Suicide by medical student : Global, world wide Rotten system of medical education


A Resident doctor student of Surgery at GMC  Surat allegedly committed suicide last week by jumping from ninth floor. He blamed work pressure and torture in his suicide note. Actions and conversations are generated only after some terrifying incident and finish with making few scapegoats to blame for  one, like five seniors doctors in this case. But the whole system continues to function in same      inhuman way.  This rotten system ignores the deleterious culture of medicine and dangerous working conditions to which junior doctors are subjected.

http://timesofindia.indiatimes.com/city/surat/5-booked-for-abetting-suicide-of-gmc-doctor/articleshow/59463184.cms

Medical students enter medicine as inspired, intelligent, compassionate humanitarians. Soon they turn into cynical and exhausted humans. How did all these totally amazing and high-functioning people get so disillusioned so fast?

Problem does pertain to doctors all over the world, as evidenced by suicide by Dr Chloe Abbott in Australia in January. Her sister Micaela said she was Eaten Alive by the medical profession.

http://www.dailymail.co.uk/news/article-4325812/Investigation-medical-profession-suicide-epidemic.html

 

Inhuman duties, neglect, apathy of regulators towards genuine problems, chaotic  system of working have left doctors, specially in residencies vulnerable to mental illness. Sometimes even driving them to suicides  because of  system failures of medical  administration and inaction by Government.

The terrible conditions have engulfed not only junior phase of doctors, but continue for longer period of their lives, for most of doctors. Because medical professionals find themselves  at the wrong end of stick of government, courts, media for brutal expectations. They face public wrath for system failure.  There is an urgent need for change in work culture and regulations, to make conditions safe for doctors. Grueling shifts, inhuman working hours have to end now, if society really wants to be treated by good doctors.

 

Untenable working conditions, long inhuman hours, unrealistic expectations of patients and thereby creating pressure situations, fear of complaints, physical assaults and medical lawsuits have killed profession largely. Bullying and harassment from all possible quarters is unavoidable consequence.

My earlier article “ enslavement of medical profession” highlights the plight of doctors.

  Almost every doctor will have horror stories to tell, about working conditions. For which medical regulators should be ashamed, there is nothing to be proud of.

      

Choosing medical career or being a medical professional a disadvantage to doctor in comparison to other professions?


Problems faced by doctors are not only innumerable but are also so exceedingly complex and diverse that they are difficult to be analysed. It is common to listen doctors discussing these problems whenever one of these crop up. If so many doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. The challenges in this profession are too many and difficult to analyse.
  1.     Medical courses are Comparatively lengthy and expansive study course and difficult training with slave like duties: that I have discussed in one of my previous article on “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialise. Because of lesser seats in post graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. They have to just flow with system ultimately.
 3. Hostile environment for doctors to begin: Suddenly young, meritorious and bright children who came out of training find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and prejudiced  beliefs of society.

4. Difficult start of career of doctors: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
5.The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
6. Doctors are blamed for all malaise: The society gets biased because of the media reports and some celebrity talking glib without proper understanding of inept medical system , administrative failure and complexity of medical industry.  These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
7.Doctor’s personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
8.Risk to doctor himself:     Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists and interventionalists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
9.Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative  is enough to spoil the mood for the day.

10.Retrospective analysis of doctor’s every action continues all the life-It could be by patients and relatives every day in the form of “ Why this was not done before” ? Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. Unfortunately, if there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
In these court cases, the doctor is at disadvantage since his decision which is now being questioned was taken at that time in good faith using all his wisdom. The decision in retrospect may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight over many years, may label it as faulty if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for punishments and lawsuits. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation will be full and almost permanent. No doctor has time to pursue such things all the time. Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of their mind.
11. Physical assault , routine instances of verbal abuse and threat  happen for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well. Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community, is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see disproportionately large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

With so many adversaries, the situation is like sailing a small boat in a tornado.
At present, with this mindset, the losers are the doctors and medical profession. But the society should be able to foresee its overall loss in the long run if these practices continue.

Enslavement of Doctors, Nurses and medical profession: specially junior doctors equivalent to modern day slaves?


