Doctors are assumed to have spent a lot of their money and time to get to where they are. Their sacrifices in working long hours to help patients, despite a few complaints here and there about low salaries and overtime payment, deserves applause.
A doctor is a human with a heart and, despite their circumstances, gives their best to patients. This is also assumed to be ensured by the respective councils that oversee this through the provision of a licence to practise.
Doctors deal with patients who are living beings, not objects. The kind of issues doctors deal with concerns quick decision-making skills that mean life and death for their patients. Wrong decisions or actions cannot be reversed or corrected.
Furthermore, the decisions doctors make have a multi-faceted impact on the patient’s recovery time, admission duration, health care facility resources, health care economics, doctor’s personal satisfaction etc.
To sum it up, the role of a doctor is a determinant for so many significant outcomes.
In recent years, the working hours of those in the medical profession have been a debate hotter than climate change.
I have my concerns about doctors working long hours.
The medical profession is distinct from other vocations as it is strongly related to human lives. The Division of Sleep Medicine of the Harvard Medical School, in its judgement and safety article, highlights that one sleepless night can impair performance as much as a blood-alcohol level of 0.1 per cent, which is beyond the legal driving limit and can affect judgement.
This can explain why those who are sleep deprived cannot recognise their own fatigue or level of impairment. It is like a drunk driver who thinks it is fine to drive. Dr Christopher P. Landrigan says that if one is depriving oneself of sleep and you happen to be a police officer, doctor, nurse or pilot, then there is a very good chance that in the line of duty, you may be exposing people to risk.
It is nothing less than a crime to encourage long, sleepless hours for people in these professions, even if there are perks of an extra allowance or even if health care workers agree to do it for free!
It is ironic that health care professionals are willing to risk their own health for the sake of working longer hours for common reasons cited like dedication and salary. This does not resonate with the counsel given to their patients.
Long working hours is a recurring theme in accidents and deaths of health care workers while at the job or after the job.
Health care workers should practise what they preach. In no way is a health care professional superior – physically, mentally, or emotionally – than their patients.
Expecting health care professionals to be superhuman is unacceptable and unethical. Having a medical degree is not a criterion to develop “supernatural” and unrealistic patterns of work culture.
Most doctors get leave on Labour Day. However, how is it that they are not subject to the same privileges to rest and work that other workers are entitled to?
Are doctors on the lower end of the scale of importance when compared to construction workers, rubber tree tappers, nasi lemak sellers, or teachers?
It is every human being’s right to be able to work well and live well. Why aren’t health care workers treated as humans and accorded the same privileges? Is this not a breach of human rights?
In fact, the medical profession is not a profession that relies heavily on physical prowess. It is highly dependent on being able to think well, which only those with adequate amounts of rest and sleep can do.
The occupational and safety unit has been the new and cool division in recent years. However, the most obvious issue of sleep deprivation hits a blind spot in health care centres.
Perhaps those in the occupational and safety unit themselves are sleep deprived, thus clouding their intelligence and judgement to handle this menace heads-on.
Patients have the right to be seen by a doctor who is not sleep deprived so that they can get the best treatment and their money’s worth. It is a breach of a patient’s rights to deprive them of this basic requirement.
A patient cannot afford to be misdiagnosed or undiagnosed, or have a delayed diagnosis that could lead to fatality or loss in quality of life. Gambling with a patient’s life is a risk that a sleep-deprived doctor cannot take, no matter the percentage of patient-victims involved.
The recent rape and murder of a health care professional in Kolkata, India, highlights the way doctors are taken for granted – lack of rest, lack of space to rest safely, and lack of space for personal professional development.
I have one question: would the doctor who was a victim in the horrifying crime in Kolkata have been able to be more alert and able to better defend herself, had she had adequate rest and sleep? Would her fate have been different if there was provision of a safer and more comfortable space for her to sleep and rest?
Such unacceptable rest and sleep arrangements are not limited to Kolkata. CodeBlue, on August 27, 2024, published an article by a specialist doctor who admits to having had to work 36 hours in a stretch.
According to the specialist doctor, health care workers had to rest or sleep in the parking lot. The writer also mentioned incidents of rape, sexual assault, vandalism, and robbery involving female health care workers at the respective facility.
When health care workers are made to work for prolonged hours, there is no avenue for them to exercise, de-stress, or meditate. Hospital canteens do not operate 24 hours to accommodate the needs of health care workers.
High reliance on exorbitant food delivery services gobbles up a significant amount of a health care worker’s income, besides encouraging unhealthy eating habits or food consumption.
Medical workers in the ancient times had no technology, but they still had to work long hours. With the advent of technology, patient care has improved. However, the same does not apply to health care workers who are still working long hours and putting patients at risk.
Health care workers are mumbling about wanting a pay raise and overtime allowance increase, but can they guarantee that 100 per cent of their intelligence and judgement faculties will not be hijacked by their lack of sleep?
Can they be involved in providing care throughout prolonged work hours for each and every patient equally?
Patients should be priority and reap full benefits from the health care system. A health care system is not about doctors getting high salaries or enduring long work hours, but having questionable decision-making.
It is about having sensible work hours, like shift work with an acceptable salary to health care workers while ensuring that patients are prioritised.
To sum it up, having sleep-deprived doctors at work is a human rights and patients’ rights issue. In fact, it may even be illegal to entice health workers with a bigger salary to work long hours because of the risk towards patients, who may be deprived of maximum benefits from the health care system.
Long waiting times in hospitals, which is a chronic issue, may even be attributed to sub-standard management due to lack of sleep.
The health care sector is not a money-making sector. Just because a practice has been widely and long practised does not make it best practice.
It is time that policymakers look honestly at the state of the health care system, view health care in a spiritual and holistic manner, be bold to embrace paradigm shifts, keep up-to-date with research discoveries, and make the necessary changes for a more healthy and humane healthcare system that truly puts the patient as the priority.
Those working in the system should also not be suffocated as this may eventually lead to a costly system collapse one day.
Changes must happen now.
Education and health are two major sectors that need more human resources, budgets, sleep for workers, and calculated and quick action. These two sectors are definitely not for those who want to get rich fast.
If these two sectors fail, everything else fails – sooner or later.
The author is a health care worker in Perak. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
