Diagnosis: Burnout. The overworking of Canada's medical professionals, and what to do about it
Physicians help others lead a healthy and balanced lifestyle. But do they have a blind spot when it comes to themselves?
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Imagine this was your schedule: Your alarm buzzes at five a.m. You’re at work by six, and then it’s non-stop until eight or nine at night. Lunch break? If you’re lucky.
The next day, you’re on call for 24 hours. It can turn into more. You may or may not get to sleep.
That’s life as a medical resident in Canada. In most specialities, residency is a four-year marathon after med school: 100-hour workweeks, evenings spent studying and up to seven 24-hour call shifts a month, except in Quebec, where they’re capped at 16 hours.
Experts have been debating for decades about whether doctors who work such long days are hurting patients – or themselves.
But their focus has shifted since 2013, when a research report from Canada’s doctors’ associations found, surprisingly, no clear evidence that patient safety improves when doctors aren’t allowed to work above a certain number of hours per week (typically 80) or are required to block off five hours for sleep.
Rather than strictly limiting hours, hospitals and doctors’ groups are turning to interventions like the resiliency curriculum developed by Resident Doctors of Canada. It’s based on cognitive behavioural therapy and teaches self-monitoring and mindfulness.
Dr. Kimberly Williams, president of RDoC, believes long hours are not the only, or even the most important, contributor to burnout. It’s the pressure of being constantly evaluated, the lack of control over your schedule, and uncertainty about the future, she said.
Two major studies in the past month, one from the Mayo Clinic and one in the medical journal the Lancet, looked at various ways institutions have tried to deal with doctors’ fatigue, emotional exhaustion (a.k.a. burnout) and extraordinary depression rate: 29 per cent, versus 12 per cent of the general population.
The Mayo clinic study found hospitals had the most success with organization-wide changes like regular psychological screening, leadership training for supervising doctors and bi-weekly group dinners where residents can vent to peers who understand.
The Lancet paper, which reviewed previous studies, found pretty much all burnout-reduction programs were equally, and not very, effective. On average, they reduced burnout rates from 54 per cent to 44 per cent, as measured by a standard psychological test.
And that’s assuming those who have a problem admit it.
And many doctors don’t, said one resident who has trained in both Ontario and Quebec hospitals. He didn’t want us to mention his name or even his speciality.
He described workplaces with a “machismo” culture and unsustainable stress, and needed counselling to cope.
Young doctors are often far from home, working for bosses who are depressed and irritable, and dealing with traumatic cases and patient deaths for the first time – all without a moment to breathe.
"I’ve worked 24 hours straight without a break of any kind, having a granola bar in my pocket,” he said. “Pretty much every resident can describe a situation like that.”
It’s a recipe for depression: “This weird thing happens. You feel like there’s no life outside of residency. You forget about yourself. You feel like a slave; like you’re never good enough and you’ll be a bad doctor.” Even going to the bathroom feels like letting down patients and co-workers, he added.
He said there’s not a clear solution. More downtime could mean the need for more residents, who will need more (taxpayer funded) jobs after their training. And with more doctors on duty, studies show, there are more patient hand-offs, increasing the chance something important will be missed.
He’d like to see hospitals reduce the amount of time doctors spend on paperwork that could be done by someone else. But at the heart of the issue is the need for more rest.
“It would be very helpful to be able to do the things we did to get into med school: volunteer, be a community member, see family and friends. The culture says those things are frivolous. They’re not,” he said.
Maximum hours per week doctors can work:
New Zealand: 72
European Union: 48
United States: 80
Canada: Varies by province, but there's no general limit. Residents can work a maximum of seven 24-hour call shifts in a month. Shifts are limited to 16 hours in Quebec.
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