‘Striking’ a Balance: The Ethics of Doctors’ Strike Action

Addressing the question of ‘harm’ in resident doctor strikes…

If you feel like your job has become untenable, you might take your case to an employment tribunal. That’s the individual route — a solo pursuit for justice. But history tells us that one person shouting is easy to ignore. When workers band together, their voices carry more weight. That's the premise behind trade unions — collective bargaining was born from the realisation that workers were stronger when they acted in unison rather than as scattered voices.

But collective action only works if it causes some disruption. There has to be a consequence. Without it, the power dynamic stays firmly in the employer’s favour. In the case of NHS doctors, the “employer” is the government, and strikes aim to make them shift their position by applying pressure. This makes strike action, in the bluntest terms, a form of coercion — not in a sinister sense, but in the way that all political protest must inconvenience someone to be noticed. So when people say strikes cause harm, they’re pointing out something that’s almost tautological: if they didn’t, they wouldn’t work.

Please Define ‘Harm’

Harm isn't a binary concept like it’s painted out to be when doctors face the media in the middle of strike action. It’s a spectrum — from the minor pain of stubbing your toe to the profound distress of an A+E admission with major trauma. The ethical debate about doctors striking hinges on where strike-related harm falls on this continuum, and crucially, where society chooses to draw the line of acceptability. The issue appears to be that people interpret 'harm' too narrowly, often focusing solely on acute care and neglecting its broader aspects.

So, how harmful is it when doctors walk out?

2021 paper published in the Journal of Economic Behaviour & Organisation took a close look at the 2016 junior doctor strikes in England. Specifically, they analysed the final 48-hour walkout in April 2016, which affected both elective and emergency care. Their findings? No significant increase in mortality or emergency re-admission rates in the hospitals most affected by the strike.

But that’s the acute phase, at least.

But if acute care was held steady, what about the longer, chronic care? Consultants and senior registrars pulled from clinics and elective lists to cover emergency services may delay diagnoses, create treatment backlogs, or postpone operations. This can be the difference between a cancer diagnosis that is picked up today or a few months down the line when it has metastasised. Equally, some may say that the main harm to the government is financial, but is this not money that would go towards the daily workings of the NHS, and thus patient care.

The Striking Paradox

Here’s an irony worth pausing on: if we argue that strikes causes no harm at all, do we unintentionally undercut our case?

Doctors are asserting — quite rightly — that their labour is essential. We claim we are irreplaceable, highly trained, and integral to the functioning of the NHS. If that’s true (and it is), how can we argue that our absence has zero impact? If patients and systems don’t suffer in our absence, it begs the uncomfortable question: are we really needed?

This doesn’t mean that strikes must cause chaos to be justified. But we should be honest (to ourselves and the public) that disruption, and by extension, harm, happens — and that some harms, especially the chronic and invisible ones, may be inevitable. Let’s not kid ourselves and insult the intelligence of the public at the same time by claiming ‘harm’ will not be present.

Ethical strike action doesn’t necessarily require the absence of harm; it requires that any harm is proportionate, mitigated as far as possible, and justified by the pursuit of a greater good: a fairer, safer healthcare system in the long run.

Has the Pay Deal Been Lost in the Post, Mr. Streeting?

More political talk—this time, from Wes Streeting.

The Health Secretary expressed his disappointment this week, criticising the BMA for launching a strike ballot before a formal pay offer had even landed. He warned that another round of strikes could push the NHS further towards crisis by undoing the work they have already made cutting waiting lists.

Streeting claims a “good” offer is coming, though he called BMA demands last week—rumoured to be over 10%—“unreasonable.” He urged junior doctors to wait and promised the deal would address their genuine pay concerns. The most outspoken resident doctors on online forums are calling this textbook political manoeuvring, expressing deep scepticism toward Streeting’s empathetic tone and promises.

The BMA is perhaps thinking that waiting is precisely the problem. Delays can soften offers and stall negotiations. Both sides claim to be acting in good faith. The government wants space to deliver a credible offer. The BMA wants proof that delay doesn’t mean dilution…

How Busyness Became a Status Symbol in Medicine

Medicine’s noble mission shouldn’t get buried under bureaucracy

Back in 1930, economist John Maynard Keynes made a bold prediction: thanks to technological advances, the average person would one day work no more than 15 hours a week… Well, he was half right.

Technology has exploded beyond anything Keynes could have imagined — and yet here we are, frantically clicking through another mandatory e-learning module on hand hygiene, more overscheduled and overstretched than ever.

Some argue that today's society is facing an epidemic of alienation in the workplace. Anthropologist David Graeber, in his provocatively titled book Bullsh*t Jobs, argued that modern work structures are dragging almost everyone toward a creeping sense of meaninglessness.

For a long time, medicine felt like an exception. Unlike many other professions, our work seemed safely insulated from this existential drift. Healing bodies, caring for minds, decoding disease — these are noble, urgent, and deeply human pursuits. When we're sick, we want a doctor who genuinely loves what they do — someone who's curious about diagnostic dilemmas, who enjoys wrestling with treatment options, and generally finds the whole business of medicine, wonderful.

But Graeber’s point goes deeper than it first appears: even essential jobs aren’t immune.

If you take an honest look at how many hours are spent chasing signatures, duplicating information across disconnected systems, or attending mandatory trainings that add little to actual patient care, the problem becomes harder to ignore.

You're not doing "nothing" — you're doing a lot. In fact, today's doctors are arguably busier than any previous generation. But much of that busyness has drifted away from the reason why we became doctors in the first place.

Strangely enough, modern medicine has started to celebrate this chaos.
The "hero doctor" image — always on call, always rushing, always overwhelmed — has been baked into the culture. Sociologist Jonathan Gershuny points out, in wealthy societies, time poverty has even become a new kind of status symbol. To be overwhelmed is, paradoxically, to seem important.

“Could you spell that for me?” “Yes—Tango, Zulu, Oscar, Murder”

“Don't you think the fact that the government won't release the DDRB recommendations suggest that the recommendation was in excess of the government offer?”

"For any paediatric patient over 10 with mum: 'Is this mum or sister?' 90% guaranteed to put a smile on mum's face and break the tension. Caveat: obviously, make sure it’s not the sister."

“There will be many Doctors thinking about the financial issues that would arise from striking. This is particularly the case for our most junior colleagues. I hope that when the BMA strike-fund is rolled out, it is proportional in nature supporting the lowest paid juniors first”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

An article this week by Rhys Blakely showed that kids as young as five make subconscious links between accents, perceiving southern accents, for example, with intelligence—a bias that could shape how patients view their doctors.

A Freedom of Information request on 1st May 2025 revealed the GMC spent £844,982 on private medical care—for its own staff across 2024.

An amendment to the proposed assisted dying bill, introduced by MP Kim Leadbeater, seeks to protect NHS staff who choose not to participate in the assisted dying process. (The Guardian)

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A Shared Parental Leave Prescription

The On-Call team believes in a system where every doctor has the opportunity to make smart financial choices and build long lasting wealth…

But when our female doctors colleagues take the full hit of maternity leave, their income, pension, and progression suffer. Some want all of that time at home, and that’s great. But not all do. Shared parental leave gives families options, yet too few men take it. Why? Because medicine still quietly reinforces old stereotypes by glorifying the always-on, never-home hero.

Shared parental leave offers up to 50 weeks to split between parents. You can tag-team it and be off work at the same time or take turns—your call. We can’t justify maintaining a system where time away is still seen as career disruption for men, but as obligation for women.