Postgraduate doctors across India complain that the long working hours have taken a toll on their physical and mental well-being.
Are young doctors dying due to the stress of long working hours? (Creative Commons)
Let’s face it. We sing paeans when we need doctors the most — like when we needed them during those peak Covid-19 days. Remember all the “Not all heroes wear capes: Many wear scrubs” posts we saw on social media?
But a few of them were found covered in white — shrouds, to be specific — during the past week, raising questions about how society is treating doctors. And worse, how governments are treating them.
Two Chennai doctors — Dr Maruthupandian and Dr Solaisamy — were found dead at their respective residences within a day of each other. Coincidently, or maybe not, both had completed 24-hour shifts before their deaths.
While Dr Maruthupandian passed away on Sunday, 10 December, Dr Solaisamy breathed his last the following day, 11 December. Dr Maruthupandian was a super-specialty postgraduate (PG) from the Madras Medical College and Dr Solaisamy was a PG doctor at the ESI Hospital in Ayanavaram.
Stress-related cardiac arrest has been seen as the likely cause of their deaths, however, postmortems are yet to confirm this.
Similarly, a 25-year-old MBBS student, Mayank Garg, died on 9 December while he was travelling on the Metro train in New Delhi. Another final-year MBBS student, Suneha Jyoti Keswani, was found dead in her hostel room on 5 December at the Khairpur Medical College. Here again, cardiac arrest was suspected to have killed her.
Recently, the Federation of All India Medical Association (FAIMA) sent a letter to Union Health Minister Dr Mansukh Mandviya, saying that it would be launching an initiative — the FAIMA National Mental Health Task Force — to provide counselling and other forms of help to resident doctors in need.
The organisation agreed that the doctors are overworked and overburdened with hectic, prolonged duty hours — most often without breaks — causing loneliness and depression that sometimes ends brilliant minds.
FAIMA’s initiative could also potentially address the mental health issues of medicos, which is not only leading to an increase in the number of suicides within the medical fraternity, but also causing other health issues.
As several people took to social media platform X on the cardiac-related deaths of medicos in Tamil Nadu, state Health Minister Ma Subramanian ordered an inquiry into whether the relentless 24-hour shifts and overwhelming workload had led to the deaths of the two Tamil Nadu doctors.
Even though the medical fraternity across the country have attributed the reason for their deaths to stress, the exact cause of death has not been ascertained. However, their demise once again brought to the fore the discussion about overworking of PG doctors.
Sleep-deprived doctors are likely to make errors.
If it is true, it has to stop.
No human being including doctors should be made to work 36 hours non-stop.
Brain gets fatigued with long working hours and without proper sleep. Attention span, focus and concentration reduce in a… https://t.co/m2J8fwJwZZ— Dr Sudhir Kumar MD DM (@hyderabaddoctor) December 11, 2023
Narrating her ordeal, Dr Archana Harikrishnan (26), a second-year postgraduate doctor in Coimbatore, still shudders at the thought of her first-year days. Twice a week, she had to work 36-hour shifts, checking on post-operative patients, doing rounds, preparing the schedule for senior doctors, and assisting them in the operation theatre.
There were days on which she skipped her meals and was on the brink of falling unconscious. “They call it 24-hour shifts but you need to work the next day as well for 12 hours. You can go to the restroom only when the patient load has decreased,” Dr Harikrishnan told to South First.
The unstable and long working hours took a toll on her physical and mental health. “My menstrual cycle was affected. I was so frustrated. You need rest to do your job properly. But when you don’t even have time to refresh, what can you expect?” she asked.
She added that she had no motivation to get out of bed on many mornings. “I felt like I was trapped. You cannot even discontinue the course because you’ve worked so hard to get here,” added Dr Harikrishnan.
Now, in her second year, she has time to take a breath as there are no more 24-hour shifts. Yet, things are not all rosy. “I still work for 18 hours on most days,” she said.
Postgraduate doctors in Tamil Nadu are so stressed that they have no time to spend with family or support system to talk about mental health.
“Even in established hospitals such as Kilpauk Medical College (KMC) in Chennai, there are double 24-hour shifts a week. We feel like we are slaves,” said a postgraduate doctor from KMC on the condition of anonymity.
