I had been awake for 30 hours.
I was hungry. I had to use the bathroom. I couldn't think straight.
Yet here I was, standing beside the senior surgeon at the operating table. We were late in the surgery, and my right hand was shaking. For the past three hours, I had been holding a retractor to better expose the patient's neck.
Under the heavy glare of the operating room lights, my eyes began to close. I was falling asleep standing up.
As I drifted off, my body started leaning over to one side. Unfortunately, the senior surgeon noticed. And he was not happy.
"Wake up," he growled, elbowing me sharply in the ribs.
Looking up, I saw anger in his eyes. The fact that I had gotten no sleep and needed badly to use the bathroom clearly did not matter. To him, I realized, I was just another trainee who neither required nor received his empathy or respect. I don't think he cared what happened to me once the surgery was over.
This mentality is far too common in American medicine. First and foremost, physicians are expected to be healers. It's the reason many of us decided to enter the profession in the first place, a privilege we all take seriously.
But when I graduate in May and take the Hippocratic Oath, I will also pledge to "remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." Unfortunately, physicians often don't heed this advice when it comes to themselves or their colleagues.
From the beginning, physicians are taught to survive in a cutthroat environment. Standardized test scores and course grades play central roles in every step in the process of becoming a doctor. High performance becomes the norm, and any deviations from that standard are simply unacceptable.
There is no room for weakness. There is no room for complaining. Sometimes, there is no room even for sleep. The result is a culture that discourages vulnerability and empathy for colleagues. From mistreating fellow healthcare workers and trainees to developing inhumane rules that allow young doctors to work 28-hour shifts, we have created a work environment marked by high rates of burnout and depression.
All of this has consequences. Both patients and providers suffer in these difficult working conditions. Surgeons who are most frequently cited by patients for disrespectful and rude behavior have higher rates of medical and surgical complications. Collectively, they may account for an additional 350,000 complications and $3 billion in healthcare costs annually nationwide. Long work days for resident trainees put enormous stress on young physicians. First-year doctors who sleep less perform worse in the hospital. They are also at higher risk for becoming depressed.
Viewing vulnerability as a weakness makes it more difficult for physicians and trainees to seek help when they most need it. Doctors and medical students are far less likely to take sick days to tend to their own health. Female and male physicians are 2.3 and 1.4 times more likely to commit suicide than the general population, respectively.
Changing the culture of American medicine will take time. More emphasis on personal qualities, rather than grades and test scores, when picking medical students and resident physicians is only part of the solution. A greater recognition of the importance of doctors' mental health would help, too.
But another important step in the right direction would be more straightforward. On March 10, 2017, the Accreditation Council for Graduate Medical Council approved the shift from 16- to 28-hour work days for first-year doctors. This reckless decision was a mistake and should be reversed immediately. It exemplifies the disregard that the medical establishment holds for its providers. Concerns about doctors' mental and physical health did not figure prominently in its creation.
It also puts patients at risk. Unsurprisingly, physicians working on less sleep commit more medical errors. Changes like this are in direct opposition to doctors' commitment to do no harm. We can do better than this.
The procedure was a success. After finishing our afternoon rounds, I went to check on my patient.
It was nice to see her laughing with her family, sitting up in bed with a spoon full of pudding. I was happy to find that she was doing well.
Before packing up, I checked in with my team to see if I could help with anything. We agreed to meet the next day at 5:30 am for morning rounds.
Only later did I realize that no one had asked how I was doing.
Kunal Sindhu is a fourth-year medical student at Brown University Alpert Medical School.
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