Our Own Worst Enemy

Medical school was supposed to be stressful and exhausting, but my experience at McMaster hasn't borne that out so far. Even though my schedule is typically packed with tutorials, clinic time and studying, I’ve always managed to find pockets of time to relax and socialize.

It helps that McMaster has taken strides to encouraging a work/life balance in its curriculum. Even the keynote speaker at this year's medical student conference, Dr. Marla Shapiro, talked extensively about her belief in self-care through the framework of her experiences with cancer.

But there are tough times on the horizon. During their residency, perhaps the toughest part of a physician's career, a resident will likely do a 28-hour shift. If you think it seems a bit unreasonable to allow an inexperienced doctor to suture cuts while being extremely sleep-deprived, then you’re not alone. The province of Quebec has capped the maximum shift rate to 16 hours, citing the fact that exhaustion chokes off cognitive and motor functions.

As far as I’ve gathered, the 28-hour shift doesn’t actually serve any true medical or educational purpose. Instead, it’s a rite of passage into the medical profession that has continued on for generations (up until recently, it was actually 36 hours instead of 28 at many hospitals). This “rite” is borne out of the traditional conception of a physician in the West as being infallible to normal human weaknesses like stress and fatigue. Before the era of House and Grey’s Anatomy, doctors were routinely portrayed as being all-knowing father figures who could handle any emergency that came their way.

Dr. Ben Casey: surgeon, hero

and manly man. A fairly typical

TV doctor in the early 1960s.

But these views have rapidly changed over the past couple of decades as evidence has shown that doctors have a relatively high rate of suicide amongst professionals. Looking at my classmates and myself, I realize that we’re just as vulnerable to burn out as anyone else, and it’s easy to see the negative effect of exhaustion on the provision of care. When we’re physically and mentally exhausted, our emotions become blunted and we’re less able to empathize with our patients. We miss the nuances and subtleties in patient communication, or we just become too tired to even care. 

At a conference I once attended, a doctor recounted a story about a particularly gruelling clinic shift. After working for 20 hours straight, he had finally fallen into a nap when a patient called in with chest pain. The doctor, who was exhausted, brushed it off as indigestion (the patient had a history of this), even though he knew there was a possibility that it was a heart attack. After waking from his nap several hours later, the doctor panicked and called up the patient, half-expecting him to be in serious trouble. 

Fortunately it was indigestion after all. Was the physician at fault for not getting up? Absolutely. But at the same time, it's also true that the medical system put him in a position where it was very easy to miss a critical diagnosis. Are our resources really stretched so thin that we can’t afford well-rested doctors?

Sadly, in this regard I think that doctors are their own worst enemy. There's still a strong attitude within the profession that we should be totally resilient to stress, that we should be able to provide care but never have to accept it ourselves. In reality, even though we made it through the gruelling admissions process of medical school, we're still vulnerable to burn out.

Ultimately, a well-rested doctor is so much more capable of communicating with patients and synthesizing information, skills that are essential to accurate diagnosis. By learning to take care of ourselves, we become better care providers. While med schools may be holding more lectures on stress management, deeper institutional reforms are needed to make a real difference.