Can "time banking" give overworked doctors a break?

  • In Your Face
  • Wednesday, 09 Sep 2015

AS this Wednesday rolled around, I found myself searching for a new positive burst to present In Your Face this week when a friend, Shea Munion saved me from having to crack my head too much.

I found my interest piqued when he shared a Washington Post article containing the details of a very interesting  pilot project by Stanford Hospital in the United States aimed at saving emergency-room doctors from burnout.

The project basically works like this. Doctors can "bank" the time they spend mentoring, serving on committees, filling in for their colleagues' shifts or even heading out to attend to emergencies.

In return, they earn credits that they can use to handle the process of getting meals for themselves and their families, housecleaning and other services, such as babysitting, elder care, movie tickets, grant writing help, handyman services, dry cleaning pickup,and speech training among other services.

It's an experiment aimed at addressing the stresses faced by American doctors.

According to a study published in the Archives of Internal Medicine in 2012, many doctors were reporting at least one symptom of burnout, and that they were twice as dissatisfied with their work-life balance compared to people working in other professions.

Can they be blamed if the survey found that that doctors on average were working at least 10 hours more a week than other professionals?

I read the article with deep interest and wondered how the situation was like here in Malaysia. What was the situation like in Malaysian hospitals, especially teaching hospitals where housemen and medical officers learned on the job, building up their experience with patients?

My search found an article in The Star from October 2012 entitled "Housemen still being overworked and bullied, sending some into depression" which was written following the death of a houseman, Dr Lee Chang Tat, 29, who was found dead in a restroom of the paediatrics ward at Kajang Hospital with a used syringe beside him.

It was mentioned in the article that the Malaysian Medical Council  reviews an average of five cases of doctors with mental health issues each month. It is learnt that there were 20 cases last October.

“Most of them are housemen, but we have also heard cases on medical officers. The types of issues range from psychiatric problems to anxiety and coping problems” said former Health director-general Tan Sri Dr Ismail Merican.

Reading this, I was left wondering if the situation had improved here. And I found an article from March which said that one in every five housemen quit before their two-year training stint is up.

And according to one houseman who quit, she decided to stop her housemanship after 14 months of training because the long hours were stressful and there was no work-life balance.

“I was on-call every other day and I realised that even after becoming a medical officer or specialist, the schedule would still be heavy. I didn’t want that kind of lifestyle,” she said.

Dr MH, who is now a medical adviser for a pharmaceutical company, said as a houseman in a training hospital in the Klang Valley then, she worked from 7am to 5pm and would be on-call duty from 6pm to 7am the following morning before continuing with the normal working hours the next day.

“During on-call duty, there are usually patients to attend to. We get little sleep in between and have to wake up at 5am to take blood samples of patients before the senior doctors come in,” she said.

This led me to speaking to two veteran doctors to find out if the Stanford program of time credits could be implemented here. And one ENT surgeon, Dr. Muthu Kumar Murugesan feels it should.

"It is a very good scheme, especially for married female doctors with children. The time they spend in emergency rooms or in the wards on call, the credits earned and spent can help them focus on their work, so they are not distracted with things they have to do on their personal time," he said.

He was of the opinion that all doctors would benefit from it, including doctors doing their housemanship due to the on-call demands.

"Apart from work, they have to do things like grocery shopping or renewing their passport or other household chores. So if the hospitals can implement such a credit system, they can spend more productive quality time with their family," he said.

However, not all veteran doctors are in agreement with such a scheme, with a veteran opthalmologist, Dr. Arjuna Vanniasingham sharing his personal opinions on the "time banking" scheme and the conditions by which doctors could earn credits.

"Serving on committees comes with the job. There are several committees which range from improvement of patient care, maintenance of clinical practice standards. Deploying in emergencies comes with the territory. I would expect the Fire services to act in a similar manner if my house was on fire. Just imagine how unacceptable or disastrous it would be if a fire started just before a shift change," said Vanniasingham.

He had a valid observation about the use of time credits for covering for colleagues on short notice as well as senior doctors being asked to mentor their juniors.

"Covering for colleagues on short notice tends to occur during unexpected circumstances. This favour will be reciprocated and hence cannot be used."

"Teaching junior doctors is an honour, privilege, duty and responsibility of a senior doctor to guide and mold the minds and attitude of the future generation. After all, I was once in their shoes and would not be what I am today if not for those whom I worked under," said Vanniasingham.

With that said, it appears that while this plan has its merits - a lot has to be considered before it can be implemented, including the concerns raised by both junior and veteran doctors.

It's definitely worth evaluating, yes?
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