Doctors are one of the most overworked and stressed professionals in India and their struggle starts from school, when they prepare for the medical entrance test. On an average around 6.3 lakh enthusiastic students appear for pre-medical entrance test every year against around 52,000 seats. This is roughly 10% of the total aspirants. This means 90% of enthusiastic young and creative minds, who are passionate to serve humanity are discarded by our poor medical education system.
Though the lucky 90% face humiliation for a day after the results is out, the remaining 10% carry the burden for their entire life. Now they have to work from dawn to dusk in an unregulated health system. In this system, ‘our duty never ends’. When we make our duty roster, we don’t even know how many hours we need to work. It all depends on the number of patients and doctors, as it is quite prevalent that a number of patients are very high in India and doctors are scarce. Usually, our work ends when we are fatigued, exhausted or dead.
The Government of India made a move to implement the Central Residency Scheme (CRS) 1992. As per the CRS, continuous active duty for the residents 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 doctor will also be required to be on call duty not exceeding 12 hours at a time. The junior resident should normally 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.
But in reality, most resident doctors work around 14-16 hours a day, with no weekly holiday or post duty off. This clearly violates the recommendations of the CRS, but there is no provision of punishment for hospitals violating the CRS. The scheme is made with so many clauses that it makes it weak and an only ‘on paper scheme’ rather than an effective method to tackle the problem. Even if we try to get it implemented, usually resident doctors come lower in the hierarchy and a whistleblower can suffer from isolation, hampered training, poor grades in examination. Due to these grave consequences we end up being submissive and accept the atrocities.
This increases anxiety, dissatisfaction, hopelessness, and worthlessness. This also increases incidences of suicides among doctors. A recent article clearly reflects the mental status of doctors. It specifically describes the struggles of young doctors who find it difficult to achieve work-life balance, resulting in a low sense of personal accomplishment, emotional exhaustion, cynicism and depersonalization (lack of empathy for the patient). It is referred to as a ‘physical burnout’. All our research is focused on increasing the life of human beings. We are only concerned about life expectancy, but what about those who don’t want to live? Life expectancy of even 200 will not be of any help if people continue to end their lives in the 20s or 30s. The quality of life is more important than its longevity.
Exhaustion due to overwork is not new to the world. In Japan, there is a growing voice against this health hazard named ‘Karoshi’ which means death due to overwork. Officially, several hundreds of deaths are linked to Karoshi each year, counting heart attacks, strokes and suicides. Campaigners say the real number is much higher. A government survey published in Japan last year found nearly a quarter of Japanese companies have staff working for more than 80 hours overtime a month, often unpaid.
Eighty hours overtime a month is viewed as the level at which a person has an increased chance of dying. Therefore, Indian doctors working in government hospitals are at high risk of death due to Karoshi because they cross this limit twice a month. Around 2,000 Karoshi claims for government compensation are filed every year in Japan. “Sometimes the victims of overwork suffer strokes or debilitating depression which leave them alive, but unable to work,” says a government official to BBC.
In February 2017, Japan launched the “Premium Friday” campaign, calling on employees to knock off early on the last Friday of the month. It’s a government campaign to boost fun and spending. According to their government, this campaign enforces employers to regulate duty hours and encourage individuals to come out of their busy schedule and enjoy their life. This also compels people to avoid overwork and engage in recreational activities at least once a month.
In an attempt to further strengthen the campaign, the government of Japan in May 2017, released its first nationwide employer blacklist, naming-and-shaming more than 300 companies including advertising giant Dentsu and an arm of Panasonic for breaching labour laws. These steps clearly reflect the intention of the government of Japan that they care for the mental health of their people.
Collaboration with Japan to build bullet train has brought new hopes to the country. Increasing cordial ties with Japan makes us hopeful of expecting the same people-friendly attitude from the Indian government too. Resident doctors of India want firm steps to regulate duty hours. Uncontrolled duty hours not only have serious health hazards but it can also hamper patient care. An exhausted doctor will not be able to impart his duties with dedication.
Can we expect our beloved Prime Minister to also borrow the concept of ‘Premium Friday’? We hope that he will strictly implement the CRS (1992). He should encourage doctors to avoid exhaustive overwork and engage in extracurricular activities like yoga, sports etc.
Only healthy doctors can make India healthy.