Head in the trough

A healthy and alert clinician is safer and more effective. It has long been known that doctors and surgeons work long and demanding hours with changing shifts, in an environment where the stakes are high. The risk of patient death from medical error is at around 1 per day in the U.K. and this does not account for medical injury from error.

We reviewed the dangers of missing meals and not having enough fluid. The aviation industry and military provide copious information about the dangers of missing meals and underhydration. However, there is little research relating to medical environments, in spite of this being an area where we would hope and expect those working in it to be as safe and efficient as possible. Our own (unpublished) surveys have shown that only 25% of clinicians eat breakfast and 50% leave the house for work having not even had a drink. This deficit is not then compensated whilst at work for a number of habitual, cultural and practical reasons.

There is a “stiff upper lip” and “get on with it” culture in medicine and a perception of weakness or inadequacy for wanting to have regular meals and fluid. In spite of the advice that medics give their patients regarding food and drink, medics do not often enough abide by their own advice or knowledge, either willingly or due to work demand circumstances.

Work establishments do little to support a culture of self-care in these areas; clinicians are not encouraged to take breaks by senior staff or management and accessibility to food and drink is often poor at the time of need.

Whilst there is an emerging trend that recognises the importance of Human Factors for clinicians and their patients, it is clear that we are a long way from providing the right cultural and practical work environments for clinicians, necessary for them to be optimally healthy and efficient.

When researching the effects upon performance, mood, illness, safety and effectiveness, it is not surprising that all these areas suffer when someone isn’t properly “fed and watered”. What was surprising however is the degree to which they are affected and how quickly the deleterious effects can emerge.

Water comprises over 60% of body mass, being the most abundant component of the body. Only a 2% bodyweight reduction in water leads to headaches, impatience, sleepiness and apathy. The body’s core temperature is raised by up to 0.2C for each 1% of bodyweight water loss. Individual fluid intake varies greatly and is linked to activity and bodyweight. Environmental effects like temperature also alter requirements.

Missing meals and hunger have been shown to lead to poor communication, bad decision making, worse short-term memory and reduced cognitive function. Moreover, missing meals has been proven to be an ineffective approach to weight loss, as people tend to over eat later and gain more weight.

Breakfast is a particularly important meal and missing it is linked with reduced learning ability and memory.

The effect of adequate hydration and nutrition on performance in healthcare staff is rarely discussed or publicised. Health Trusts should be promoting and facilitating their staff to drink and eat regularly and providing adequate provision for this. With regular breaks introduced as part of the new junior doctor’s contract, surely it is time for all healthcare professionals to recognise the importance of looking after themselves at work and recognise that adequate hydration and dietary intake is essential.

D. Parry 1, R. Oeppen 2, P. Brennan 3
1King’s College London, Hodgkin Building, London, SE1 1UH, United Kingdom
2University Hospital Southampton, Southanpton, SO16 6YD, United Kingdom
3Queen Alexandra Hospital, Portsmouth, PO6 3LY, United Kingdom

Publication

Impact of hydration and nutrition on personal performance in the clinical workplace.
Parry D, Oeppen RS, Gass H, Brennan PA
Br J Oral Maxillofac Surg. 2017 Dec

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