Everyone knows that medical students have to
face a tremendous stress during their entire academic life.Even they are ready
for it because they learn lots of skills during this period. But it doesn't
mean that they have to work for hours and hours continously just like
machines.Non-medicos are generally unaware of these facts that how many hours a
post graduate doctor works in a week ? How many sundays they can spend with
their family ? How many days they can take dinner at home ? Afterall junior
doctors are also human beings, but nothing is done to change this system of
unjustice which is there since many years.We are seeing many changes in various
sectors, but still a junior doctor is working for the same time. This shows the
inhumanity to such health service providers.
All
interns,junior doctors and post graduate students of medical colleges or
teaching institutes are generally forced to work for more than 70 hours per
week. These are the minimum working hours for them,because sometime they have
to work for continously 30 to 36 hours. And we all know that stress always
effects the quality of work. Such things are there in our medical education
system since many years but no medical institute is following any rules and
regulations for working ours.Today in all other sector where continuous round
the clock duty are required i.e. Telecommunication, Railways, Airlines, Travel,
Forces etc., the norms of 48 hours/week or less and shifts and
night duty norms are followed (compensatory off are given, if stretched any
time beyond recommended limit). Then why not such norms are followed by medical
institutes?It is unfortunate, as well as inconsistent with their own
principles, that the organizations most vitally concerned with the health of
the community should in many cases show such DISREGARD for the
health of their own employees. The issue of long working hours in medical and
health services is particularly important, not only because the staff/doctor
has not only to provide care, mostly on a round the clock basis, but also
because THEIR WORK INVOLVES A HIGH LEVEL OF RESPONSIBILITY FOR THE HEALTH
AND WELL-BEING, AND SOMETIMES THE SURVIVAL OF PATIENTS.
As
per the directives of the Honourable
Supreme Court in its judgment dated,25.9.87, in writ petition No. 348-352
of 1985, all the State Governments, Medical Institutions and Universities are required
to amend their rules and regulations to introduce a uniform residency scheme by 1993.Ministry of health and family
welfare, Government of India sent consolidated instructions to all states and
UT administration vide letter number S-11014/3/91 ME(P) regarding
implementation of Uniform Central Residency Scheme after the
directives of the Supreme Court in its judgment dt. 25.9.87 in writ petition
No. 348-352 of 1985,
The instruction No.13 of this letter ‘Hours
of Work', it is mentioned that
"Continuous active duty for
resident doctors will not normally exceed 12 hours per day. Subject to
exigencies of work the resident doctors will be allowed one weekly holiday by
rotation. The resident doctors will also require to be on call duty not
exceeding 12 hours at a time. The junior Residents should ordinarily work for
48 hours per week and not more than 12 hours at a stretch subject to the
condition that the working hours will be flexible as may be decided by the
Medical Superintendents concerned keeping in view the workload and availability
of doctors for clinical work."
The International
Labour Organization, Geneva (India being the member of the same) as early
as in 1962 in its recommendation No.116 concerning Reduction of hours of work
states as Where normal weekly hours of work are EITHER FORTY EIGHT OR LESS,
MEASURES FOR THE PROGRESSIVE REDUCTION OF HOURS OF WORK should be
worked out and implemented in a manner suited to the particular national
circumstances and the conditions in EACH sector of economic activity.
International Labour Organization in its Night Work Recommendation 1990 (No. 178) states that "the normal hours of work of night workers should generally be less on average than those of workers performing the same work to the same requirements by day." Considering that today in India in 5 days week most of the office workers perform a 42-43 hours/week and the maximum limit is set as 48 hours/week for all including the health sector, the total hours of work of doctor (especially Junior doctors , interns) per week must be less than this (i.e. 48 hours/week) as they perform most (all) of the night duties.
International Labour Organization in its Night Work Recommendation 1990 (No. 178) states that "the normal hours of work of night workers should generally be less on average than those of workers performing the same work to the same requirements by day." Considering that today in India in 5 days week most of the office workers perform a 42-43 hours/week and the maximum limit is set as 48 hours/week for all including the health sector, the total hours of work of doctor (especially Junior doctors , interns) per week must be less than this (i.e. 48 hours/week) as they perform most (all) of the night duties.
Presently Resident doctors (Post graduate students in Medical colleges)
in India are forced to work 85-105 hrs/week in most of the clinical departments
without the protection of any service rules because they are students. This is
done under the instruction of the Head of the Departments concerned. Junior
doctors pursuing their post graduation course, whose final assessment are in
hands of these authorities, i.e. HODs. There fore no one normally risks their
career. This way exploitation of this floating population of junior doctors
goes on and on the other hand patients suffer routinely and many times even die
due to this forced negligence. While stretching duty hours our learned authorities
simply forget the proven FACT that errors and accidents increases sharply (An
exponential graph) in mental and physical work, when duty hours are stretched
beyond 10-12 hours continuous duty.
After approximately eighteen hours of work Doctors have got the
equivalent psychomotor dysfunction as having a blood alcohol level of .05. So
not only at .05 you're not allowed to drive but at the equivalent level of
psychomotor dysfunction you're allowed to look after patients. And by the time
you've worked for twenty-four hours you've got the equivalent of having a
blood-alcohol level of 0.1 and that's just ridiculous.
In most of the countries there is a limitation on
extra hours, the average over month or quarterly it must be with in norms,
which varies 40 to 48 hours per week in different countries. In most of the
states in India no duty hour’s norm exists. Most hospital authorities do not
even bother how many hours a junior doctor has worked, and so it increases up
to inhumane levels as high as 103 hours in a week.
