night to return home
They decide to call a taxi and when it
arrives just before getting on it
they realize that the driver’s breath
it smells like a canteen your hair is that
ruled his shirt buttoned his eyes
they are red is clearly drunk
you would climb that taxi the limit
maximum blood alcohol level allowed in the
Ecuador to operate a vehicle is
0.3 grams per liter of blood
equivalent to have taken a couple of
wine glasses or a crank we are
strict in countries such as France or
belgium is 0.5 in the united kingdom 0.8
but it’s fine true because all
we know about the dangers
imminent that involves driving under
The effects of alcohol
now we change the scenario its
eight-year-old son presents from this
tomorrow a belly pain that has gone
is intensifying throughout the day
you self-medicate and hope that
better and but not for the early morning the
pain has become unbearable
so they decide to take it to the
hospital emergency after the
blessed paperwork and waiting
receive medical attention
after a couple of exams the
doctors inform them that it is
an appendicitis and that is necessary
operate time is gold
it’s four in the morning
they would sign the documents authorizing the
operation of your son
at four in the morning in the system
of health of Ecuador
most likely the doctors who
he was attended they are without sleep
between 20 to 22 hours there is already a huge
amount of scientific evidence that
shows that the defects of the
deprivation of sleep over our
brain are equivalent or even
greater than those of alcohol consumption and
all our cognitive abilities
memory attention motor ability and
response speed are affected
22 hours without sleep are equivalent to
exceed the maximum limit of
Breathalyzer allowed to drive from
united kingdom and the doctor is not going to manage
the doctor to operate on yours
this afternoon I want to talk about something of
what is rarely talked about
regarding the education system and
I practically want to talk
about the mistreatment of who we are
victims the doctors on the part of this
system worldwide and it seems to me
super relevant to talk with you
about this topic because it’s obvious
that not only affects the
health professionals
a doctor who has been mistreated
transmit to that violence and that
mistreating your patient becomes incapable
to provide the best care and the best
possible care
so what is the problem
I tried to summarize it in five points
although in reality there are many more and
all are strongly interconnected
Ladies and gentlemen welcome to the side
dark of medicine
first the schedule and the lifestyle
hospital before the guard
after the water before the guard
after the guard before the
guard after the guard
although these images pretend to be
funny under them hides a
worrying reality
let me tell you about my year
of rotating internship
I made my year of rotating internship
in one of the most hospitals
crowded of quito
the type of hospital whose delivery room
Emergency room fills more than the
trolley in rush hour of a rainy day
a common week of work
had the following schedule we started a
Monday with guards so he entered the
seven in the morning and I leave on Tuesday
three or four in the afternoon the
Wednesday entered seven
tomorrow and except at three or four of
the afternoon
Thursday guard again I do not go out
from the hospital until three or four of
Friday afternoon
and good finally a weekend for
rest something not not at all because the
Sunday there were guards again a
common week and work stream
I had between 80 to 100 working hours
with work shifts of up to 32 hours
followed and no weekend
completely free
did you know that deprivation of
dream is legally recognized by
several countries as a form of torture
and for doctors it’s a lifestyle
and one dangerous doctors and scientists
and researchers from the University of
Harvard conducted a study in which
compared the error rate committed
by doctors who have been working more
24 hours in a row and doctors to the
that they were allowed to work as
maximum 12 hours in a row that
they found the doctors with the shifts
prolonged work committed 36%
more severe errors than the others
doctors what kind of mistakes are
they will ask to work the right side
of a patient’s chest to drain a
spill that was in the lung
left prescribe the wrong dose of
very delicate use medications put
a probe to the patient from bed 4
when the one who needed it
the one in bed 5 the same group of
researchers in another study
discovered that the professionals of
Health
tired for lack of sleep
adequate they had twice the risk of
suffer accidents like punctures and
cuts in medical procedures
with the consequent risk of becoming infected
by agents like the virus of the
hepatitis b hepatitis co even hiv
from an emotional point of view
lack of sleep causes fatigue
irritability mood changes and
risk seeking behavior
from a physical point of view
the health professional who is missing
chronicle
of hours of adequate sleep has rates
much higher diabetes
hypertension obesity and addictions
from the coffee that becomes a
need until alcohol or even
illegal drugs
2 the system of hierarchies the
Traditional medical education is a
very well established food chain
the doctors of past generations
they have the conception that
new doctors have gone well
weeping little whiners
that in his times he will work even
much more and nobody ever
I complained
when we are in a hospital
we are subject to a system of
discipline that is imparted through
punishments such as buying from the
legend to all the staff that was on
service that night in the guard in the
better case or doubling in the worst
of the cases and if you were wrong
do not worry as long as you have
someone below you to whom to throw
the fault
inside a hospital
we grow as doctors in an environment
thanks to which we want and make great
to get revenge if I suffered
all have to suffer trying to
rebel against this system and break
this chain this cycle of abuse can
Be dangerous
We want to be the warmest with
our patients the most understanding
with our patients
however on more than one occasion
let’s make the bad guys
news
the diagnosis of a cancer
unexpected complication that arose in
a surgery having to inform a
family that the odds that your
be loved recover are very low
if we take as our own the
problems, anxieties and worries of
our fans of our patients or of
their relatives in less than a month
we will have achieved more than we
