern On rotation Less than 10

Macy Woman 21-30 Partner Childless Proximal House Officer Medical Less than 10

Paul Man 31-40 Partner Childless Distal DMO Primary Care/Medical Legal Care Less than 10

Rebecca Woman 21-30 No Partner Childless Proximal House Officer Medical/Surgical Less than 10

Ron Man Over 50 No partner (divorced) Child/Children Distal Consultant Surgical More than 10

Tina Woman 21-30 Partner Childless Proximal House Officer Medical Less than 10

4.2.3. SOs.

All SOs were married partners of on-call doctors. The majority were married for less than five years; had at least one child; were employed and had partners who were on distal call. Additionally, three SOs had partners who worked at public versus four whose partners worked at private health institutions, including at their own practices. As a result, the official ranks of the doctors were not applicable in all cases. For example, in most private institutions, ranks were not used or were not equivalent to the ranks used in public hospitals. Still, with the exception of one partner who was a junior doctor, all SOs indicated that their partners were middle range to senior doctors (i.e. either registrars or consultants). The doctors represented six specialties and one doctor belonged to two specialties.

On-call rotas varied widely from one in every four days to one in every four weeks on- call and some rotas were based on staffing and skill demand. Since most partners were relatively senior doctors, they were only called out for emergency or complex cases. The on-call period also varied and ranged from lasting about two hours for house calls to 24 hours on-call at public hospitals.

The table below identifies the participants by their pseudonyms and categorises them per their demographics. It is worth noting that the on-call categories for SOs’ partners were mutually exclusive. In the section, which follows, the analysis began with a description of what it was like for doctors and SOs when they or their partners were on- call.

Table 2: Showing SOs identified by pseudonyms and characterised per demographic data

SO Gender Age category No. of years married based on a 5-year marker Child status Employment Status Partner's type of on-call Partner's rank Partner's specialty

Brad Man 41-50 Less than 5 Child/Children Employed Distal Not Applicable Surgical

Faye Woman 31-40 Less than 5 Child/Children Unemployed Proximal Not Applicable Medical

Nicki Woman Over 50 More than 5 Child/Children Employed Distal Consultant Medical

Robert Man 31-40 More than 5 Child/Children Employed Distal Consultant Medical

Smith Man 31-40 Less than 5 Childless Employed Proximal House Officer Medical

Tiffany Woman 31-40 Less than 5 Child/Children Employed Distal Not Applicable Medical