HEAL THE HEALERS!
Date: Friday, January 30 @ 04:01:35 IST
Topic: Research


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Doctors are regarded as next to god. They are the pillars of our health-care system. Yet a doctor has to face many hazards during his long working hours which many a times he himself is not aware about. He/she becomes a subject to many occupational disorders which have to be addressed & their importance & awareness has to be inculcated in every health care professional.

The most important occupational hazard in a doctor is stress. The stress can be both psychological & physical. The physical complications of stress are better known as repetitive stress.

Among the enumerable causes of stress, the notable ones are long working hours, pressure of patient-handling, lack of participation in decision-making, faulty management & lack of role-clarity. One of the terms commonly associated with psychological stress is the “Burnout Syndrome”. Burnout syndrome is characterised by emotional burnout, depersonalization & lowered efficiency. Work-related stress can lead to depression & addiction. Repetitive stress, as mentioned above, leads to physical complications owing to repeated exposure to the same inciting physical stimulus, say for example, maintaining awkward positions during surgery for an extended period.

Doctors & other health care professionals are also exposed to many infectious hazards like HIV, Hepatitis B/C, Tuberculosis & so on…….the list is endless……..!!

The aim of this article is to address the professional hazards doctors face in their day-to-day practice. The other health care professionals like nurses, laboratory technicians are equally at risk if not more, but the article mainly focuses on doctors.

To determine the ground reality we conducted a survey of 35 doctors working in Sir J.J Group of Hospitals, Mumbai. The results & conclusions are given below.

METHODOLOGY:

For analysing the professional hazards in doctors we conducted a survey of 35 doctors working in Sir J.J Group of Hospitals through a structured questionnaire, which included 16 residents, 8 lecturers, 11 associate professors/professors. The aim was to determine how much the doctors were aware & concerned about their own health & how their work was affecting their quality of life. All the doctors were from clinical branches like Medicine, Surgery (including super-specialities like Neurosurgery & CVTS), Obstetrics/Gynaecology, Radiology (Radio-diagnosis) & Neurology. The identity of the doctors was kept strictly confidential.

RESULTS:

# 40% doctors reported that they worked for more than 15 hours a day; 34% worked in between 10-15 hours; 26% worked for less than 10 hours a day. The quantity as well as the quantity of work is important & both are correlated with stress.

# 24% doctors said that they slept for less than 8 hours; 73% slept between 6-8 hours & the remaining slept for more than 8 hours. Again both quality & quantity of sleep are important for relaxing the mind & the body.

# 36% doctors said that they experienced severe stress; 43% experienced moderate stress; 21% said they experienced mild stress. This was based on their own perception of stress; it may differ from one person to another.

# 46% doctors thought that the medical fraternity was careless (having a knowledge but not doing anything about it) regarding their own health; 42% thought the medical fraternity was ignorant; only 12% thought that doctors were well abreast with their own health & taking good care of themselves.

# 53% of doctors said that the medical infrastructure provided to them was bad; 3% thought it was worst; 44% thought it was good.

# 6% of the doctors said they always experienced either cervical pain or back pain; 28% said they mostly experienced the same; 50% said they occasionally experienced the same & 16% said they never experienced either back-pain or cervical pain.

# 52% doctors said they did not do any form of exercise, yoga or meditation. Out of the remaining 48% doctors who claimed that they engaged in some form of exercise; be it physical exertion, yoga or meditation; did not have a fixed pattern for the same.

After analysing the suggestions given by doctors to alleviate the stress & other occupational hazards to which a doctor is exposed, the most notable ones are the following:

# Special treatment of the VIPs should stop in government hospitals.
# Increasing the number of Resident doctors to reduce individual workload.
# Proper time-schedule for time management so that all the doctors get time to eat & pursue other recreational activities.
# Compulsory exercise & meditation programmes for doctors & inclusion of meditation rooms in every ward.
# Organization of regular symposiums on dietary habits that a doctor should follow.
# Increase in remuneration.
# Proper channelizing of funds for improvement of existing infrastructure.
# Mandatory half-yearly health-checkups for all residents & senior doctors.
# Resident doctors should be treated with dignity & respect & a cordial relation should exist between a Resident & his Senior doctor.

