KV Network

The need to secure the doctor

Decrease Font Size Increase Font Size Text Size Print This Page

Healthcare is not just the responsibility of the Medical residents. It is the joint responsibility of residents, senior Doctors, Hospital Administration and Civil Administrators

Kanchan Basu

This issue of ‘Safety of Doctors’ has become a National issue post the Nil Ratan Sircar Medical College and Hospital (NRS Hospital) of West Bengal incidence on 11th June, 2019.
While ‘Safety of Doctors’ is a must and has to be ensured at all costs, also we have to consider the plight of the patients who belong to the lowest strata of society and come to a tertiary care center after being referred from the best ‘Healthcare’ facility available in their vicinity.
Healthcare is not just the responsibility of the Medical residents. It is the joint responsibility of residents, senior Doctors, Hospital Administration, Civil Administrators of Health Ministry in State or Centre and our Legislators.
Recent comments by Chief Minister of West Bengal after the incident of attack on an ‘Intern’ in a Hospital in her State, “several policemen also die on duty, but they never say they will go on a ‘strike’ because of that.”
This comment is really silly and not expected from a Chief Minister. The two professions cannot be compared at all. Only thing common between the two is both the ordinary ‘Security Personnel’ and ‘Junior Doctors’ are on the front line. But the profession of the former involves combat at times with goons or an angry mob and they are given proper training for it. Doctors are healers and Junior Doctors who are on the front line are trained to deliver Healthcare to the patients in need. The ‘legitimization of violence’ against Doctors that has happened in last few years is sad and this has to change.
This article will enlist possible solutions so that best Healthcare delivery is ensured to common masses.
Before I appeal for a possible reforms which can be brought, the reader should understand the cadre of ‘Hospital’.
INTERN: Completed Four and a half years of MBBS- now doing One year obligatory ‘Internship’ in a Hospital before they are awarded MBBS. An ‘Intern’s’ role in Hospital is to give relevant investigations to the ‘Patient’, Patient monitoring and learning procedures and techniques under guidance of residents and senior Doctors.
RESIDENT: Post Graduate (P.G.) course is Three years in duration. Accordingly, we have residents – PGY1, PGY2 and PGY3. They specialize in one particular branch; say Medicine. Residents are the backbone of any Hospital. They are the most numerous in number and they run the Hospital 24×7.
Rest of the hierarchy nomenclature is irrelevant to this article and the reader.
POSSIBLE SOLUTIONS
1. WORKING HOURS OF RESIDENTS:
We have to understand that Doctors in India are overburdened. A Medicine or Pediatrics Resident on average gives 10-12 duties of 36 hours in a month. The State of Residents of other branches is not so good too. These hectic duties surely affect the performance of the service providers. It brings in the Residents psychological changes too.
Also, this is not all that Juniors Doctors have to face. Interns have to concomitantly prepare during their One year Internship for NEET, P.G. examination to get high ranks (which ensures them the branch of their choice in Post Graduation). The PG Residents have to attend a lot many Conferences, Journal Clubs, Presentations and also prepare their ‘Thesis’ while giving hectic duties that I mentioned above (easily crossing 100 hours in a week).
In the United States, the Accreditation Council for Graduate Medical Education (ACGME) regulates Residents’ duty hours. In September 2010, the ACGME released new standards which came into effect in July 2011 (after they found there Residents are overburdened), include the maximum of 80 duty hours per week (averaged over Four weeks).
These guidelines were brought to decrease error rates. Although the trainees working under the current work rules spent fewer hours at the Hospital, they were not sleeping more on average than Residents did prior to the rule change, and their risk of depression remained the same as it was among the Doctors working prior to 2011.
How could fewer hours lead to more errors? For one, Interns reported that while they weren’t working as many hours, they were still expected to accomplish the same amount that previous classes had, so they had less time to complete their duties. According to the Researchers, this may be leading to work compression, and that can increase the risk of ‘Errors’ or ‘Mistakes’ if Residents don’t have as much time to make and recheck ‘Patient-Care’ decisions. In addition, the pressure may be even greater for Residents in many Hospitals where the new restrictions on hours were not accompanied by funding to hire new staff to balance the workload.
2. HIRING OF ADEQUATE NUMBER OF RESIDENTS
There should be ‘Periodic Audits’ (by Auditing Body; Structure explained below) in all Hospitals to determine the need of actual number of Post Graduates; if fixed working hour times for Post Graduates have to be followed. Annually, considering the Patient load in respective Hospitals, demand for ‘Seats of Post Graduates’ should be increased or decreased by the Auditors involved in the process. At the same time, Hospital Administration should make sure that all prerequisites set for granting Post Graduate seats are meant, so that the Hospital gets permission from central regulators to increase Post Graduate seats as per demand to much Patient load effectively.
CONCLUSION FROM 1 AND 2:
There should be further comparative studies to determine adequate working hours for the Residents. But one thing is for sure; currently Medical Residents in India are overburdened by their duty hours and hence are not able to maintain work-life balance. Even if at 80 hours per Week, Residents are able to deliver same level of Health care< 80 hours per Week, still a Resident is entitled to a life outside Hospital and should be treated at par with other professions in work hour times. Instead of overburdening one Resident, work should be divided properly by employ adequate number of Residents.
