What ails our healers?

Are the doctors and nurses who treat and cure fellow Malaysians, in the pink of health?

THIRTEEN years into his medical career, Dr Zakaria (not his real name) has gone through the mill and made it as an ear, nose and throat surgeon.

Throughout the years, he has had his fair share of stress at work, especially in the earlier days as a houseman and medical officer in addition to studying for his speciality, getting married and having three children.

Somewhere along the line, however, Dr Zakaria has seen his weight balloon from about 80kg during university days to about 103kg. He is also borderline hypertensive.

“I have managed to lose some 10kg. I also look forward to my runs and joined the Borneo marathon 10k run last year,” adds the Sabah-based specialist.This year, he decided to take charge and make lifestyle changes including exercising up to four times a week and cutting down on carbohydrates.

Dr Zakaria, not withstanding, is among the many healthcare practitioners whom Malaysians turn to for medical help or advice.

In looking after their patients, these practitioners can, in turn, forget about keeping healthy themselves.

Some also have to work nights – studies have shown that those on such shifts are possibly more prone to develop irregular heartbeat.

A University of Chicago survey recently revealed that more than 50% of resident doctors have reported that they have worked at least once when they were down with flu-like symptoms while 16% said they worked sick at least three times in the past year.

Another study carried out by the Harvard Orthopaedic Combined Residency Program and Massachusetts General Hospital in Boston, United States showed that fatigue is a common problem among surgery residents.

Closer to home, the Malaysian Journal of Psychiatry ejournal published a study, “Work-Related Stress Among Healthcare Providers of Various Sectors in Peninsular Malaysia” by Universiti Sultan Zainal Abidin aimed at comparing job stress levels of healthcare employees.

While it found no significant difference between government and private-sector workers, support staff reported a significantly higher stress frequency compared to professionals.

Meanwhile, within the support group, radiographers were the most stressed. This was followed by nurses and medical laboratory technologists.

It also found that research-based professionals had significantly worse stress frequency in all components compared to professional practitioners.

The study concluded that because “stress levels are affected by job category and specialisation, flexible strategies to ensure employees’ job productivity, contentment and personal well-being should be implemented.”

Dr Zakaria, 37, remembers that the first few years were the most stressful as he did not have time to exercise due to on-call duties.

“I also had a habit of not controlling my portions, besides snacking,” he says, adding that skipping meals was also the norm.

However, being married to a nurse for the past nine years, he adds, has its advantages as it helps having someone to talk to about work.

“We understand each other,” he says. “To destress, we play with the kids.”

Dr Zakaria is also mindful of having discipline and work ethics when it comes to warding off work stress besides having a good working relationship with his colleagues and superiors.

“Most of my patients are not well off and not demanding like the KL ones. It feels nice to treat them and it’s not stressful if they are happy,” he says.

The Health Ministry, in its role as the agency responsible for the people’s health, has started a programme for “creating a healthy workplace for a healthy workforce”.

This, minister Datuk Seri Liow Tiong Lai says, encompasses screening of the staff for medical conditions, assessing and improving workplace health and safety as well as having continued health education.

“Screening includes medical examinations and blood testing at a recommended interval. Specific medical problems are treated and followed up accordingly,” he says.

He adds that the National Health and Morbidity Survey 2011 has shown that the prevalence for non-communicable diseases (NCDs) risk factors among Malaysians continues to increase. Consequently, the staff are also not spared from developing NCDs.

“Being front-liners, the additional NCD risk factor that the healthcare staff is exposed to, are high levels of stress,” he says.

“This is in addition to unhealthy eating, sedentary lifestyle, and smoking. The MOH has an on-going programme for managing stress at the workplace, consisting of educational, recreational and motivational sessions conducted at regular intervals.”

Counsellors are also available at the ministry headquarters and state level to provide support to healthcare staff.

Besides this, there is also the buddy system, Program Akrab, run by counsellors. Here, the staff themselves are trained to assist their colleagues in managing issues at the workplace.