DISCUSSION:

In order to understand the situation more closely we need to look at the results from a broader perspective. The aim of this article is not to form a lopsided view in favour of doctors but to improve the situation for the benefit of both the doctors & patients.

It is not only the quantity of work but also the quality that matters. Dull & monotonous work is not liked by any professional. A doctor must look for new challenges every day & engage himself in research. Also important is the relationship of between a junior doctor like a resident & a senior doctor. Junior doctors need to be treated with respect like a pupil. The relationship between a junior & senior doctor should be that of a guru & a disciple rather than that of a boss & an employee. Most of the junior residents that we interviewed told us that they wished to be treated with dignity & respect by their seniors.

As far as the medical infrastructure is concerned this is again a matter of debate. Some would ask what are the standards compared to. The facilities in a government tertiary care hospital will always be better than a public health centre (PHC); that will not be the case with major private hospitals. Also there is the question of lack of skill to use the existing infrastructure. For example, a resident working in a ward having a defibrillator will still prefer to transfer a patient suffering an acute attack of fibrillation to the CCU because of lack of skill to use the instrument or to escape the responsibility. These are the issues which have to tackled & sorted out by the higher authorities. On the other hand the lack of basic facilities like some laboratory tests forces the doctor to send the patients to outside centres & this leads to a delay in treatment, thereby affecting the patients & adding to the stress levels for doctors.
Infrastructure also includes providing proper hostel rooms, food & other amenities for our resident doctors. Sadly due to poor accommodation & unsanitary living conditions many doctors fall prey to many diseases.

In addition to psychological stress, doctors are exposed to many repetitive stress symptoms. Some are common to all the specialities & some are confined to a particular branch. Like for example backaches show a higher prevalence among obstetricians/gynaecologists as they maintain awkward positions during surgery & other procedures. The incidence of burnout syndrome is greater among those nurses & doctors who have a high workload in intensive care units (ICUs). Radiologists are prone to various radiation hazards. Surgeons have a higher incidence of varicose veins as they have to maintain standing position for prolonged periods.

Perhaps the most important threat to doctors is exposure to innumerable infectious diseases from their workplace. In our survey majority of doctors reported that they received needle-stick injuries. The important infectious diseases that can be transmitted are divided into three categories: Blood-borne, droplet & contagious. HIV & Hepatitis-B/C are the two most dangerous blood-borne infections transmitted through needle-stick injuries. Tuberculosis is the most dreaded droplet infection acquired by doctors in hospitals from patients. Scabies is an example of contagious disease hazardous to doctors. In order to prevent or reduce incidence of diseases acquired from hospitals by doctors, the most efficient vaccine is “precaution”. Seminars about Universal Safety Precautions should be regularly organised among the medical students, residents, interns & senior doctors. Needle-pricks from patients suffering from HIV, Hepatitis should be reported to the Medical Officer.

It is high time that the doctors awaken themselves to the possible hazards of their profession in order to have a safe, rich & productive work-life. Ours is a noble profession. What we advise to the patients must also be followed by us. The story of Swami Vivekananda & the sweet-loving child would be very appropriate in this context:
A mother came with her ten-year old son to meet Swami Vivekananda. She complained that her son was addicted to sweets & went on eating even after her repeated scolding. She was tired of telling him off & so she asked the Swami to tell her son to stop eating sweets. He simply asked the mother to come back again with her child after one week. Next week the mother came with her son. The Swami then explained the child about the ii-effects of excess intake of sweets & told him to avoid them. The mother asked him why he didn’t tell the same thing to her son last week. The Swami replied that when she came to him last week even he used to have excess sweets! How could he advise against something to someone if he himself was a prey to it! The same analogy applies for a doctor & his patient!!

By -
Abhishek Avinash Mangaonkar
{Student, MBBS, Grant Medical College & Sir J.J Hospitals, Mumbai}
RxPG Nick: super7


Special Thanks to-
1. Rishi Shankar
2. Naveen Gupta
3. Prakhar Vijayvargiya
4. Sagar Mundada
5. Ankit Anand





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