– Article contributed by Dr. Farid, IMS-BHU (SFC)
On February 27, 2018 suicide of a 24 year old resident doctor working in PGIMER, Chandigarh came as a shock for his fellow doctors who claim they remain under stress due to long working hours and unprecedented patient rush at the institute. The working hours set for a resident doctor at the PGI are 12 hours but most of them always work well beyond the set time. Understaffed hospitals and disproportionately large patient burden is the common story of most of the government hospitals of the country. Much of this burden falls on the junior residents of the hospital as they are expected to oblige to whatever their senior counterpart demands of them. For example, it is a common phenomenon to find a first-year medicine resident in the casualty department of Sir Sunderlal hospital, BHU on a shift lasting more than 30 hours at a stretch. Numerous protests have been held in the past demanding more strict regulations and implementation of duty hours for resident doctors. In January earlier this year, resident doctors at IGMC, Shimla protested against the state government as they were made to work for 36 hours non-stop in the emergency and they had no proper duty room to take a break from the hectic hours of work at the hospital. On an average, over 200 patients are admitted to the emergency department of IGMC that needs 12 resident doctors to be posted but there are only 6 of them. Nothing has been done on the issue so far apart from empty reassurances.
A recent article in the journal “Nature” found that staying awake for 24 hours impairs cognitive and motor performance to the same degree as having a blood alcohol level of 0.1 percent, above the legal driving limit in many states. Exhausted residents are often asked to perform operations and make life-or-death decisions that not only have damaging effects on the physical and mental health of the doctors but also endanger the life of patients. An online email survey, conducted by PGIMER, Chandigarh last year to assess various psychological problems (depression, perceived stress, and burnout) among medical professionals working, has also suggested that a significantly higher proportion of resident doctors experience stress, depression and burnout. Residents spend up to 40 percent of their time performing ancillary care — much of it is administrative paperwork — not related to patient care. Such duties could easily be delegated to other support staff in the hospital. Strict regulations and implementation of the duty hours of resident doctors, increasing the support staff at the hospital and setting up new government hospitals are some of the ways in which the problem of workload could be tackled.
India has a huge shortage of qualified medical professionals. Doctor to patient ratio in India is 1:2000 against the WHO norm of 1:1000. This statistic does not tell the full story either as the health services are largely concentrated in urban areas while quackery predominates in rural areas. According to a WHO report, only 18.8% of allopathic doctors in rural areas in India are qualified. The situation is particularly grim for Jammu & Kashmir and North-East states. There is no initiative by the government at opening new medical colleges and hospitals while giving a free run to private ones as is seen by the recent adoption of National Medical Commission bill which is intended to gradually privatize the whole health care system of the country. It is not difficult to see that giant pharmaceutical companies and corporates are forcing the hand of the government at every step of policy making.
Recently doctors have become easy scapegoats for the administrative failures. Government authorities find doctors as soft targets for hiding its shortcomings. This has set up a dangerous precedent which is evident from the increasing incidents of violent attacks on the resident doctors in recent years. We must raise our voice against the blatant lack of concern on the part of government at improving the public health care system of the country and making hospitals a healthy place for both the patient and the doctor.