3. SECURITY OF HEALTHCARE PROFESSIONALS:
Now we have got adequate number of Residents with good working hours those are able to work life balance. Still there can be instances, when the residents can face the wrath of angry attendants. Some of the things which can be done are:
A. Decreasing the attendant load in Hospital (possible solutions).
Only 1 attendant can accompany a patient in Emergency or OPD. If the Patient is very sick, not more than two attendants will be allowed.
In wards, we see lots of relatives coming to visit the sick Patient in recovery. There should be a mechanism to ensure that if any more than 2 attendants come to visit.
Less attendant load will help residents to deliver more time to the Patient. At the same time, less number of attendants in the Hospital decreases the chance of Doctors being assaulted.
B) Effective number of ‘Security Personnel’ available at all high patient load points in Hospital round the clock.
C) CCTVs. should be present at all possible places in the Hospital.
D) Written undertaking should be taken from the attendants that they in any case would not get involved in any form of violence against any Hospital staff. If they do so, they will have to face legal action (outlined below).
4. EFFECTIVE AUDITING BODY OR MECHANISM:
Now our adequate numbers of residents who work fixed number of hours (decided after many comparative studies what are ideal duty hours) have been provided with effective ‘Security’ to rightfully deliver their services (hypothetically in this article above).
But there has to be an effective timely Audit mechanism to assess the performance of this system. Ideally, it should be undertaken by a committee which must include Postgraduate residents too as its members. There should be Government Civil Servants and Prominent Citizens of the City or Town (where the Hospital is located) in the Auditing Committee to assess the efficiency of Health Care delivery, adequacy of residents available, if shortage of Residents felt: ensuring steps have been undertaken by Hospital Administration to match the prerequisites set by National body overlooking allotment of Postgraduate seats. The actions of the Auditing Committee will obviously come under Right to Information (R.T.I.) Act. so that average citizen should know how proactively the Auditing body is working to lessen the deficiencies.
The selection of the members of the Auditing Committee should be Democratic and should involve Voting that includes Voting by all the Healthcare Staff of the Hospital. The Auditing Committee can also be given additional Powers of being a grievance cell for Hospital staff which includes Work Place Harassment, Crime against Women etc. Sufficient Powers should be given to the body so that a healthy work environment is made for Residents to work and incidences of ‘Corruption’ by anyone in Hospital ‘Top to Bottom’ are settled in the Hospital only. If anyone has issue with the decision of the proposed body, the Courts are always there.
5. EFFECT MEDICAL AUDIT:
In West Bengal no Government and Non-Government Hospital does ‘Medical Audit’. For this if a ‘Patient’ dies for negligence, it cannot be proved if ‘Medical Audit’ is done the family member of the ‘Dead Patient’ would get read of this anarchical condition. The culprit Doctor will be identified. So all the Doctor will not be blamed for one’s fault.
6. SIMPLIFICATION OF PATIENT CHEEK UP:
A Patient entry a ticket and goes to the Government Hospital O.P.D. for cheek up. The Doctor may refer him/her to other relevant Department for another cheek up or opinion. For this he /she will have to go another day for entry a ticket, go to that referred O.P.D. and come back to his/her O.P.D. another day for treatment. If the Doctor of referred O.P.D. could cheek up the referred patient on same day, then time and harassment could be saved for Patient.
7. LEGISLATIVE SUPPORT:
Point 3 which requires protection of the Residents definitely needs a sound backing of Law so that those who take Law in their own hands are effectively dealt with. Thankfully, Honorable Health Minister of India has shown positivism in this regard. Any incidence of violence against the Doctors ‘On Duty’ should be made a ‘Non Bail-able Offence’.
8. EFFECTIVE DOCTORS RERESENTATION IN HEALTH MINISTRY:
The Central as well as State Government should make sure that Civil Servants working in their respective Ministers ought to have a fixed percentage of Doctors. How can a ‘Sociology Graduate’s Opinion’ (qualified I.A.S.) be more relevant that a Doctorate of Medicine in Cardiology with 10 years of experience in Hospital and who knows the Hospital working from inside.
Lateral entry should be promoted further to ensure experts are able to frame effective ‘Health Policies’.
9. INCREASING GROSS DOMESTIC PRODUCT (G.D.P.) EXPENDITURE:
India spends a little over 1% of Gross Domestic Product (G.D.P.) on Health, far below Singapore (22%), which has the lowest ‘Public’ spending, amongst countries with significant universal ‘Health Coverage’ service. Prime Minister of India has said in one of his speeches that he aims to increase current spending to 2.5% by 2025. Schemes of Central Government like ‘AYUSHMAN BHARAT’ are laudable and show good intent. But, there is a lot of margin still left in terms of implementation of the schemes actually on ground. All the solutions mentioned from 1.5 need money. So, effective funding is crucial. But my opinion is if Central Government takes necessary steps for ‘Treatment for All’ through like “Employees’ State Insurance” (E.S.I.) that would have been better than ‘AYUSHMAN BHARAT’.
Similarly, States can increase their spending on Health in ‘State Budget’. Instead of opposing each other’s ‘Schemes’ for Political factors, both Center and State should come together and keep ‘Healthcare’ out of the Politics. In this way, in a developing Country like India, we will be able to maximize the impact of limited resources we have in terms of GDP expenditure on Health.

(The writer is based at Kolkata)


KV Network

Kashmir Vision cover all daily updates for the newspaper

Leave a Reply

Your email address will not be published. Required fields are marked *