we thought humanly possible and now if
On the contrary, we both take off
completely of that reality
we become cold doctors and
indolent the unfortunates who treat
your patients as if they were objects
we have to carry out the act more
delicate balancing and so
imagine what emotionally exhausting
that can be
as a fourth point and now that I’ve
mentioned to doctors who treat their
patients as if they were objects
did you know that for the ministry
of public health a good doctor is
the one that attends a patient every 20
minutes to thus meet the
default standard of
productivity
we are facing a system that values
much more the speed of the
medical care than the quality of
same and finally fifth something that I
called the curious syndrome of all
advance and I’m stuck
my schoolmates who had
studied other careers graduated
they undertook business they married they traveled
they enjoyed their life
meanwhile my whole life revolved in
around what the hospital needed
my
many doctors even boast about
of the losses and sacrifices that have
had to suffer in his life only
to have to favor his career
professional
honestly this philosophy seems to me
absurd because I do not think a doctor
have to sacrifice his health his family
your friends your interests do not
professionals only to favor their
career will be more or less five years
of university studies one year of
internship
what we have is making the thesis a
Year of rural medicine 3 to 5 years of
specialty
depending on which you choose two to three
years of his specialty
if they want to become a
pediatric surgeon oncologist a
gynecologist obstetrician specialist
high-risk pregnancies like the kind of
doctors who glamorously appear in
series like gray’s anatomy and house
necklace that are great series but that
little or nothing approach the true
life inside a hospital after
all this after knowing this side
Dark
they would really be surprised if it’s that
I tell you that between 10 to 60% of
doctors and medical students a
world level suffers from depression with
symptoms that include ideation
suicide every year only in states
united 400 doctors or students of
medicine they commit suicide is the equivalent to
a whole medical school of all
health professionals with problems
psychological or emotional is less than the
half
seek professional help is how
said my colleague Dr. Pamela Willy
is the ultimate irony is how
find a shoeless shoemaker with
cher malnourished with a suicidal doctor
Now this is where these are
it’s really interesting because
I came to complain for 20 minutes
now I want to talk about you I want
that for a few seconds
close your eyes and imagine the
perfect doctor
the ideal doctor how you imagine
allow educated guess is very cult
note that it is very up to date but it is
modest is very talkative solves
all the problems and all your
concerns but never explains it to you
words that you can not understand is
warm smiles you a lot does not charge expensive and
good yapa ya is beautiful and
do that when we are sick
we feel vulnerable a simple
fever a cold can make a
man see your whole life pass in front of
your eyes because the end is near
the point is that when we are sick
we want to feel protected
We want to feel in the arms of a
superhero and any reality that
fell even a little below that
fantasy turns out to be a huge
disappointment
I have a solution so for the
moment I feel that it is closer to a
solution is truly simple is a single
word empathy the ability to
experience objectively a reality
alien to yours empathy the ability of
put yourself in another person’s shoes
However, empathy starts being
transparent
I can not feel what you are
feeling if you are actively
I tried to hide it from me
the problems begin to be solved
when it became visible in the case of
medicine when the dark side comes out to the
light what goes of this philosophy is that
can be applied for any problem
that they may be having in their lives
your boss who does not stop fucking your neighbor
that keeps letting your dog hurt your
garden your boyfriend that these almost certain
that is putting the horns like
we visualize the problems not the
we want and when someone externalized
your problems before you
listen empathy have they maybe
Some family member, someone you love
is a doctor who is trying
become one I recommend that of
replace in the little message
of whatsapp asking them to
diagnose eo that you sign a
certificate to miss work by
an invitation to go out to eat for
have a coffee to talk
ask him how he feels
look in the eyes
it will be difficult because they have not
trained in the useless art of hiding
our feelings because that’s for
The bees take food to bring food to
the hepatic uahe
let’s go back to the beginning bet that none
of you would have gotten into the taxi
driven by the drunkard is more more
from one of you I would have thought of
call the police to do what
stop the drivers we ask you to
if they feel tired on the road
stop and rest in a few moments
because then it seems socially
accepted to share photos like this one in
social networks with the following
statement that download
we are aware that this work
is tired but they have the obligation to
fulfill your responsibilities
there are dozens of patients who need
care at any time
this photo of a sleeping america
sitting in a nursing station
It was taken in a public hospital
mexico at three in the morning and it was
a fortunate fact because it activated a
chain reaction from doctors
and medical students of all
Latin America
the hashtag I also fell asleep was made
mirage we lack empathy a doctor
tired irritable is neglected hurry
the result of a health system that
is not working
we can all help a doctor well
care perfectly can be the
superhero that we all need
As for me when my year ends
of boarding I knew that until I had
considerable changes in this western
and malicious machinery does not
would force to live not one more day
due hospital and would fight for
changes so the best graduate of the
medical school was not going to
become an internist or in
a surgeon a pediatrician I found my
passion in scientific research
in immunology and diseases
infectious has all the content
academic and scientific that I always
liked my career
actively contributed to the advancement of
medicine and the well-being of so many
patients and most importantly
every night I sleep in my bed
Thank you
[Applause]
”
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