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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Cranky doctors: A myth? A fact?

A good night's sleep is priceless, boosting
your mood, energy level, and even learning
capacity. Unfortunately, doctors often suffer
from chronic sleep deprivation.

Q: I am a student nurse who just began my in-hospital clinical training. Yesterday, I overheard some experienced nurses griping about cranky doctors. That led me to wonder: Are doctors really as cranky as they as sometimes said to be?

Thanks and Merry Christmas!

Answer by , MD: There are millions of doctors. Any group that large is bound to be heterogeneous; that is, they're not all alike. Some are as sweet as honey, and some are habitually cranky.

Considering what they endure, it is surprising that more doctors aren't cranky. Historically, physicians and surgeons have suffered from years of sleep deprivation during their residency years, although laws limiting work hours have recently made residency less hellacious. However, for some specialties, such as surgery and emergency medicine, sleep deprivation is unavoidable.

Most people become somewhat peevish after a day without sleep. Now imagine how tired and perhaps cranky you'd be when you are already exhausted by a lack of sleep and you're on-call again, and go without sleep for another 38 hours or so. I've done that not for a few weeks or months, but for years on end. The most common antidote to sleepiness—caffeine—doesn't help matters much, because it can sour one's mood and exacerbate anger. (Yes, caffeine can also boost mood, but that's generally in well-rested folks.)

Unfortunately, sleep deprivation is not the only stress that doctors must put up with. Dealing with a stressor—such as extreme time pressure—when you're well-rested is one thing, but it is much worse when you are not. Imagine that you are so tired that you could fall asleep while tying your shoes, and a mother runs into the emergency room and shoves her blue baby into your hands. She's screaming at you, but you don't know what, because she speaks only Spanish. In less than half the time of a typical television commercial, you must determine what's wrong with the baby and take the appropriate corrective action. If you don't save her baby, she might get a malpractice attorney to sue you for $10,000,000 more than you will make in your entire career. Don't believe me? Such a scenario happens every day.

WOMEN: Would you pay your doctor
$1000 if he could tell you how to slash
your risk of breast cancer?

You would be a fool not to do that. Breast cancer
can strike even young women. For example, when
I was an intern, I was called to see a 20-year-old
no-code patient with breast cancer to pronounce
her dead. Countless other young women in their
20s, 30s, and 40s develop breast cancer and lose
a breast—or their lives. Consequently, it would be
foolish not to read a FREE book that could save
your life. The problem is that most doctors know
very little about preventing breast cancer. They'll
give you trite advice you already know, and if you
pick your doctor's brain for ways to drastically
reduce your breast cancer risk, you still won't
learn enough. However, I know how to slash your
risk of breast cancer, and I won't charge you $1000
for it—nor will I charge you even a penny! To get
it, contact me.

Doctors have a multitude of other stressors that most people never bear, so they have difficulty empathizing with the doctors' plight. Nurses, for example, generally don't have to contend with sleep deprivation and many other stresses unique to the practice of medicine. Hence, while nurses work side-by-side with doctors, they often do not fully understand them and how they struggle to withstand stresses that no one should have to face. To add insult to injury, physicians now know that while they typically work many more hours than most other people do in their careers, docs can earn less than strippers, personal trainers, chefs, life coaches, real estate agents, and even autoworkers, as I proved in my analysis of doctor income.

Frankly, it is enough to make anyone cranky, yet most doctors are not, at least not most of the time. I hate to say it, at the risk of starting a war with nurses, but I think that the prevalence of crankiness is higher in nurses than in doctors. Incidentally, one of my friends, a nurse and psychologist, agrees with me. In her opinion, the nursing profession tends to attract people with a greater prevalence of psychological problems—generally not major ones, of course, but milder degrees of dysfunction that can make interpersonal relationships a bit too perilous at times. I don't know if nurses enter training with more personality problems, but their work environment can exacerbate any underlying psychological propensities. I don't think that nurses bear as much stress as doctors, but their jobs are often very challenging, too.

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