Food, glorious food

The Medical Protection Society recently did a survey of foundation year 1 doctors, which included a question about what doctors had struggled with during the first year of their new job. Two thirds of doctors responding to the survey (66%) listed irregular meal times as one of the biggest issues they had struggled with. This was greater than the number citing heavy workloads (64%) and second only to the proportion listing long hours (75%).

The issue of doctors’ long and stressful working hours is often raised in public discussions, but issues around irregular meal times and missed meals are less frequently mentioned. As doctors, we advise others regularly on good eating habits, regular balanced meals, plenty of fruit and vegetables, and lots of water. However, we often do not or cannot heed our own advice and sometimes fool ourselves into thinking that caffeine constitutes a balanced meal.

I recall working shifts starting at 11 am. In some ways these were great; I could have a nice lie-in. On the other hand, they really did confuse meal times. Having only started at 11 am, I found it difficult to justify going for lunch even one or two hours later. Besides, colleagues who had started shifts earlier took priority for breaks, and then, if it became busy, it could be hours until you had a chance to take a break. Sometimes, if this was nearing the end of the shift I thought, “Why bother now? I may as well finish my jobs off so I can get home on time.” Food could wait till after work. Then there was the problem of eating late at night after on-calls and going to bed soon after. If it wasn’t for being on my feet for hours a day rushing from ward to ward I would probably have been obese by now.

On one weekend shift a kindly nurse noticed I was looking a little pale. I didn’t even need to tell her I hadn’t had a break or eaten for hours. She took the initiative and brought me biscuits and orange juice from the patients’ fridge. Normally I would think it was morally wrong to eat the patients’ food, but at that moment I needed the sustenance to keep me going so I could care for my patients properly.

Another time I recall making it to the front of the café queue before my bleep called me. I went back up to the ward, put my jacket potato down at the nurses’ station, and didn’t return to it until after my shift had ended. By then, it didn’t look so appetising.

As the results of the Medical Protection Society survey show, I am not unique in these experiences. A consultant recently described that, in the days when they did 24 hour on-calls, at times they would not have eaten for hours, the bleep would be going non-stop, and when it wasn’t, the nurses would be chasing them for other jobs. The way they got away was to use the hidden button on their bleep that made it go off; that would be their excuse to leave. Sadly, I don’t think they make bleeps with those buttons any more.

I have also had colleagues who have described how they would sometimes escape to the toilets for a bite to eat as this was the only way of getting a few minutes to rest and eat something. Even the doctors’ room wasn’t safe from yet another request to see a patient or rewrite a discharge prescription. If the nurses could see you, you were available to work. Aside from the hygiene issues, this is a rather gloomy situation, and no doubt compounds the stress levels of junior doctors.

However, I write this article while I am fasting for Ramadan, my last meal and drink was 18 hours ago, and, in my humble opinion, I think I’m functioning fine. So maybe we can simply train our bodies to adjust to not eating. On the other hand, maybe the constantly changing shifts in hospital don’t allow us to do that. Being overworked certainly compounds the consequences of not eating and drinking.

In 2010, a Christmas issue of the BMJ included a case-control study on urine output in junior doctors working in an intensive care unit.1 I won’t go into a critical appraisal of the quality of the study, but taken at face value it showed that junior doctors were classed as oliguric and “at risk” of acute kidney injury on 19 (22%) of 87 shifts, with this oliguria being at the point of being “in injury” in one case. These doctors were more likely to be oliguric than their patients.

As doctors we need to be careful that in doing our best to look after our patients we are not inadvertently causing short or long term harm to ourselves.