The National Medical Commission (NMC) had recently asked medical institutes to provide a detailed report by today, 7 October, on the number of students who have died by suicide and resigned in the last five years, and the working hours and weekly offs given to students.
The NMC in its circular sent to colleges said that an Anti-Ragging Committee headed by Dr Aruna V Vanikar, President of the Under-Graduate Medical Education Board (UGMEB), has been constituted. The Anti-Ragging Committee in its first meeting held on 27 September 2022 reviewed the ragging complaints and expressed its concerns over incidents of suicide.
“Although all incidents of suicide and suicidal tendency are not linked to ragging, in many cases … they have been. … Therefore, the committee has decided that all the colleges should submit the information for the last five years,” the circular states.
Died by suicide, not ‘committed suicide’
While experts have appreciated the NMC’s move to take note of the suicides and the other problems that PG doctors are facing, they said the language used by the commission in the circular itself has to be corrected.
“The NMC has taken cognisance of an increasing number of suicides amongst postgraduate medical students. However, I wish they get the language right. It is ‘died by suicide’ and not ‘committed suicide’,” Dr Aqsa Shaikh, a transgender activist, and professor of community medicine at Hamdard Institute of Medical Sciences and Research (HIMSR), told South First.
Similarly, Dr Anant Bhan, bioethics researcher, said, “It is good to see they are taking note of the issue but I am disappointed with the language used. Also, this is a bureaucratic approach of wanting reports and numbers, but does not really say what the regulator’s vision to improve the issues is.”
Psychiatry stigma even among doctors
Medical students dying by suicide and going through depression could also be related to burnout due to pandemic stress and also pressure from seniors, academics, etc., said Dr Nimesh Desai, senior consultant psychiatrist, and former director, Institute of Human Behaviour and Allied Sciences (IBHAS), Delhi.
“This move by NMC is definitely appreciated but it should not be only limited to collecting numbers like an administrative exercise. It has to go much deeper into the issue and understand the possible reasons. It must also ensure there are appropriate means through which the students can come out and speak about it,” he added.
Meanwhile, Dr Satendra Singh, professor at University College of Medical Sciences in Delhi, said he was also the faculty advisor of the mental health student support group Safe Place for Affective Counselling & Empathy (SPACE).
He said the reason for setting this up was to identify those students who do not come out in the open to talk about their depression.
“Here, the students are trained to identify the red flags. It is these students who will notice that their colleague is not coming out to the classes or not going to the clinic. So, these red flags are raised, and the students are then counselled,” explained Dr Singh.
He said that the NMC should have followed up on its earlier order instructing all medical colleges to have grievance committees set up and provide counselling.
“Many colleges across the country claim that they have their psychiatric departments who will do the counselling. But I have had students walk up to me and say that there are problems with maintaining secrecy, and that they are judged when they go to see the doctors in the psychiatry department. There is also a stigma attached to this. So it is best if the institutions decide that doctors from neighboring colleges will come to counsel their children and they will go to other colleges for the same,” he explained.
Some colleges in Karnataka appreciated
Meanwhile, doctors and PG students South First spoke to have appreciated the fact that a few colleges do maintain the secrecy of the student, with the entire counselling process done in a discreet manner that does not embarrass the students.
Citing an example, Dr Hitha B Kiran, MBBS student from Kodagu Institute of Medical Sciences in Karnataka, said that St John’s Medical College in Bengaluru has a “secret counseling room”. Here the counseling is done by the same doctors and the option of speaking in person, or over phone or through video calls are also encouraged. The hours are flexible too and secrecy is an absolute criterion.
“This makes the students more comfortable to open up and since it’s doctors counseling doctors, they understand the situation better as well,” Dr Hitha said.
Meanwhile, Dr B Unnikrishnan, Dean of KMC Manipal College in Mangaluru, said there has not been a single case of suicide or dropouts in the college in the last five years.
“We have formed a grievance committee in our college as per the NMC guidelines. We even accept anonymous complaints. We have provided drop boxes in all the locations for any type of complaint. For medical postgraduates, we have fixed 12 hours of work plus duty off and weekly off. We also provide round-the-clock counseling services by trained clinical psychologists,” he added.
Research by the Post Graduate Institute of Medical Education and Research (PGIMER) in 2021 showed that about 86% of students have not sought psychiatric help and 57% feel there’s a stigma attached to mental health problems.
Nearly 50% of doctors will connect with their peers for help and 10% said they believe psychiatrists will be the best bet. Meanwhile, around 21% say they will go to the faculty members of their own departments.
PG doctors say they are stressed
PG doctors South First spoke to said they are not only stressed due to academics but also due to pressure and expectations to wade through the erratic schedules, and the instances of humiliation and harassment by guides and HoDs. That they also face the brunt of the anger and worries of relatives of patients adds to the stress.
“We try our best to address it in our own way. Some of us seek the help of psychiatrists and get into taking antidepressants, while a few share with friends and family members and vent out the stress. But there are a few more who can’t bear the pressure and quit the profession or sometimes even decide to take their lives,” said Bharghavi S Shetty, a final-year PG student of a medical college in Ballari.