Ministry facilities have also been instructed to form a safety and health committee as per the Occupational Safety and Health Act 1994.

“This committee conducts activities pertaining to the safety and health of the staff and assists in conducting the wellness programme in the facilities. This is necessary in the ministry as it is in other workplaces,” Liow stresses.

The ministry has also introduced policies to promote healthy eating. The Public Services Department circular initiated by the ministry covers two aspects – the health menu for meetings and health vending machines.

In denial

Doctors and other healthcare professionals, opines College of Anaesthesiologists, Academy of Medicine of Malaysia past president Dr Mary Cardosa, do not pay attention to their own health while they are caring for others.

“They do not know how to play the patient role. More often than not, they have a ‘corridor consultation’ with their colleagues and ask them what could be wrong,” she says.

Dr Cardosa adds that an Australian model that advocates every doctor to have his or her own general practitioner should be implemented in the country.

“Plus, self-medicating is not an objective way of treating oneself. There are also situations where they are in denial,” she says.

“They need to be responsible and look after themselves.”

She says the College of Anaesthesiologists has started a programme to look after their well-being, adding that it is necessary to look after one’s health as the profession is highly stressful.

Anaesthesiologists and psychiatrists, she warns, have a high rate of suicides.

This is because anaesthesiologists have easy access to the necessary drugs and they know how to do it, she adds.

Doctors, says Dr Cardosa, who is also Malaysian Medical Association immediate past president, also experienced stress at multiple levels, including at work, home and studying.

“Doctors also do not stop working when they are studying for their post-graduate training. It is on-the-job training,” she points out.

Like a pencil

For Shine Guidance centre director and consultant clinical psychologist Assoc Prof Dr Alvin Ng Lai Oon, coping with stress can be compared to holding a pencil – it becomes heavier if you keep on holding it.

“It is the same with life when you keep on working. Sometimes, you have to put the ‘pencil’ down and then pick it up again,” he says.

Healthcare providers need “chill time” or breaks, even if it is a trip to themamak stall with friends or five minutes of reflection.

“Healthcare providers have feelings too. You need sleep and enough rest. If you keep on working, you are going to get cranky. And there is a relation between feelings of anger, hostility and stress, and heart disease or stroke,” he reminds.

Dr Ng observes that stress levels are also dependent on job hierarchy or requirements. Medical students and housemen experience very stressful times and this continues through their junior years where the pay is “not that great”.

He adds that the salary problem also applies to those in the allied health services sector besides those who have families to support.

Dr Ng, who has treated medical practitioners, says it is one’s responsibility to take care of oneself to avoid experiencing a mental breakdown.

Former Health director-general Tan Sri Dr Ismail Merican, who is still consultant physician and hepatologist at Hospital Kuala Lumpur, says it is important to live healthily and cope with stress. This includes being knowledgeable, competent and confident when at the job.

“Those at the lower levels are more stressed due to the demands from their medical officer or specialist because they are inexperienced, incapable or their knowledge is poor,” he adds.

Besides, the firm believer of exercise who has managed to keep fit through the years, says one should always find time to exercise.

“Climb the stairs. That is a good way to exercise. Why would you want to take the lift for just one floor?” adds the avid stair climber.

Dr Ismail, who is also Mahsa University College pro-chancellor, adds that it is important to go for regular medical checks once one is over 40 while those with risk factors should make it every six months.

Malaysian Dieticians’ Association president Indra Balaratnam says the long hours and nature of the job don’t give healthcare providers sufficient time for proper breaks.

“They skip lunch or have a late one. Sometimes, it’s skipping breakfast. They also don’t have time to exercise. This is part of the problem,” she says.

Among the problems she lists are weight problems, hypertension and high cholesterol.

Indra emphasises the importance of exercising to destress.

“Do it either before the start of or at the end of the day. Defuse the stress and make it more positive.”

Source - Thestar

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