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‘Why would anyone want to become a doctor?’

By Dr Owen Wiese

I remember very clearly an incident during my community service, when I walked into the trauma unit at a day hospital in Cape Town one morning and found a patient lying on the trolley, bleeding profusely from a knife wound. I picked up the patient’s file and read: stab wound to the chest — assault. This was after I had already spent the entire weekend at the hospital, working two full night shifts from 7pm to 7am attending to similar cases.

Holding the file in my hands I wondered what on earth I was doing there. This had become a pattern, day in and day out. After enduring this relentless onslaught for months on end, I was close to breaking point. It was at that point that I decided I wanted out as soon as my year of community service was over. Five months later I exited through the dusty swinging doors of the day hospital and vowed never to return to state medicine.

Sometimes I think I could have coped if I had support from the hospital, or if it were just run better. Simply employing more doctors would have helped significantly but, regardless of how busy the hospital was, management would always put only one physician in the trauma unit during the day, and two at night. I often saw more than 100 patients during a single night. If you consider that each patient needs assessment, treatment and referral, and the time it takes to perform all of this, it’s blatantly obvious that none of them get the care they need.

Gallo
Gallo

A study published in The Joint Commission Journal on Quality and Patient Safety (2008) found that, when working overnight, on-call junior doctors have twice as many attentional failures and commit 36% more serious medical errors. They also report making 300% more fatigue-related medical errors, often leading to patients’ death.

If you tried to speak up and ask for help with the patient load, management’s reaction would always be, “What do you expect us to do?” They’d tell us to tell the patients to make another appointment, or to go to the trauma unit that night when there were two doctors on call. They were not interested in finding solutions – they had given up caring long ago and had no interest in the quality of medicine in their facilities as long as the casualties and out-patient departments were cleared at the end of the day.

But even when we had the time, we rarely had the tools we needed. Another source of stress is the constant shortage of basic equipment such as drip needles, or basic meds for hypertension or diabetes. The hospital’s poorly-stocked pharmacy would have an “out of stock” note where the life-saving meds would be, which meant I had to write a private script for a person who could hardly afford a loaf of bread. Of course they weren’t going to buy it (some 80% of SA’s population don’t have medical insurance), which meant in a week’s time they’d be back with even worse symptoms, and we still wouldn’t have the meds.

What also got me down is the lack of self-care and education among regular patients. Because you have to see so many people during a shift, there is no time to educate them about their disease. This means that they don’t continue taking their medication or make changes to their lifestyle, and become a chronic burden on state health.

Then there are the dangers to the doctors themselves. Doctors in South African government hospitals are frequently exposed to tuberculosis, and I knew of five doctors who were being treated for TB while I worked for the government. Needle-stick injuries are also extremely common, especially in the trauma unit where we’d have to deal with aggressive patients who are often still on drugs. At one stage, four of my colleagues were taking anti-retroviral medicines (ARVs) following needle-stick injuries. Taking ARVs is no walk in the park – most people who take them become very sick, but taking sick leave is not an option.

Should one of the doctors become ill, there is no backup for the remaining doctors who have to take on the absent doctor’s load. Doctors know this, so most come to work anyway and work through their illness, putting themselves and patients at risk.

The hopelessness of the situation – long hours, not being able to help people who don’t want to help themselves and a total lack of support from the hospital’s management made me feel totally useless. For a doctor, this is the worst place to be.

A study published in the SA Journal of Psychiatry in 2012 showed that more than half of the doctors who participated in the study usually saw 30 to 50 patients a day. Of the 67 doctors in the study, 51% were found to be stressed and 27% morbidly stressed.

He found that stress and burnout are common among SA healthcare professionals, and while work-related stress rates among the general working population averages 18%, among doctors the rate is around 28%.

It’s no wonder I became one of those statistics, though it may be that it is mainly the doctors who care who burn out. The dilapidated passageways of government hospitals and clinics all over the country are filled with doctors who stopped caring a long time ago and stay in their jobs because it’s easy, or because they are aiming for specialist positions, and rocking the boat could ruin their chances.

When I realised I couldn’t do this any longer without losing all sense of humanity, I succumbed to emotional exhaustion, a deep sense of depersonalisation and an enormous feeling that I had accomplished absolutely nothing since the day I first set foot in the hospital – full of hope, and eager to start helping people.

There are major concerns regarding the exodus of doctors from South Africa, yet the government does nothing to keep them. Many other countries offer better salaries, a more favourable working environment and a sense of partnership. I can’t remember how often I heard my colleagues say: “Just get through your internship and community service and then leave the country.”

The only answer the authorities are apparently capable of is: “We are a third world country with a critical shortage of doctors due to the increasing burden of disease, yet we accept that the doctors we train leave the country because we have a solution: we import foreign trained doctors.” This is a slap in the face of every doctor ever trained in South Africa – because it shows so clearly that the government just doesn’t care enough to improve working conditions for doctors.

I’m not sure if medicine in our country can still be considered a good career choice. Why would anyone want to become a doctor if it is a merciless struggle just to get through a working day?

If something is not done, there will be no South Africa-trained doctors left in the country, and hospitals and clinics will be manned by foreign doctors who are unable to communicate with their patients due to language and cultural differences – while other nations will be served by some of the best trained doctors in the world. And, at the end of the day, the people who are losing out the most are the people we’re aiming to serve – the patients.

Dr Owen Wiese is Health24’s resident doctor and holds degrees in medicine and science from the University of Stellenbosch. He worked in the government sector before joining Health24 as resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media. Dr Owen is based in Cape Town.

