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11 May 2018

Malady of doctor drain and strain ...... Textbook take on pressure

Participants at the sixth convocation of the West Bengal University of Health Sciences on Thursday. Pictures by Bishwarup Dutta
Sanjay Mandal, TT, May 11, 2018, Calcutta: A chapter in a textbook on internal medicine that describes long hours of working without a break as being hazardous to both doctor and patient has elicited renewed interest among medical practitioners overburdened with work and other professional pressures.

The chapter on sleep disorder in the latest edition of Harrison's Principles of Internal Medicine mentions that more than 16 hours of duty in a day impairs performance "similar to alcohol intoxication".

"... the practice of scheduling resident physicians to more than 16 hours of duty in a day impairs performance similar to alcohol intoxication and is hazardous to both the patient and the physician. WHO has added night shift work to its list of carcinogens," the chapter says.

Harrison's Principles of Internal Medicine is an American text first published in 1950 and remains a ready reckoner for medical professionals and students. Its 19th edition discusses the problems that can arise if doctors are overworked and fatigued.

The book states that 20 per cent of interns in hospitals admit to making mistakes that cause injuries to patients while five per cent acknowledge fatigue-related mistakes leading to death of patients.

The topic is being currently shared in social media groups of doctors in Calcutta and abroad, with almost all of them admitting to being overworked and at times below their best because of this.

Bengal faces a shortage of doctors in both state-run and private health care. Private hospitals and nursing homes are often accused of hiring non-allopath practitioners to meet the shortage.

At state-run medical colleges, junior doctors regularly work up to 48 hours at a stretch, which sometimes leads to frayed nerves and misbehaviour with patients.

"Doctors can perform with a high level of efficiency for eight hours a day, preferably five days a week, including both routine and emergency duties. Additional working hours do create increased mental stress and fatigue leading to below par performance which is detrimental both for the patient and the doctor. The guidelines for daily working hours of doctors need to determined and implemented by the appropriate authorities," said surgical oncologist Gautam Mukhopadhyay.

Mukhopadhyay performs several surgeries in a day, sees patients and takes calls from the hospital and patients at night.

"The medical profession is an ever-changing speciality. If the brain cells are fatigued and a doctor is unable to update his or her knowledge on new technology, it will affect performance," said interventional cardiologist Rabin Chakraborty. "Duty hours are closely monitored in hospitals in the UK. I had to give a declaration there that I do not work beyond scheduled duty hours. This schedule has gone haywire in Calcutta because of the scarcity of doctors."

A postgraduate trainee in a medical college said he was unable to properly attend to patients needing special care because of work pressure. "I have to attend OPD, then go to take part in a surgery and do the night shift in the emergency department. Next morning, another set of patients comes in."

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