One should also note that a number of countries have enacted duty hours regulations for doctors. In Denmark, Norway and Sweden, residents work only 37-45 hours per week. In Netherlands, residents’ duty hours are limited to 48 hrs per week. France has a 35 hour per week limit.
The unexpected death of Libby Zion, 18 yr old daughter of an attorney and writer for the New York Times, at New York hospital in 1984, led to series of investigation that resulted in profound changes in residency duty hours in USA.
In similar situation in London in December 1990 a junior doctor obtained a preliminary judgement from the court of Appeal on a claim for damages against Bloomsbury Health Authority. The court said that health authorities could not lawfully require junior doctors to work for so many hours that there was a foreseeable risk of injury to their health. The Vice-Chancellor, Sir Nicolas Browne-Wilkinson, said: “In any sphere of employment other than that of junior doctors, an obligation to work up to 88 hours in any one week would be rightly regarded as oppressive and intolerable." The doctor had served a writ on the health authority in March 1989 after working a 112-hour week which included a 49-hour shift over a weekend. He felt that his health had suffered so much that he resigned from his job at University College Hospital, London, and gave up medicine for a time.
Great public and media attention was drawn in September 1990 when two doctors in the neonatal pediatrics unit of the Southern General Hospital, Glasgow, were threatened with dismissal for refusing to carry on working 115 hours a week. After two sessions working the 115-hour week, the doctors said that chronic sleep deprivation was severely impairing their medical judgment and putting the lives of new-born babies at risk. In the same month a hospital patient in Middles borough died after a tired doctor gave her the wrong injection. The doctor had been on duty for 30 hours with just three hours interrupted sleep when she gave the fatal injection.
The comments of the acting coroner in the inquest into the death of a New Zealand woman, the innocent party in a car crash, reinforce the importance of addressing the issue of fatigue. The patient survived the accident, but died following a mishap while in hospital. A significant issue for the coroner was the extent to which the fatigue of one of her doctors may have played a part in her demise. The coroner remarked that there was a growing level of concern, both nationally and internationally, over the hours of work of doctors in hospitals, and suggested that the medical professional bodies address the issue of extended periods of work.
Hope in India, justice will not get delayed until some VIP will die. Negligence and irritative behaviour (due to chronic sleep deprivation) of doctors in government hospitals are known to every one and the death due to such forced negligence are nothing but routine (!) death of hospitals.
One should also note that a number of countries have enacted duty hours regulations for doctors. In Denmark, Norway and Sweden, residents work only 37-45 hours per week. In Netherlands, residents’ duty hours are limited to 48 hrs per week. France has a 35 hour per week limit.
The unexpected death of Libby Zion, 18 yr old daughter of an attorney and writer for the New York Times, at New York hospital in 1984, led to series of investigation that resulted in profound changes in residency duty hours in USA.
In similar situation in London in December 1990 a junior doctor obtained a preliminary judgement from the court of Appeal on a claim for damages against Bloomsbury Health Authority. The court said that health authorities could not lawfully require junior doctors to work for so many hours that there was a foreseeable risk of injury to their health. The Vice-Chancellor, Sir Nicolas Browne-Wilkinson, said: “In any sphere of employment other than that of junior doctors, an obligation to work up to 88 hours in any one week would be rightly regarded as oppressive and intolerable." The doctor had served a writ on the health authority in March 1989 after working a 112-hour week which included a 49-hour shift over a weekend. He felt that his health had suffered so much that he resigned from his job at University College Hospital, London, and gave up medicine for a time.
Great public and media attention was drawn in September 1990 when two doctors in the neonatal pediatrics unit of the Southern General Hospital, Glasgow, were threatened with dismissal for refusing to carry on working 115 hours a week. After two sessions working the 115-hour week, the doctors said that chronic sleep deprivation was severely impairing their medical judgment and putting the lives of new-born babies at risk. In the same month a hospital patient in Middles borough died after a tired doctor gave her the wrong injection. The doctor had been on duty for 30 hours with just three hours interrupted sleep when she gave the fatal injection.
The comments of the acting coroner in the inquest into the death of a New Zealand woman, the innocent party in a car crash, reinforce the importance of addressing the issue of fatigue. The patient survived the accident, but died following a mishap while in hospital. A significant issue for the coroner was the extent to which the fatigue of one of her doctors may have played a part in her demise. The coroner remarked that there was a growing level of concern, both nationally and internationally, over the hours of work of doctors in hospitals, and suggested that the medical professional bodies address the issue of extended periods of work.
Hope in India, justice will not get delayed until some VIP will die. Negligence and irritative behaviour (due to chronic sleep deprivation) of doctors in government hospitals are known to every one and the death due to such forced negligence are nothing but routine (!) death of hospitals.
These information was provided to THE NATIONAL HUMAN
RIGHT COMMISION in 2006. But no implementation is there in our medical
education system still now . Such exploitation will not be stopped until we all
oppose together. We just want to be treated like humans ,not like machines. We
all want “working hour norms” to be
followed by all institutions. When there are law,punishment and anti-ragging
committees against ragging, then why there is no any action against such illegal
duty hours for junior doctors.
With great hope, that government will look in to the
matter and take necessary steps to end this violation of human rights of both
patients and junior doctors.
This issue will not be solved if entire PG community doesn't participate...
Share this info to each and every medicos whom you know.
This issue will not be solved if entire PG community doesn't participate...
Share this info to each and every medicos whom you know.
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