Working night shifts (#doctor&Nurses) may cause DNA damage, risk of cancer & Heart diseases


        Medical profession getting stressful is nothing new.  There are multiple dimensions to  the multi-pronged stress in present  era.  A new dimension has been discovered. Night shift are integral part of a hospital, doctors and nurses life. But it has shown to be having far reaching consequences. Night shifts have been linked to DNA damage and more serious illnesses.   If these kind of effects prove to be correct in future, it  needs a serious thinking over the issue.

    Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight.

Working night shifts can damage a person’s DNA, increasing the risk of cancer as well as cardiovascular, metabolic, and neuro-degenerative diseases, a study has found. For the study published in the journal Anaesthesia, researchers analysed blood samples of 49 healthy full-time doctors taken at different times.

“Although this work is very preliminary, it is clear from the results that even a single night of sleep deprivation can trigger events that may contribute to the development of chronic disease,” said Siu-Wai Choi, of the University of Hong Kong.

Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight. In these overnight on-site call doctors, DNA repair gene expression decreased and DNA breaks increased after sleep deprivation.

Damaged DNA increased after only one night of sleep deprivation. This DNA damage may help explain the increased risk for cancer and cardiovascular, metabolic, and neurodegenerative diseases associated with sleep deprivation, researchers said.

How to survive medial lawsuit for central venous line insertion


 “ doctor- save the patient, but save yourself also”.

Consent must before invasive procedures: consumer panel  

National Consumer Disputes Redressal Commission has said that doctors must take consent of a patient or his family members for any invasive procedure during treatment. (11.5.2017 Times of India link below).

I really feel sad for the doctors, who sometimes due to overwork or zeal to do things  find themselves in a soup, because of lack of paperwork.  But they are learning the lessons the hard way. Law and media call them a mistake but I think the errors in documentation are due to lack of proper training and poor understanding of legal requirements of profession in consumer’s era. The ignorance is about necessity to save thou self, when we try to save the patient. These documentation have become all the more necessary in current scenario because of the non-acceptability of even common complications. If a complication occurs during treatment, prolonged retrospective analysis goes on at leisure by lawyers with an intention to find fault. They are driven by money as an incentive, and with the wisdom gained on the hindsight, they may find some fault almost always in some way. Thus, doctors are at great disadvantage on this issue. choosing medical career a disadvantage to doctors.

It is high time for doctors to learn how to save themselves. It is important to have a thorough documentation. I am mentioning certain aspects which should be taken care of, while putting a central line .

  1. As already in news “consent” is very important. Take care to write patient identity, age sex and all other relevant columns. Explain and write all benefits and possible complications of procedure. Get signature of patient, relative and a witness. Put doctor’s signature with date and time.
  1. Always try to use ultrasound to help you to locate lines. Patient can be obese, having short neck and it may be difficult anatomy. Ultrasound will help you in differentiation of artery and vein and avoid arterial puncture as in above case.
  1. Be sure before dilatation that you are in vein. Sometimes it is difficult to differentiate between artery and vein. Do everything to prove that you are in vein before dilatation.
  1. Take suitable precautions for to prevent sepsis, air embolism
  1. If it is not emergency always check coagulation profile.
  1. Make sure doctor who is doing the procedure is well trained for it.
  2. Upgrade quality assurance program by keeping record of adverse events during procedures.

These are simple steps, although documentation is cumbersome. But it is worth because it can help the doctor from future litigation, harassment and so many problems. This is need of the hour. Bottom line is “save the patient, but save yourself also”.

http://timesofindia.indiatimes.com/city/delhi/consent-must-before-invasive-procedures-consumer-panel/articles how/58618137.cms

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