Our hospitals are very filthy buildings. The average hospital hosts around 40% more germs than other public areas. They are playgrounds for resistant-strain bacteria, lethal viruses, opportunistic fungi, and other nasty creatures. In 2002, an estimated 1.7 million healthcare-associated infections occurred in the U.S, resulting in almost 100,000 deaths. A report released by the Centers for Disease Control & Prevention (CDC) in 2009 estimated annual medical costs of $28–45 billion for dealing with healthcare-associated infections.
However, that’s not the proverbial parasite I’m talking about. The real parasite is elusive, occult, and quite inconspicuous. Like a malarial trophozoite, which stows itself inside the safe confines of the human red blood cell, this parasite is concealed within the fabric of society. It is hiding in plain sight. And just like the reproductively active trophozoites uses up the erythrocyte as breeding grounds, this parasite exploits its obscurity by breeding and propagating — ensuring it doesn’t lose grip on us.
This killer is not only prevalent within the medical wards, it looms through each and every corner of our streets, and even permeates the air of classrooms and airplane cockpits. It likes to blame others for what it causes, hiding behind more suspecting entities. Can you guess the parasite I am referring to?
14% of physicians say they have had thoughts of suicide but have not attempted suicide. 1% have.
In 2018, sleep scientist Matthew Walker published a book titled ‘Why We Sleep’. In it, he argues that sleep is responsible for memory-forming, creativity-honing, cerebral detoxification, organ cleansing, fat burn, and mental stabilisation. A lack of sleep, on the opposite end, increases the risk of many incurable diseases such as cancer and diabetes, causes weight gain, decrease in cognitive ability and accelerates memory loss. Sleep is non-negotiable.
One idea that Matthew Walker emphasises repeatedly in his book is the general minimum sleep we must sustain every night in order to support our physiology. That number is 8 hours. 8 hours of good-quality, night-sleep. Most physicians report sleeping an average of 6.5 hours on workdays.
A report released by Mayo Clinic in 2018 compared the burnout rates between physicians and the general working population in the U.S. For the majority of U.S citizens, that number was 28%. For physicians, that figure was closer to 54% — almost double the number. Physician burnout is a real thing, and it’s slowly killing our doctors. Another report by Medscape in 2019 revealed that urologists are the most burned-out specialty, and 59% of doctors say that superfluous bureaucratic tasks such as charting and paperwork contributed the most to their burn-out.
We are literally risking our lives to save others.
Within the same report, anonymous anecdotes illustrated how burn-out had affected their life. One surgeon said, “My relationships have withered… my family is frustrated. We rarely make plans to do anything socially as they are likely to be canceled.” Another family physician said, “I’m having medical problems as a result; having recurrent miscarriages.” The report also underlines a very grave reality — 14% of physicians say they have had thoughts of suicide but have not attempted suicide. 1% have.
Moreover, the ghastly effects transcend personal disadvantages. A 2009 study found an increased rate of complications among post-nighttime surgical procedures performed by physicians with sleep opportunities of less than 6 hours. Three years before that, a study found that extended wakeful hours at night caused a 300% increase in preventable mistakes that led to a patient’s death.
In 2011, Harvard Medical School surveyed 281 first-year medical residents before they started their program. The survey measured the sleep quality of physicians and evaluated their current levels of daytime sleepiness. The measurement was repeated after nine months, but it was completed by only 153 resident this time around. The study demonstrated the deterioration of sleep quantity within that time period — from 7.6 to 6.5 hours — and also showed that half of the participants exceeded the cutoff for excessive daytime sleepiness.
“It was surprising that some residents with normal sleep at the study’s outset developed severely impaired sleep, sometimes worse than those with preexisting sleep impairment,” says Jonathan Zebrowski, a Harvard Medical School psychiatrist. “The theory that it would be helpful to identify trainees with sleep impairment before they begin residency does not seem to be a viable strategy.”
The situation appears quite grave, but there may be a sliver of hope in this. Zebrowski’s colleague Lisa Berkowitz, who is an assistant OB-GYN professor provided an optimistic proposition to this issue. “All residents appear to be at risk for sleep impairment and its effects on performance, and since long work hours are a hallmark of residency training, strategies to reduce those effects are paramount,” she acknowledges. “In an era of increased recognition of and attention to physician burnout and impaired well-being, sleep hygiene is an important part of self-care that needs to be stressed.”
The idea she is suggesting is by no means a silver-bullet for this epidemic. Instead, it is an wake-up call (pun not intended) for all doctors to start becoming more mindful of their daily routines. Changing laws and regulations and protocols may be the more preferable solution here, but it can be a long and arduous process. Meanwhile, as we wait for new mandates for a more sustainable system, we can try to befriend the current system. By being more mindful about our sleep behaviors, we can cultivate a lifestyle that makes sleep our top priority.
And with that, I’m heading straight off to bed. Good night.