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10 Comments

  1. YajChetty YajChetty 27 May 2015

    too true. a terrible indictment

  2. John Paterson John Paterson 27 May 2015

    The fact that our academic hospitals (especially in Gauteng) are using the registrars as a form of cheap labour, rather than prioritising their academic interests, is going to lead to a wholesale collapse of the academic institutions.

    These departments are being politicised through poor leadership choices, and will result in qualifications being stripped of any international accreditation. Added to the fact that the work load in certain hospitals (Bara) doesn’t allow for the pursuit of academic excellence in, say, part 2 exams (especially when certain registrars are doing >30 hour calls ever 4 days), one can only imagine the effect on loyalty.

    Public health in this country is diverging from the path needed to successfully implement NHI, yet leadership will not acknowledge this, and prioritise remedial action.

    I haven’t even touched on “Certificate of Need” in this rant.

  3. Brendon Versfeld Brendon Versfeld 27 May 2015

    As someone married to a doctor, who completed her community service in the emergency room of Mitchells Plain District hospital in Cape Town, I will say that this article is 100% on the money. If anything, its euphemistic about how truly appalling the death statistics are on the cape flats. The situation is, in my wifes eyes, basically beyond hope.

    The sense of alienation from management, who basically dont give a damn (I would like to use a stronger word here, but will refrain from doing so), is profound. And the true travesty here is that the Western Cape, whilst being something of a disaster, is the shining light in South African health care.

    I shudder to think of the conditions in rural hospitals in the Eastern Cape etc…

  4. Haiwa tigere Haiwa tigere 28 May 2015

    This article could have been written by anyone who has contact the lower end of the spectrum in our society. The lawyers the police, the agricultural extension workers nurses, community service workers etc etc. This is what it means to be third world. There just is not enough money to go round and what little there is goes to build Nkandla. The doctors are lucky they can leave and go to a first world country where they are paid better(yes this is the green pasture everybody alludeds to). It so happens these countries have less patient to doctor ratio.

    This is not unique in any way no matter how unfortunate it sounds.I am sure the situation is worse in a lot other places. I always thought it was the rites of passage for doctors to go this stressful work in preparation for your future as a doctor at large

  5. Martin Young Martin Young 28 May 2015

    Spot on, Colleague. But don’t be fooled – the demoralisation goes on into private practice and specialisation. Instead of working for the state doctors effectively work ‘for’ the medical funders and take flak from patient and funder for simply trying to do their jobs at a reasonable income.

    This profession takes the country’s brightest kids, and qualifies them for a job that then breaks them down with generally appalling conditions in the state sector. Super bright kids should be steered away from Medicine in my opinion – do something else that changes the world like water sanitation or biomedical engineering.

  6. Claudine Claudine 28 May 2015

    I honestly wish that someone would take all of this seriously but less face the truth no-one will. It is sad indeed, as the writing is on the wall. And really the solution actually so simple. A little bit of accountability in terms of funds – so that it can actually reach where it needs to, a little bit of intelligent PLANNING and thought put into the current collapse, counselling for traumatised employees on a grand and ongoing scale and it could all change. It is not going to happen and it is sad indeed.

  7. Yusuf Allain Yusuf Allain 28 May 2015

    So your response is basically that we shouldn’t expect any better coz we’re in a third world country, that we mustn’t complain because it must be worse somewhere else, and doctors need to suck it up because it’s a rite of passage?
    Did you even read the article??
    It’s not luxuries we’re asking for, it’s basic essentials, without which patients can’t be treated properly. These are things that are cheap and could easily be afforded if the money that is available is just spent properly and some basic planning is used.
    Stress isn’t what the writer is complaining about – it’s the hopelessness of the situation, the fact that doctors feel they can’t make a difference with the lack of care from management and government and the appalling conditions and the frank exploitation of doctors.
    Your point that it must be worse somewhere else so we shouldn’t complain is frankly so ignorant that it doesn’t merit a response

  8. Alexander Ronald Botha Alexander Ronald Botha 29 May 2015

    Spot on. Working as an intern in a Mpumalanga hospital, most of the conversations doctors have during breaks revolve around either getting out of the state sector/country or getting out of medicine in hopes for better work. Your experiences are mirrored everywhere in S.A. I’m sure, but from all the articles I’ve read stretching from Mexico to Australia all doctors are experiencing terrible working environments with very little support coming from anywhere. I for one will not be encouraging anyone, ever, into our profession.

  9. RSA.MommaCyndi RSA.MommaCyndi 2 June 2015

    Many years back, my GP would do one afternoon, per week, of volunteer work at Bara. She would pack her box of gloves and her bag of magic and leave her office at 11:30am every Tuesday. My gynaecologist was not available on a Friday morning, for the same reason (albeit a different hospital). I even remember my ganae arranging for us, very pregnant, patients and our partners to come help him paint the ward, one rather enjoyable Saturday. It seemed to be a general rule of private practice. Why did that get stopped?

  10. Ashlene Pingelly Ashlene Pingelly 9 June 2015

    As some-one who lived in M/Plain, I agree with you Brendon, and the worst part of it all is that the patients actually blame the doctors and believe that they do not care…they do not even know about the careless attitude of management at the hospital.
    I once became very ill around 2-3am in the morning and opted to make use of Melomed and paid just over R1200 just for consultation just to avoid the emergency rooms in the M/Plain day hospital as it is really really bad :( and yes without hope

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