Klaus Morales: Can doctors be healthy AND happy?

Klaus Morales “Work is central to wellbeing, and certain features correlate highly with happiness.” Tony Delamothe (BMJ  2005;331:1489-1490). Agree. But to what extent? I just got home from a whole day of activities and duties at the hospital and let’s say – a bit of bla bla blas.

Yes, I am a junior doctor, but not a “F number” doctor. Medical training in Brazil includes six years of graduation and, only if you wish to do so, a residency program. It looks quite simple at first glance, but isn’t so simple in practice. I am an aspiring specialist in anaesthesia in my first year of training. And yes, I am a bit tired already (certainly not unusual for junior doctors worldwide).

Being a doctor is quite different from being a medical editor, a job that I took on within the BMJ Group as editor of the studentBMJ in 2006. No more wine next door at 5 pm, no more phone calls to authors in Asia or Africa or the US or anywhere in the world everyday, no more interesting discussions about novelties in medicine and definitely no more caramels on Friday afternoons (as Jessie Colquhoun, the current editor of Student BMJ pointed out in her first blog entry). Let’s not forget about the stressful deadlines too! On the other hand, being a doctor has also involved many positive experiences; loads of practical work, rewarding patient contact and challenging cases.

But what really made me sit down and write this blog entry was to realise, after almost nine months of being a fully qualified doctor, that I am an unhealthier individual nowadays. Why on earth do we choose to take care of other people’s health (of course not always being 100% successful) while giving up some of our own? I have my personal reasons and of course you have yours, but almost everyone agrees that it is almost impossible not to feel physically and emotionally drained after up to 14 hours a day of intense work, with not unusually a 30 minute-break for lunch? No Latin American Working Time Directives around here fellas… and even if it existed, I bet it would solely be theoretical!

When I have a bit of energy left to drive to the gym, just the thought of exercising on the treadmill makes me want to rush home and go to bed to be able to start all over again the next morning. I know I am sounding pessimistic here – it’s great to be able to work and Delamothe’s quote is really appropriate. I know it is almost a sin to complain, considering the Catholic guilt most Brazilians are raised around, but doctors including juniors, consultants and professors, need better quality time at work and outside of work. I would say “work is central to wellbeing, and it’s even better when you are feeling healthier.”

I am six kilos heavier, I can’t concentrate as well as I did in the past, my anxiety levels are as high as the Sears Tower and I am still happy. I just feel that I have the potential to be healthier, but clueless about how to do it. I am sure time will give me the answer, as soon as I adapt to this new routine (in fact, it is a matter of adapting to a whole new life). Isn’t it?

It would be nice to hear from juniors around the world – does the European Working Time Directive make training in the UK any better or worse? Are doctors in Spain allowed to indulge in their siestas? Is it true that US residents are required to be on a 72 hour shift every week? How is it to be a junior doctor in the Middle East? Any tips on how to lose 6 kilos let’s say, in a month?

Klaus Morales is a former Student BMJ Editor who now works as a junior doctor in Brazil.

  • Dear Klaus Morales
    I am a senior doctor,52,now professor of pathology at Institute of Post Graduate Medical Education & Research , Kolkata, West Bengal, India. I passed graduation degree in 1981, doctoral degree in 1989. Before getting absorbed in teaching profession, as a doctor in a rural primary health center and in a sub-divisional hospital of West Bengal Health services, I had to do job for average 10-12 hours[ weekly 80-85 hours shift] either as a M.O or a specialist according to posting nature for benefit of local patients of low economic strata of society, who had no ability to purchase their health, but to come in free public hospitals for a treatment. Suburban/District hospitals & Medical colleges of West Bengal are fantastic resources of Varity of cases. At those time I used to be really happy when a serious or a dying or near dying patient used to get well on application of my knowledge of medicine after my diagnosis. I had then very good seniors colleagues who often praised me or celebrated if I was correct in difficult cases & if pt. got well- I used to feel myself king for few days. But since I had to opt for pathology, in my subsequent postings, I had to sacrifice direct contact of patients but to handle their organ tissues which I get for cytological, histo pathological diagnosis, on which clinician’s decision for treatment of patients rests. At first, I used to miss my patients & Harrison Text book of Medicine- was painful to me no doubt. But absorbing myself gradually as a histopathologist, researcher, I find gradually the job is really challenging one when you come to a final diagnosis. Besides daily routine job in my dept, I have to take Classes for undergraduates, post graduate, Post doctoral, to conduct thesis of MD of successive 3/or4 batches students, PhD students under my guidance, to update myself at least going through pathology & other journals like BMJ, Lancet, New.Eng J. Medicine, Journal club, CPC and what not. Of course, some time it appears to me boring & tiring. But I become happy as soon as one of my work or my article is published in the international reputed journal of very high impact factors. I prefer BMJ, The Lancet, Lancet Oncology, WHO Bulletin, JAMA, Nature, Science for getting myself published. I become really depressed when editorial board or reviewer rejects me- many of times it happens. I never engaged my self in private practice to earn more & more, where sky becomes the limit for most of the doctors of Kolkata by hook & crook. Beside my office hours, even in my home ,I have to work till night most often 11 pm to prepare manuscripts and that was since 1990. I am considered probably one of the appreciated histopathologist& academics of Kolkata by my peers &students presently. I am in charge of many units like of Blood Bank,VCTC, cytogenetics,Post Graduate Courses in Pathology of West Bengal University of Health sciences & thus one can understand that how much work I had to provide for my subject & academic career. Amongst all these, I give much attention for my publications &thesis of my students. I can hardly give few hours to my seven years only daughter.- Yet, I becomes happy when any international journals editors accept my article & I treat the day as special one with my friends or post graduates.- so I am to depend on people like yours(Editors) decision for the fate of my article- my sweat. you can understand that most of time I have to do sedentary job and I am overweight more than 10Kg. I think Obesity is becoming pandemic due to sedentary works & diet habit. I have little time to do exercise like treadmill or going to a jims. On week days I leave home at 8AM sharp and return home at 9-30PM.I have dyslipidimia, hypertension, though I strictly control my diet & calorie for long & take beta-blocker, statin & aspirin as per my cardiologist friend’s advice. I decided to walk at rate of 6 Km/hour alternate days & practicing for last 2 months. In Kolkata street due to narrow , crowdie footpath & heavy rush of vehicles it becomes difficult also. still I try! It helped me something to reduce my LDL, VLDl and toal cholesterol-though I am 70 kg and should be <60kg.
    Professor Pranab Kumar Bhattacharya- Professor of Pathology, Institute of post Graduate Medical Education &Research-kOl-20,West Bengal, India

