A universal problemThe issue of overworked doctors is not exclusive only in Malaysia; rather, a global one. According to a survey conducted by Physician Wellness Services (PWS) and Cejka Search in the United States in 2011, around 87% of physicians are moderately to severely stressed. This is an alarming figure as more than half of the medical practitioners are experiencing similar issue.
“This data shows that physician stress and burnout is prevalent and increasing,” remarked Mitchell Best, chief operating officer of PWS. “Until now, little research has been done that delves into why physicians feel stress, the impact it has on their lives and the impact physician stress has on patients,” he added.
“Physician stress and burnout can drive turnover, which is highly disruptive and expensive for a medical practice,” noted Lori Schutte, president of Cejka Search. The number of doctors leaving the practice is higher than the number that is entering, which will lead to shortage of trained staff at a point of time. This in turn will demotivate the new staff due to the high workload, long hours and stressful environment, and the cycle will continue until actions are taken to recognize and improve the stress level among physicians.
The implications behind this worrying trendWhen a doctor’s mental health is compromised – whether he is severely sleepy, tired or depressed – this will affect the patient’s care. Not being in a sound mind can disrupt a doctor’s judgement and also his concentration when performing procedures. Doctors who experience burnout are also reported to be at greater risk of making errors in patient care, disengaging from work, demonstrating hostility toward patients and having difficult relationships with colleagues and staff.
Apart from that, having burnt out doctors is not only detrimental to the patients, but also to the doctors themselves. Due to the long working hours, the lack of rest and sleep contributes to an alarming number of road accidents.
As stated by Malaysia’s Health Minister Dr S Subramanian, from 2014 to 2016, a total of 554 cases have been reported among the healthcare staff, with 96 of the cases occurring outside of regular office hours.
In Malaysia, there is a call for the revision of the on-call system in the hospitals. Dr Subramaniam said that medical staff were required to work not more than 65 to 75 hours per week or not more than 16 hours per day, and were given one day off according to existing regulations. This is, however, not the case in departments where there is shortage of staff and doctors are required to attend to patients on top of the administrative and procedural work. Some departments have junior doctors to assist in the daily ward work while other departments require doctors to do everything themselves.
A modern-day physician’s pledge in the revised Hippocratic Oath
“I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.” The newly revised Hippocratic Oath now includes the clause for doctors to take care of their own health as well, which was not included in the previous Declaration of Geneva.
"Doctors haven't been taking care of their own health because we've been operating under the paradigm that we should sacrifice ourselves to look after our patients,” expressed Dr Sam Hazledine, doctor and founder of MedRecruit from New Zealand.
Hazledine recently made history by petitioning to include a clause for doctors to focus on their own health, as well as of their patients, in the Hippocratic Oath, which was approved by the World Medical Association in October 2017.
Ultimately, there is also a pressing need to revise the number of hours doctors need to work each day – as the physical and mental health of doctors are equally important. MIMS
Malaysian doctors at risk on the roads post-call
“Drop Out Club”: Explore the alternatives – Part One
Part-time doctoring as a means to cope with burnout