Saving lives by working to death

CHENNAI: Popular medical shows on TV and OTT platforms epitomise the dedication of doctors and other medical professionals with their long working hours. It’s glamorised to the extent that working 90-100 hours each week could be considered ‘normal’.

Cut to real life in India, where families pray to their deities to save their loved ones but they look to doctors to actually do the deed. And that’s why doctors are often hailed as gods here.

However, the recent death of at least three medicos in Tamil Nadu, reportedly after working long hours, gave the country and its citizens a reality check. It also prompted the National Medical Commission (NMC) to release new regulations that stipulated all post-graduate (PG) students to work as full-time resident doctors for ‘reasonable working hours’.

Though a similar circular was issued in this regard in 2019, implementation was abysmal in government medical college hospitals (GMCHs).

The State government had told the Madras High Court that eight-hour duty with shift system would be followed for PG students in GMCHs, but depending on exigencies, they would also have to perform their duties beyond the working hours considering the nobility of the profession.

However, given the heavy workload of the GMCHs in the State, PG students usually work beyond 12-hour shifts in many specialties, including emergency, orthopaedics, general medicine, paediatrics, and obstetrics and gynaecology in several hospitals in the city.

“A normal duty day in GMCHs begins at 7 am and extends till 7.30 am the next day. There is no post duty-off for PGs. They go straight to the wards and resume the normal ward works which go on till 10 pm. This is already 40 hours,” said Dr V Vignesh, president of Tamil Nadu Resident Doctors Association. In case of any emergency, death or severe illness, they have to work that too, without getting rest or a wink of sleep for 48 hours.

The recent doctors’ deaths are not an isolated phenomenon. It’s the result of mental and physical stress that had piled up over months of hectic schedule and busier academic years.

Though the NMC has mandated that duty hours should not extend beyond a number of hours, that rule is seldom followed. “We’re unsure about how it’s going to be in the future too,” added Vignesh.

The recent notification on PG Medical Education Regulations, 2023, also stated that students would be provided a reasonable time for rest in a day. They would also be permitted a minimum of 20-day casual leave and five days of academic — both per year.

While it sounds good on paper, students are unsure over its implementation.

A student doing the Compulsory Rotatory Residential Internship (CRRI) at a government hospital in the city says, “We’re posted in about 10 departments in a year. While some departments require 8-9 hours of duty during the last year of our graduation, we have to be on-call duty always. The working hours are hectic in paediatrics, orthopaedics and surgery, which is about 12-24 hours, and it’s even more for PG students who have a higher workload. Though as CRRIs, we’re able to get some time off, PG students don’t.”

Concurring with this was a PG student at a GH in the city, who added that any student doing internship in surgery or critical medicine will have to manage at least 10 sick cases and 5 deaths per week. “We soon become numb to it. But the stress of trying to keep a patient alive, dealing with their relatives, treating sick cases, ward works, inhuman working hours, personal crises and financial burden takes a heavy toll on us,” the student rued.

The NMC’s new regulations have replaced the PG Medical Education (Amendment) Regulations. However, doctors pointed out that the implementation should not increase the pressure by shrinking only the time period, without reducing the workload.

“There are government orders for regulating work hours. It’s a complex process to implement these. The physical and mental stress in certain specialties can involve life and death situations, which put us under a lot of stress,” said a PG student of obstetrics and gynaecology in the city. “Our work involves a lot of non-clinical work too, which can be done by a paramedical staff but there is an acute shortage of these staff members in almost every government hospital.”

He added that the shift system must have a proper mechanism to enable the right training and academics. “We cannot have a shift system with the same workload, which will instead worsen the situation for the doctors. The work needs to be divided properly and more staff needs to be employed to cut down on the stress,” he opined.

Meanwhile, senior doctors dismissed the claims of excessive workload and said that the nature of the profession demanded untimely calls on duty, loads of paperwork and long working hours.

“We conducted committee meetings with senior professors at the medical college to understand if PG students were facing any issues with the work schedule. However, we do not see such issues currently,” averred the dean of a medical college hospital in the city. “The super specialities such as surgery, emergency, anaesthesia and orthopaedics are busier, and students may have to be on duty for even 72 hours. However, as a doctor, this is our duty. Besides, workload used to be even more when we were students.”

Responding to this, R Muthuselvan, dean of Kilpauk Medical College and Hospital and selection committee secretary, said, “Medical colleges follow NMC guidelines for working schedule of all specialities across medical colleges in the State.”

The workload of doctors is immense, to say the least. This creates stress and anxiety, and several mental health issues, which, if left unchecked, leads to suicides.

Several doctors died by suicide last year, which highlighted the immediate need for an effective system to focus on their mental health.

“Doctors, especially PG students, face conflicts with patients. They also have academic pressure and the stress of working long hours. Lack of sleep is a perennial problem with younger residents, which does affect their mental health. Since doctors work in stressful situations, given the kind of patients they have to treat, it can lead to severe stress health problems,” said a psychologist, Institute of Mental Health.

The State government had started the ‘Mananala Nallaatharavu Mandram’ (MaNaM) scheme on December 22, 2022 to provide mental health support to medical students through a helpline in the State. However, the helpline does not cover all medical colleges currently and is being expanded to other colleges in the next phase.

“The State Health Department, through the Directorate of Medical Education, is working on an exclusive standard operating procedures policy and regulations for suicide prevention in medical colleges. We’re also working on expanding the access to the helpline for medical college students in all government colleges,” explained Dr M Malaiappan, director, IMH.