Surgical registrar’s ‘toxic’ experiences highlight need for change

Evelyn Lewin

6/02/2019 3:11:51 PM

Overworking and exhaustion are common in young hospital doctors, and led Dr Yumiko Kadota to resign. GP Dr Evelyn Lewin reflects on her own training.

When surgical registrar Dr Kadota resigned, she was told, ‘… If you can’t handle the hours, maybe this isn’t for you.’
When surgical registrar Dr Kadota resigned, she was told, ‘… If you can’t handle the hours, maybe this isn’t for you.’

Like many doctors around Australia, I was appalled when I read Dr Yumiko Kadota’s story in The Age.
The 31-year-old joined Bankstown Hospital’s plastic and reconstructive surgery department as an unaccredited registrar in February 2018.

She was rostered on-call for 10 days every fortnight. This means she was on-call for 180 continuous hours before having one night off, and being on-call again for another 80 consecutive hours.
In April last year, Dr Kadota emailed the hospital administration, saying, ‘I often feel unsafe to drive and I am concerned it will start affecting the care I give to patients’.
She didn’t take the decision to voice her concerns lightly.
‘I had been trying so hard not to complain because I knew what was at stake,’ she said. ‘I needed my bosses to support my application [for the accredited plastic and reconstructive surgery program]’.
Dr Kadota’s health deteriorated until she became ‘physically unwell, overweight, stressed, dehydrated and had bowel issues’. Her GP wrote to Bankstown Hospital’s administration advising they reconsider the roster.
On 1 June last year, Dr Kadota resigned.
It was her 24th consecutive day of work, including 19 days of 24-hours on-call, and the young doctor crashed her car driving home.
As Dr Kadota wrote, her head of department rang her after she resigned, saying, ‘It’s a shame. You’re good at what you do … but if you can’t handle the hours, maybe this isn’t for you.’
Dr Kadota’s story saddened me – but it did not surprise me.
Over the years, I’ve heard numerous similar stories of young doctors being overworked to the point of exhaustion. It’s almost like a ‘rite of passage’ when you’re a young hospital doctor.
The statistics paint a bleak picture, with 2016 data published in the Medical Journal of Australia showing that female medical professionals are more likely to die by suicide than the general population, and research from beyondbue finding that doctors aged under 30 years are most likely to report burnout.
As I read Dr Kadota’s story, I couldn’t help but think back to my own experiences as a hospital trainee.
My first ever rotation as an intern saw me being posted to a country hospital, where I worked long weeks, followed by 14-hour days on Saturday and Sunday (when I was rostered on), followed by another week of work.
I remember heading back to my room after a particularly harrowing shift.
I had been rostered on overnight as the sole doctor on the grounds at the hospital. During the night I had treated a patient in cardiac arrest, seen numerous patients on the wards and in the emergency department. And, in the early hours of the morning, I was called to the hospital morgue to certify a woman who had been found in her backyard – she had been deceased for so long that she had maggots in her eyes.
Tears streamed down my face as I crumpled outside my room when I was finally finished that shift.
Following that stint in the country, I never wanted to put myself through that level of stress again. I wasn’t burnt out or overworked to the point of exhaustion like Dr Kadota, but I was disillusioned.
I wasn’t just worried about the toll it was taking on me; like Dr Kadota, I also worried about the type of care I was capable of delivering to my patients.
I started looking beyond the areas of medicine to which I was drawn (which, as a resident, were emergency medicine and obstetrics), and began searching for a field where I could engage in a meaningful job, without being worked to the ground.
There were other reasons I chose general practice, of course, but it certainly helped that it ticked those boxes. And when I started GP training, I heard the same types of reasoning from many of those around me.
While I’m happy with the path I chose, I know it’s not the answer for everyone.
I don’t think about my years of hospital training often these days. Life gets busy, and there’s so much else to focus on.
But reading Dr Kadota’s story shone a light on how far we have to go when it comes to the treatment of hospital trainees.
An anecdote included in her story for mind body miko perhaps gets to the root of the issue.
Dr Kadota writes about how she requested a ‘quick break’ after working until 3.00 am the night before, only to have her request refused by her head of department.
‘I remember doing those sorts of hours when I was at your stage. It’s good for you,’ he replied.
Until such outdated beliefs are shattered, I worry that stories like Dr Kadota’s will continue to sadden – but not surprise – me.
*Evelyn Lewin is a fully trained GP, but is currently not practising.

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Dr Sugan Appasamy   8/02/2019 10:57:04 AM

The reality of surgical training is that it is brutal .This has been the case always.It does not matter whether you are male or female.The endless grind is part of the game .I couldn't do it and many people can't .That's just the nature of the job.There are easier career Pathways in medicine.This is not a gender issue.
Someone s got to do it.Thats why I don't begrudge the fees that are charged.They earned it.

Dr Paul Spedding   8/02/2019 11:52:29 AM

I remember being a Mersey Deanery surgical SHO in England 2005. The roster was illegal, HR were doing the usual dodging the time-in-motion surveys just waiting for the next cohort to turn up and the GPs contract allowed them to opt out of out-of-hours work with paramedics replacing them.
Result was catastrophic, record was 32 consecutive days in the building at some point in the 24 hour clock.
Once fell asleep face down in a plate of cold pasta, awoke at 02:00 with the lights on, TV still and cold pasta stuck to my face.
I quit, timed to make it as difficult as possible for the them to get a locum in time for Christmas 2005. Merry Christmas Countess of Chester NHS trust.

Dr Joveria Javaid   8/02/2019 1:59:16 PM

Dr Sugan,
I beg to differ Dr Sugan. It not only impairs a Dr's personal life but it also effects the quality of care they provide. It's just a stereotype that if you make the interns work like a dog, they will be a better Dr. they will be a better doctor. The more fatigued you are, the more are your chances of error. It's not showbiz that if you forget your lines, you will have a re-take.

jo   9/02/2019 10:41:22 AM

Good on you Dr Paul! Some times the authorities need that kind of tough love to awake them from their slumber.

Joe Radcliffe   9/02/2019 1:44:47 PM

There is an ugly side to medical administration. In the 74 years since the end of WW2 it has failed to take the initiative to change the wartime working hours. This has become ingrained in our culture. Other than in war, no other human or animal is forced involuntarily to work non-stop for 72 hours under threat of penalty without rest.
The system, and contracts which disguise a bullying employment relationship, can revoke employment at will. This affects both income security and career options.
And so the lunacy continues, in which those who cannot manage the forced labour are left to die or burn out along the way.
The time is long overdue when management should be called to account for their failings.

jo   11/02/2019 10:19:49 AM

Summed up beautifully ; Joe.

Gillian Eastgate   11/02/2019 3:19:56 PM

Yes, 'work-hardening' has been part of the medical culture for decades. So have high rates of doctor suicide, fatigue-related road accidents, alcoholism, family breakdown and other serious consequences. And that's before even considering the likely catastrophic effects on patients. It's long past time to stop this kind of abuse and treat doctors as human beings.

Sarah Adil   27/06/2019 8:15:03 AM

So many promising careers ruined and so much hard work gone to waste due to non existent workplace ethics in the medical field . Will things ever change ? The system needs an major overhaul ..