‘Over worked’ doctors write to govt, seek eased work conditions
Srinagar: Doctors in Kashmir have been working on extended, enormous shifts for long now. The issue seems, has not been taken seriously by the government as well as the same has not been addressed so far.
While the Lalla Ded incident has generated debate on various fronts, with government issuing guidelines in regard to the referral of the patients from the peripheries, the question that remains unanswered and unaddressed is that are the medicos over-burdened and stressed beyond limits.
On an average, the doctors in the valley work for 70-80 hours per week, which is against the norms and the Supreme Court directive. On top of it, the PGs usually face the brunt. Though, the guidelines to address the issue are as old as the humanity, same have not been implemented so far. The work shift can go up to 30 hours at a stretch in many cases, which is bound to manifest its effects.
The resident doctors of GMC and associated hospital, have, in a way, voiced the same concerns of over-work and being made to work for longer shifts, which they also say can affect their decision making faculty.
In a letter that has been shot to Principle Secretary Health and Medical Education, AtalDullo, and the copy of which has also been sent to the Principal GMC, the doctors have made few points that demand a serious debate post the incident at LD on Friday. “It has been more than 27 years since the Ministry of health and family welfare, Government of India sent consolidated instructions to all states and UT administration vide letter number S-11014/3/91 ME(P) regarding implementation of Uniform Central Residency Scheme with instruction number 13 of the letter ‘hours of work’, stating that “Continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time. The junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch,” the letter reads.
While silently raising the issue of working for longer hours, the doctors in the letter state: “We don’t plead the excess duty hours (70-80 hours/week) nor do we beseech the inhuman shifts (30 hours at a stretch) of resident doctors as a ground for overlooking any mistake committed by a resident doctor.”
Mental health experts are also saying that longer shifts of work are bound to affect the decision making capabilities, apart from other related aspects.
“While the longer shifts of work affect other mental faculties, the sleep deprivation caused due to it also have negative effects on the mental faculty of a doctor, or any other person for that matter, who works for longer shifts,” said Dr Yasir Rather, a Psychiatrist.
A study also states that after approximately eighteen hours of work Doctors have got the “equivalent psychomotor dysfunction as having a blood alcohol level of .05.” It points that at level .05 one is not allowed to drive, and at the equivalent level of psychomotor dysfunction looking after the patients is out of question.
“By the time one works for twenty-four hours he/she has got the equivalent of having a blood-alcohol level of .1,” it states.
In this regard, the Supreme Court directive in its judgment dated 25-9-87 in a writ petition No. 348-352 of 1985 is: “Continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time. The junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch subject to the condition that the working hours will be flexible as may be decided by the Medical Superintendents concerned keeping in view the workload and availability of doctors for clinical work.”
While putting forth the ill-effects of longer shifts of work, the letter reads: “We will not put forth as defence the myriad of authentic medical studies posted in international journals of repute which state that the neurocognitive functions and decision taking abilities are impaired with prolonged duty hours and prolonged shifts and quote that “Compared with day shifts, risks are 15% higher for evening shifts and 28% higher for night shifts. When compared with 8-hour shifts, 10-hour shifts increased the risk by 13%, and 12-hour shifts increased risk by 28%. Risk increased by 17% for the third consecutive night shift and 36% for the fourth.”
The doctors said that to “douse down the public anger,” the resident doctor was being made a ‘scapegoat.’ “Making a scapegoat out of the resident doctor, without any fault on her part, just to douse the public anger will assassinate the morale of doctors working under hostile conditions in the valley,” the letter says.
Putting across a point that if the doctor is made a ‘scapegoat,’ it will make the doctors to see any patient in future as a ‘potential litigation’ and every clinical decision will be seen a ‘criminal offence.’
“It may result in a situation wherein doctors will prefer to not take any decisions regarding the management of a patient and will rather subject the patient to extended investigations even against their clinical judgement just in order to save their skin from such unwarranted harassment. A situation wherein doctors will prefer to refer the patient to the next higher center available to save themselves from unjustified persecution,” the letter reads.
“A situation wherein the doctors will view every patient as a potential litigation, every treatment option and every clinical decision as a criminal offence in the making,” the letter reads.