When I was doing house job, once I had to do continuous 72 hours duty because there was no other house surgeon. I had to leave the ward without rounds which hadn’t started on time that day. And I was marked absent and had to apologise for leaving without rounds!!! Amongst many queries in my mind came the question “ Am I an animal?” but I guess even animals have better rights. Courts and animal right lovers show their concern for them all the time. Then “Who am I?” I was forced to think………some species who is being treated worse than animals. My seniors told me “You are a “doctor” and have to work like this only”.
Can this happen the same way with someone in any other profession? That too a profession wherein a young brilliant child, after 10-15 years of most tough studies ,exams, difficult training throughout the golden years of his youth, starts earning pittance. And in a job that also requires doing duties day and night, sometimes for 24 to 48 hours at a stretch without proper meals and sleep. Most of the hospitals don’t even ensure tea and food on these duties for doctors .But these young hardworking people do it gladly and enthusiastically, doing a most noble work saving innumerable lives or relieving countless people of their pain. No rights have ever been defined for these young brilliant children.
This great work is not even acknowledged in any way. These duties are merely systematic exploitation of doctors because of:
– sometimes in the name of Hippocratic oath,
– sometimes in the name of morality
– because of the kindness in their hearts
– in the name of suffering and dying patients
– in name of shortage of doctors and staff.
– for fear of courts and medico-legal cases
– for fear of assaults since the number of doctors is less per patient.
– by some administrative systems who use pressure tactics and sometimes
bullying to get work done
– by similar widely prevalent culture in most hospitals
– for sake of their career and higher degrees
for sake of employment
– in the name of training , and in many more ways.
And these innocent, brilliant and enthusiastic young doctor with stars in their eyes, go on doing it for years along with never ending studies. There is no count of hours, no money or compensation in most of healthcare systems of world for these inhuman duties, exploited young energy and lives. And then comes the most painful part when they do not get the due respect in the society. Their selfless hard work goes unnoticed and unappreciated most of the time. Most people take this slave like working as guaranteed and do not feel it as any injustice to these young doctors. These brilliant children while on duty, may be verbally abused, routinely threatened, assaulted or dragged to courts for trivial issues and that too for no faults of theirs. They just become punching bags for the inept healthcare system and invisible medical industry though lives saved by these young men are uncountable and people relieved of pain and agony innumerable.
Though some western countries of European union and NHS medical systems have realized the inhuman duties and are now following a fixed hours duty schedule, but still most of countries and health systems have kept their eyes closed regarding these slave like duty hours and poor work conditions.
I have enumerated just a few of the problems and the actual burden on the doctor is substantially more and that is further compounded by the behaviour of the society. All these factors put together threaten the very core of the healthcare system, the doctors, who are then not able to work to their full efficiency.
I wonder if this is perceived as normal and routine then what else does slavery constitute ?

nurses and doctors, altruistic professions not treasured in present era

fading charm of medical profession

choosing medical profession a disadvantage  to doctors and nurses

 

Doctor is a soldier : fights the enemy within human body.


I have used this analogy since the situation is similar in certain aspects (life and death situation involving human beings, a war footing effort). When there is a disease, doctor will have to find out the attacking ailment and then find a way to combat that. In emergency situations, it is usually a life and death situation. This battle may involve different kinds of armours ( medicines) and techniques( surgeries and interventions). However unlike a soldier, a doctor while treating an emergency case has many distractions like fear of abuse, assault, legal lawsuit, compelling detailed documentation to save himself, veiled and open threats of implied force (physical, verbal or legal) every day, while the battle(treatment) is going on. With all these distractions, he still has to fight and win in situations where life and death are just moments apart
Though most of doctors learn to fight, with all these distractions, with their increasing experience and wisdom but these do dampen their fighting spirit and enthusiasm. It is ironic that both the patient and attendants, though desirous of positive outcome for the patient and winning the battle against disease, act counterproductively. Although the doctor tries to do his best almost every time, in certain cases, the patient is not able to win the battle. This could be because of any reason like a genuinely difficult situation or an action or decision taken , which later turned out to be not so good in that particular patient. Such cases are usually followed by some sort of assault (physical, verbal or legal)by patient’s attendants. This is akin to weakening your own army. In a battle, when the fighting becomes more risky and fierce ,the soldier is compelled to choose between his ownself versus those for whom he is fighting and this leads to a defensive approach to his fight. Similarly the doctor if exposed to repetitive threats to his own self, will have to become defensive and that surely will affect his treatment.

Just a thought: Imagine a soldier during a war preparing a detailed documentation of his decision making and the reasons for the same so that in case of failure, his actions could be analysed by courts and lawyers over years to find out the errors with aim to punish.

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