In July 2015, a 27-year-old anaesthesiologist in Malaysia met with a road accident while driving home after an ‘on-call’ duty at the hospital. Her car collided into a tree, and she died on the spot.

The news of her tragic death spread like wildfire, and the Health Ministry was called to review the working conditions and hours of doctors.

“These doctors perform under pressure every day and we urge the ministry to improve their work environment, especially in government hospitals,” agriculture and agro-based industry, health and rural development committee chairman, Dr Afif Bahardin, said at the time.

Rest is important because doctors are faced with life and death situations on a daily basis. It is important for them to have proper rest to focus on their job.”

Tired individuals unfit to be behind the wheel

Experts have long debated whether the workloads of healthcare professionals are reasonable, and if such long hours are harmful to patients – or to healthcare professionals themselves. While many agree that the long hours negatively affect work-life balance, several seasoned providers debate that on-call duties are essential for training young doctors to manage emergency conditions that may occur at any given time.

“Many have accused that the on-call system had resulted in the death of an officer in a road accident,” said Malaysian Health Minister Datuk Seri S Subramaniam. “But the system is not something new in medical history.”

A recent survey by MIMS revealed that 133 out of 298 healthcare providers in Malaysia and Singapore – including doctors, nurses, pharmacists and other allied health professionals – admitted to have fallen asleep while driving after a long day at work, out of which 97 further confessed to have dozed off on several occasions.

17.1% of these health professionals also revealed that they have been involved in a motor-vehicle accident following long working hours, with 4% admitting that this has occurred more than once.

“If you have not slept seven or more hours in a given 24-hour period, you really shouldn’t be behind the wheel of a car,” said Jake Nelson, the director of AAA Foundation for Traffic Safety Advocacy and Research.

This leads us to wonder; If doctors are unfit to drive after a long day at work, should they be allowed to continuously provide care to patients?

Healthcare professionals burdened by workload

“I have been in situations where we had to work over 24 hours, which is physically and mentally exhausting,” said an unnamed doctor who responded to the survey. “We often skip meals and toilet breaks. The working environment contradicts the healthy lifestyle that we advocate as health professionals.”

A majority of healthcare professionals in Malaysia and Singapore work an average of 40 to 50 hours a week. Approximately 46% of health professionals surpass 50 hours of work a week, out of which 9% of doctors and 1.98% of pharmacists clock in over 80 hours weekly.

The Singapore Medical Council (SMC) stipulated that work for house officers should not exceed 80 hours a week, including night shifts, and cannot be scheduled for over 24 hours of continuous active duty.

Likewise, the Malaysian Employment Act 1955 states that an employee should not be required to work more than eight hours in one day, nor more than 48 hours in one week. However, the limit can be exceeded should the service be essential to the life of the community.

Burnout affects quality of patient care

A meta-analysis by researchers at The University of Manchester and the University of Southampton revealed that excessive workload, imbalanced job demands and prolonged stress in the healthcare industry led to burnout amongst healthcare providers.

Burnout, in turn, can result in higher incidences of medical errors and reduced quality of patient care.

In fact, 56.1% of doctors, 30.3% of nurses and 61.4% of pharmacists surveyed admitted to committing a medical error at work during a long day at work, while an additional 18.7% said that they have heard of a colleague who committed an error.

“We need to have enough rest to ensure the high quality of service provided to patients,” said a pharmacist in the survey. “Prolonged working hours can impact healthcare providers’ judgment and ability to make decisions.”

Many studies have linked burnout with negative physician-patient relationships, poor quality of care and safety, and some governments have attempted to thwart the issue by introducing shorter shift systems, compulsory rest-days and capping the limit of working hours per week.

With 43% of healthcare providers in Malaysia and Singapore still reporting dissatisfaction with their working hours, however, more efforts should be focused to improve the work environment and psychosocial health of healthcare providers, not just for their own wellbeing, but for the safety of patients as well. MIMS

Read more:
Infographic: Survey results of HCP working hours in Malaysia and Singapore
2016 MIMS Career Survey (Malaysia) - Part 1
2016 MIMS Career Survey (SG Results) - Part 1
Is a work-life balance impossible for doctors?
“Karoshi” or death by overworking: A lethal epidemic of stark proportions