Conduct Unbecoming of a Doctor | Shohei Onishi (Dean, Graduate School of Health Management)
2008.07.03
At the Graduate School of Health Management, I am researching the relationship between proper sleep and life performance with a first-year doctoral student. Proper sleep is evaluated based on factors such as sleep latency (the time it takes to fall asleep after going to bed), the presence or absence of nocturnal awakenings, and sleep duration. Recently, it has been found that a sleep duration of seven and a half hours is associated with the longest average lifespan. It is said that sleeping for shorter or longer periods is not ideal. Sleep deprivation has caused various social problems. It has been proven that major accidents, such as the accident at the Three Mile Island nuclear power plant and the explosion of the NASA Challenger, were linked to mistakes made by sleep-deprived personnel. The same applies to doctors; there was an incident where a fatal accident was caused by a misjudgment from a young doctor (resident) working in emergency medicine. This was a case in the United States. Following this, improvements were made to the working conditions for doctors.
I graduated from the School of Medicine in 1977 and subsequently began my residency at Keio University Hospital, working on the wards and in outpatient clinics. The working conditions of our time would be considered completely abnormal by today's standards. In the morning, we would start drawing blood and examining patients who needed it before they had their breakfast. This began around 6:30 a.m. Then, after organizing medical records, we would assist with the outpatient clinics of lecturers, associate professors, and professors. We took dictation from senior doctors for the medical records, wrote prescriptions, and explained illnesses and tests to patients. It was a dizzying amount of work. When I was assigned to the respiratory and cardiovascular medicine outpatient clinic, I was first surprised to see doctors smoking while examining patients. Of course, this would be unthinkable today. But at that time, it was commonplace.
After finishing our morning outpatient duties, we would return to the wards to conduct tests and examinations on inpatients. If we had time for lunch, or could find a spare moment, we would go to the Kimuraya cafeteria in the basement of Keio University Hospital. If we were unlucky enough to be spotted by a senior doctor, we would often be barked at, "You have time to eat lunch?!" and would scurry back to the ward. The surrounding patients would look at us with surprised eyes.
When I was assigned to the diabetes outpatient clinic, it was an elegant clinic. After the morning clinic finished, the attending physician and the senior doctor assisting in the clinic would often take us to a restaurant under the National Stadium, which is no longer there. And the meal would end with a chocolate parfait. I couldn't help but think, "For a diabetes specialist, you're eating quite a lot."
Our afternoon work would usually finish around 10:00 or 11:00 p.m. The supervising physician for the ward would return from their outside duties in the evening or later, and it was only after we reported the day's results, received guidance, and finished organizing and processing everything that our day ended at this hour. Since we were still young back then, we would usually go out for drinks with colleagues afterward. And the next day, it was back to work at 6:30 a.m., every day. Of course, we also had on-call duties during this time. Naturally, we provided medical care with no time to sleep. I wonder how many hours of sleep we actually got. When in charge of a severely ill patient, we couldn't sleep at all, of course. I continued this kind of work for over 10 years. I mentioned at the beginning that various mistakes caused by lack of sleep can lead to serious accidents, and looking back now, I am horrified that we didn't cause a major one.
Many students also study day and night, but it is through sleeping that what you learned before is consolidated into memory. The appropriate amount of sleep varies from person to person. Some people are fine with short sleep, while others need longer hours. It varies. Please keep in mind that the most important thing is to lead an efficient daily life through an appropriate amount of sleep.
(Date Published: 2008/07/03)