However, except for KMC, other government hospitals in Chennai, including MMC and Stanley Hospital, have only one 24-hour shift a day, which itself is a strenuous task, because the doctors continue the next-day shift, clocking 36 hours without a break.
“I would not even know if it is sunny or raining outside the hospital. The system normalises slavery,” said Dr Abul Hassan, President of Tamil Nadu State Indian Medical Association, recollecting his postgraduation days at the Madras Medical College in 1991-93.
He added, “The prevalence of stress and burnout is evident, with an increasing number of young doctors experiencing fatal heart attacks. Factors such as stress, sleep deprivation, and irregular eating habits contribute to the deterioration of the cardiovascular system.”
Especially in departments such as General Medicine, Surgery, Paediatrics, and Trauma, the long working hours become longer with PG doctors pulling off 48-hour shifts as well. “I wish we could talk about it to the administration. But I dare not do that because I am afraid they would fail me in the viva,” said another PG doctor from MMC.
Citing a study by the Indian Medical Association, Dr Deepak Krishnamurthy, senior interventional cardiologist at Kauvery Hospital in Bengaluru, said doctors’ lifespan is 10 years less than that of the general population.
“Stress, lack of adequate sleep, and exercise are some of the common risk factors among doctors. Dealing with human lives and the associated anxieties take a toll on the doctors,” he said.
He added that more stressful fields are known to have higher mortality. Depression is also more common among certain branches of medicine.
“According to the World Health Organization (WHO), doctors have a lower life expectancy compared to the general population. Stress-related issues, as highlighted in a Washington Post report, contribute to a disproportionate ratio of 2:1 in suicides between doctors and the general public,” Dr M Keerthy Varman, president of Tamil Nadu Medical Students Association, said.
While several studies have shown that stress has a negative impact on cardiac health, Dr P Kamat, a renowned cardiologist from CAD said, “Stress can negatively affect the inner lining of arteries, which is known as endothelial dysfunction. This can eventually lead to heart-related problems. Therefore, it is crucial to maintain a healthy balance and give adequate rest to both the mind and body.”
Simple measures such as playing light music in the operating room, participating in indoor games on the hospital premises, or creating a relaxation area for doctors can significantly help achieve this balance, he said
“Ultimately it is vital to take regular breaks from work since every individual’s body is unique and complex,” he asserted.
Various doctors’ associations and the Indian Medical Association (IMA) have made several attempts to persuade the Tamil Nadu government to abolish 24-hour shifts. However, these efforts are yet to be fruitful.
The Directorate of Medical Education, in July 2015, issued a notification mandating eight hours of duty per day on a shift basis for PG doctors and undergraduate compulsory rotatory residential internship (CRRI) candidates in Tamil Nadu government hospitals.
In September 2021, the Madras High Court directed the Tamil Nadu government not to exceed eight hours of duty for postgraduate medical students and those undergoing compulsory rotatory residential internship (CRRI) in medical colleges.
The directive was issued while resolving a public interest writ petition filed by Dr GR Ravindranath, the General Secretary of the Doctors’ Association for Social Equality.
“Two months later, we also met the then-health secretary J Radhakrishnan to ensure the implementation of eight hours of duty. But to date, nothing has changed,” said Dr Varman.
The IMA is launching a 24×7 mental health helpline specifically for doctors. A panel of 15 psychiatrists will be formed.
This national helpline, initiated in Tamil Nadu, aims to address burnout and stress among medical professionals.
“The state, with 75 medical colleges and an annual intake of 10,000 medical graduates, including 5,000 postgraduates, will benefit from this crucial mental health support system,” Dr Hassan said.
The IMA had also requested the intervention of the National Medical Council (NMC) on the matter, after which the latter issued directions to all institutions in the country to reschedule the working hours. “While this was followed in a few medical colleges in North India, especially in Delhi, Tamil Nadu took no measures towards it yet,” Dr Abul Hassan said.
In a 2019 study, conducted by the IMA Junior Doctors Network, the 4,100 postgraduate doctors in India who participated in the study complained of stress due to long working hours.
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