Are junior doctors being driven to suicide by sheer work pressure?
The families of two junior resident doctors who killed themselves over the past 15 days believe such is the case, each having had to keep stressful hours — with a shift sometimes stretching to even 40 hours — in the days leading up to their suicides.
There are many who subscribe to this supposition, many who don’t, and alongside, there are other theories of why bright young people from India’s medical world are taking their own lives.
“There is a need to systematically analyse such suicides,” says Dr Sunil Kumar, India’s former Director General of Health Services.
In his view, these cases are not being scientifically analysed.
“An audit report will tell us what exactly is leading junior doctors to take such extreme measures,” Dr Kumar says.
“We can then provide a better work environment.”
Toxicity killed one more talent of India!
Dr Amit Nayak
Jr1 anaesthesia
Dr Ram Manohar Lohia institute of medical science Lucknow
died due to #suicide !!!
Doctors plz be strong!!@NMC_IND @PMOIndia @PTI_News @ANI @mansukhmandviya #MedTwitter #neetpg2023 @official_aimsa pic.twitter.com/dNcdu5S2It— Dr.manoj Choudhary (@Drmanoj68) January 15, 2023
Doctors’ Suicide Syndrome?
A junior resident at Gandhi Medical College in Bhopal committed suicide in the first week of January, and her family claimed she was overworked and stressed.
A week later, a first year junior resident at Dr Ram Manohar Lohia Institute of Medical Sciences in Lucknow similarly took his life. While there was no statement from the doctor’s family, senior doctors affiliated to the Federation of All India Medical Associations (FAIMA) suspect stress was a factor.
Dr Muralidhar Avinash, spokesperson of the Telangana Junior Doctors Association, has a simple explanation: “We are under constant pressure.”
According to him, medical students have to grapple with the academic pressure of preparing for their exams. “And now that we are junior doctors, it’s only work and more work. We have no social life,” he told South First.
It’s time to compile data of resident doctors suicide state & college wise so that preventive measures can be taken @dnbfoundation @FordaIndia @FAIMA_INDIA_ @IMAIndiaOrg @NMC_IND @MoHFW_INDIA
If anyone having suicidal thought plz talk to your friends or parent #StopSuicide
— Dr. Niraj Singh (@DrNirajSingh4u) January 13, 2023
So much so, Dr Avinash says when a junior doctor tries to find some time to play cricket or take part in some leisure activity like singing or dancing, “society wags a finger and says, you are a doctor and you cannot do all this, go see to your patients”.
Young people lack the ability to handle such stress, he says. He even has a name for what is happening: Doctors’ Suicide Syndrome.
“Like every syndrome, this takes time to develop; it progresses over time and doesn’t happen in one or two days,” explains Dr Avinash.
“We are suffering and there is no one to listen to us, not even society.”
Related: NMC should find out why medical students are stressed, depressed
Part of job, say seniors
Ex-health services chief Dr Kumar disagrees with this description of a doctor’s current work atmosphere.
“The working environment is improving,” he told South First. “Diagnostic facilities are getting better, hospitals are becoming more modern.”
However, at the same time, a doctor’s work is also becoming more and more demanding, he admits, but argues this is part of the job profile.
As population increases so do diseases, he says; people flocking to the hospitals and doctors working over there are duty-bound to attend to them.
“We too have worked the same way,” Dr Kumar says. “I used to work for almost 40 hours at a stretch when placed in the gynaecology department.”
Agrees Dr Namratha C, senior resident at Mandya Institute of Medical Sciences, located off Mysuru in Karnataka.
“Students should consider this as an opportunity to get moulded and trained for the profession,” she says.
Plus, Dr Namratha believes, it is “an exaggeration” to say junior doctors are overworked and have to grind for 30-40 hours.
But Dr Kumar maintains that “one cannot function well when stressed”, similar to an overworked bus driver or a pilot losing focus if he or she who has not rested for some time.
“Overworked doctors cannot handle complications competently,” he says.
“So I don’t think the juniors have to go through more hours.”
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Lack of resources
In fact, the medical veteran feels, it is not long hours that are the problem, but the lack of adequate resources.
While hospitals in the private sector have incorporated modern equipment and amenities, those in the government sector have not kept pace, Dr Kumar says.
“State hospitals have issues with resources, this is why junior doctors are burdened,” he says.
How resource-strapped are they? Junior doctors’ spokesperson Dr Avinash paints a grim overview: Many Public Health Centres (PHCs) in Telangana frequently have nothing more than paracetamol and some basic medicines.
“Our seniors tell us that in a country like India we have to learn to manage with minimum of resources,” he says.
“But if the resources are inadequate, how do we ensure the quality treatment or manage medical emergencies?”
In Dr Avinash’s view, what added to the job pressure for junior resident doctors was that if anything went wrong, it would have to be them facing the patients and their families of the patients.
“Nobody will question the lack of resources. Instead, the available doctor will be beaten up by the families of patients,” he complains.
Worse, he says, senior doctors are never available in such situations.
This view is endorsed by Dr Rohan Krishnan, former president of the Federation of All India Medical Association (FAIMA).
“Stress among junior doctors is increasing mainly because of workforce that is lacking right now,” he says.
“Also, senior doctors often do not cooperate. We saw during pandemic duties that senior doctors were nowhere to be seen in the wards or in the OPDs,” he told South First.
Also Read: PG doctors made to wash cars and serve dinner by seniors
Bullying by senior doctors
Dr Avinash also talked of an issue not much discussed: Bullying of junior doctors by their seniors.
“I constantly hear from our association members that they get ragged by senior doctors,” he said, using the common term for initiation on college campuses in South Asia.
“If students rag juniors in college then it is ragging. But what about the senior doctors, heads of departments, and consultants ragging the junior doctors? Why is that called ‘being professional’ and ‘training to be better doctors,’ ‘preparing for the field’, etc?”
Dr Avinash says it is time the National Medical Commission looked into these charges, which he claims usually get brushed under the carpet in the name of “professionalism”.
“If this is not addressed, the toxic trend will continue,” he avers.
Dr Kumar too feels it is the duty of senior doctors to mentor their juniors.
“Seniors must not have an ‘I have worked for so many hours during my days, so now you have to also go through it’ kind of attitude,” he says.
“We do not always have to take a punitive kind of approach.”
In Dr Kumar’s opinion, the National Medical Commission also needs to step in and “do a lot more than what they are already doing”.
“The government should recruit more doctors to deal with the issue of lack of resources,” he says.
Most MBBS students avoid government hospitals which are hence perennially short-staffed, even as the number of patients is way higher than private hospitals.
