I
have a habit of eating vegetables on the plate after I have finished eating
everything else. It is surprising that many times when I eat with my friends,
while I am wholly enjoying the ‘ayam masak merah’ with steamy rice, leaving the
vegetables at the side to be consumed later, they would jokingly point out “Ha,
you don’t eat vegetables? I thought doctors always ask people to eat healthy
food?” This is a simple case of a common people assuming the doctors are not
walking their talk. We have all heard the story of the heart surgeon who smokes
a lot, the physician who is too obese, the psychiatrist who is always depressed
and all those sorts of irony. As doctors, we always advice people to maintain a
healthy lifestyle: Go for workouts, do not eat fast food, eat home-cooked
meals, spend time with family and friends. But surprisingly, as we tell people
all these things, deep in our minds, we say to ourselves “yeah good luck with
that, even I have no time for those”.
Recently
there has been a lot of commotion about the incompetence of Malaysian House
Officers. We had the same furor half a decade ago, and the solution thought by
the Malaysian Medical Council and Ministry of Health is that the House Officers
need more exposure. Hence, from the one-year housemanship time period, it was
increased to two years. Then a few years down the road comes again the same
complaint. The assumption? Still need more exposure. We cannot increase the
number of years (been there, done that). Hence, the suggestion was to increase
the hours.
Doctors
are not manual labors. Every decision we make may mean life and death to
somebody. Tasha Eurich, a Ph.D. holder in psychology and author of a new book
‘Bankable Leadership’ go as far to say that “We actually get stupider when we
work too much”. No matter how competent a doctor is, no patient wants a
half-asleep doctor taking their bloods. The decision-making of a person is
severely impaired simply because of sleep deprivation. I am a coffee lover and am
familiar to the adage: “Drink coffee and keep working, you can sleep when you
are dead!”, but research shows that even stimulants do not help. The researchers
at Harvard Medical School recently found out that people who were sleep
deprived might as well make a random decision. They performed less well as
compared to those who had enough sleep even when given stimulants. Then when
they were given a long period of recovery sleep, baseline decision making
skills are back to normal.
As for the house officers themselves, studies show that over
time, working long hours can increase their risk of depression, heart attack,
and heart disease. It also increases the risk of road traffic accidents. This
might not be proven yet in Malaysia, but with all the same stories I receive
from house officers, I think a research should be done on how many housemen
fell asleep at the traffic light back from a long day at work. It is downright
dangerous. House officers, they have gym memberships but never had the time to
go, they learn to cook healthy foods when we were students but now we are going
to have to forget all of them, they have good friends and families, but never
have time to see them. They go out of the house before the family wakes up, and
come back at night after they have slept. For those with spouses, an article on Harvard
Business Review reveals that 50% of workers who work more than 40 hours a week are
so depleted and drained when they get home at night that they’re speechless, incapable
of conversation. Can you imagine how this will take a toll on relationships? How
are we supposed to take care of other people when we do not have the time to
keep ourselves healthy?
Realizing
the bad effects of working long hours of health, we should forget the idea that
to increase competency we should increase the number of working hours. It is
not the hours that are at fault but the years before they graduated from the
medical schools. We have too many students graduating from unrecognized
Universities, too many private medical schools sprouting out without the
capacity of enough lecturers to teach, too many students in a teaching hospital
wards, and such. In recent years, the health indicators of Malaysians have seen
good progress. Working here at the World Health Organization,
Malaysia is always held in high regards when it comes to health care. It makes
me proud being a Malaysian. House officers are too used to being told by
specialists: “during the old days, I am the only doctor in the ward, worked on
call 2 days straight”. Well then, look at the Life Expectancy, Malaysian
Maternal Mortality Rate, Deaths of Children Under-5 and Prevalence of
Infectious Diseases in the old days. If you want everything to be ‘like the old
days’, would you also like our health indicators and life expectancy to regress
back to the ‘old days?’. Doctors are also human beings included in all
statistics on health indicators.
Going
back to the conversation that I had with my friends as I was eating ‘ayam masak
merah’, I wish someday I can fork the vegetables into my mouth, eat it all and
say “Yes, I eat vegetables, I exercise at the gym 3 times a week, I usually
cook my own food, and I usually go jogging on weekends when I am not working”.
“Gosh, you are a doctor, you have time for that?”
“Yes,
a doctor is an advocator for health,
no?”
Sources:
Sources:
1. The impact of sleep deprivation on decision making: A review. Harrison, Yvonne; Horne, James A. Journal of Experimental Psychology: Applied, Vol 6(3), Sep 2000
2.
- Burke RJ,
- Cooper CL
3.
- Nakanishi N,
- Yoshida H,
- Nagano K,
- et al
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