Thursday, December 12, 2013

“We Actually Get Stupider When We Work Too Much”: The Case of House Officers

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:

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

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The Long Work Hours Culture: Causes, Consequences and ChoicesBingley, United KingdomEmerald Group Publishing Ltd2008.

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Long working hours and risk for hypertension in JapanJ Epidemiol Community Health 2001

4 comments:

jimmyng said...

Browsed through some of your writings here. You're doing amazing things and I pray that God will be with you in your undertakings and may they be successful. What you and your team is doing is inspiring, and it is definitely in its baby steps to bring the nation forward on the health care front. May God guide you along the right paths towards eternal glory.

Izan said...

Well said =)

farizah farr said...

I would say that your discussion is indeed true..n being a professional too we focus much on work than other may think..27 hours non stop..perhaps..huhu..

Anonymous said...

I design courses, mostly content-based educational courses for adult profesionals. I am quite amused by some of the thoughts of people in the medical field, particularly by senior doctors on 'long-working hours'.
Many have the notion that long hours means better training and ultimately better doctors! As a course designer, I know that's far from the truth. Proper training is based on using the appropriate methodology together with specific techniques to develop changes in behaviour. Long working hours has never been developed or recognised as atraining methodology. Unless you are training army commandos for extended covert missions or members for the SWAT team. I would say that those comments in the many forums are made by able doctors but not trainers. They must have been trained in the old trusted way and that's probably the only system they know. We can't totally blame them as risistance to change is universal. I would be convinced by their arguments if they can provide some supporting data or research on the benefits of long working hours on the training of medical personnel.

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