  • Dr Clair Melville

    I am reading this and feeling as though I am hearing exactly what patients say to me on a daily basis.

    “I don’t have time to excercise doctor”, ” I don’t have time to cook healthy meals” ” it’s not possible with my job”

    And how often do we tell patients that these changes have to be made in some way that fits around their lifestyle?

    We in Britain also have busy lifestyles (the EWTD does not work as well as it may be portrayed, although I am sure most doctors in the UK are more than aware of this), and a busy homelife that they have to maintain. But most of all, we are human like all of our patients.

    However, at the same time, we have all made a commitment to get here (medicine) in the first place, where is the commitment to stay here and be healthy so we can stay here for longer?

    Many of my collegues, including myself I like to think, manage to fit a healthy lifestyle around medicine. I think that it takes no more than the commitment we showed in medical school. We all worked hard (and for the majority) played hard then, why not now.

    If you cannot manage it, then how are any of your patients going to ever believe that they can also do it?

    Clair Melville
    A very happy and healthy Foundation 2

  • Tiago Villanueva

    Thanks, Klaus, for your insightful article.

    I completelty agree with you, it is very difficult for a young doctor to lead a healthy lifestyle when faced with 80 hour weeks of grueling work. Of course that does not even include extra time to study, prepare presentations or reports, write papers and so on… our life easily becomes our career, but we have to resist that, not only for our sake in the long term, but also for our sake of our loved ones (partner, family and friends). We need to learn to draw a line, even if that just means squeezing in 30 min a day to go for a run.

    I have a better deal, as I am in Primary Care, and thus free from 24h on call commitments and night shifts, but my career can be equally absorbing as well.

    My little secrets are to exercise everyday, even if for 30 min, and even if that means running at midnight in the street, as I have already done not so long ago. Most of the time, I get home on time to go to the gym, a 10 min walk from home, even if it’s already 20h or 21h when that happens.

    I have never given up this precious time, even in times of exams or of more work. This has helped me remain fit and feel good, which then has implications in my daily work. I feel boosted by the endorphine rush, and motivated to face my patients and my colleagues, and the odds are that I will do it full of energy and with a smile in my face!

    We just possible can’ fully give in to our career, no matter how demanding it is, even if that requires from us some spirit of sacrifice and determination.

    Tiago Villanueva
    GP trainee, Lisbon, Portugal

  • Matiram Pun

    Dear Klause Morales,

    Thank you so much for bringing out the issue so vividly and in a vibrant manner! I agree with you.

    I was so excited and found myself there while reading first four paragraphs! Splendid! Then you take plateau phase then U-turn accepting the reality and need of the work and starting to enjoy it. May be because, there is less chance of getting alternatives to it.

    The work load and rotations are there but what makes we junior doctors even worse is unsupported responsibilities! If you are just recruited junior doctor and doing your house officer work or first few months of residency, is it wise enough to give all responsibility to deal with Emergency or ward calls? When an orthopedic first year resident is on duty and sent emergency to handle all pending cases, that’s of course, giving some extra stress to him/her.

    Definitely, giving full responsibility will train the junior doctors on dealing the cases and triaging them but it matters when to start, how much to give and how to support and correct their decisions! Even more important is to help them (support) with the decisions in first few months which will raise their morale, confidence and encourage to work up the case.

    Yes, working hard and getting involved with the cases is part and parcel of the profession. Exactly, it is the matter of making it more interesting and enjoying it with serious concern on our health as well.

    Best wishes,
    Junior Doctor

  • Peter

    Hi Klaus,

    I came across your blog when looking for oportunities to work in Brazil in a year from now. I too am a Junior Doctor in my first year after qualifying currently working in Ireland. Theres no doubt that the hours worked make a healthy lifestyle much more difficult and the EU working time directive is unlikely to change things.

    Currently Junior Doctors in their first year work a standard 49 hour week with overtime and unrostered hours making a normal week 90-100 hours. In my 3rd week working I have seen friends work 115 hours in a week and myself worked 96 hours last week. However, I’m not really complaining. Most of us are glad to have the opportunity to work extra time in order to pay off the debts encried throughout college.

    The problem is that the new EU working time directive isnt workable. It is supposed to come into action in August, however most hospitals are pushing it forward to October or as far off as they can. As things are, a normal day in Surgery starts at 7.30 and finishes at 6 earliest. the EU directive looks at doctors working a 39 hour week (9am-4pm on a Friday) with 2 days off post call. This model isnt workable as the hospital system would collapse if the doctors were to work to rule. What is most likely to happen is that doctors will end up working extra hours and just get paid for the 49 hours. Not a nice situation when a normal working week extends beyond 90 hours.

  • kieran

    Hi Klaus,

    I am an Irish doctor working in London as a locum Psychiatric SHO. I was considering working in Brazil as a trainee psychiatrist but my portuguese is moderate. I s it difficult to get work there?
    Please email me back if you have any suggestions.