- Long hours mean sleep deprivation and poor training
By: Shahjehan Sarwar
Doctors in Pakistan face the stumbling block of high duty hours exceeding their intrinsic abilities to work. A great number of doctors are made wretched by the burden of regular routine chores. Pakistan, being a hub for producing numerous doctors in manifold fields after MBBS (Bachelor of Medicine and Bachelor of Surgery) is unable to make provision of better training systems and management of duties in a non-iniquitous manner.
Medical officers don’t get facilities congruous to their services, yet they save lives of people. In fact, doctors have become just material being used as a pawn for interests of Senior Registrars and Medical Superintendents who consider themselves superior officers or medics. One could call them ward-fodder.
Postgraduate trainees are savagely incorporated into the hub of devils and difficulties. Postgraduate trainees cannot enjoy mental peace and remain fighting with bacteria and viruses. Focusing upon less tergiversating, affirming low or negligible reverence for postgraduate trainees in training medical institutions is like the moon suddenly appeari g a black night. Yet, it is not the headway towards right medical professionalism or ethics.
Postgraduate trainees work exceedingly long, far more than normal duty hours prescribed on paper. Although doctors raise a voice for this clandestinely, yet they are more oppressed, as they have little authority of freedom of speech. If they speak about this overtly, it becomes a nightmare for their medical career. A doctor carries out a duty of 36 hours at a stretch on call. If you search for an elaboration of training, it is like “Teaching a person about something or any skill or behaviour”. It does not mention any obligatory excessive duty hours or hard work.
Pakistan is a developing country-which requires the meeting of basic needs, including the best health system. A health system without the best postgraduates is unattainable. Doctors getting miseries and problems of badly-organized systematic postgraduate training will not produce fruits for Pakistan as they are themselves unhappy, wretched and suffering a disjuncture of theory and practical work. So, it is incumbent upon all health-related authorities to look into matter and reconcile doctors’ sleep and relaxation, so they can save the nation of 220 million people
In a call of 24-36-hours in postgraduate trainings, doctors feel a fish out of water. “No criteria for capacity building yet want work, work and work” is senior registrars’ psyche. The emphasis on work is a pressure on a doctor to be an active participant in the senior registrar’s or medical superintendent’s personal interests. “Sanctimonious shows being played in hospitals with postgraduate trainees” is more transparent than water. Clumsy senior registrars merely order postgraduate trainees to search and diagnose patients themselves as far as the majority of difficulties are concerned. I have personally seen a senior registrar asking a postgraduate trainee to display the diagnosis of a person whom he himself could not diagnose.
Postgraduate traineess find only eight hours at the most as free time. It’s up to them in that time either to hit the books or the sack. Difficulties of doctors include health problems, insufficient relaxation, and sometimes an unpaid training process, the lower importance of sleep and a veritable storm of bulky books.
The practice of long work-hours has made common the existence of lamentable conditions-producing risks for postgraduate trainees, ultimately resulting in the decline of their physical and mental health. Patient of hypertension cannot carry out postgraduate training successfully.
Postgraduate trainees suffer painful hours with little provision for sleep. LThese lng work hours just cause anguish to doctors, severely hitting hard their efforts in the medical profession. When is the solution of problems by authorities going to occur? One might say, “When pigs fly”.
The irresponsibility of senior registrars, medical superintendents and trainers is ubiquitous in the whole of Pakistan. There is no helping hand behind the PGs scenario. Doctors learn from their senior registrars by paying the cost of paying them uncommon praise or favour. This was the philosophy in postgraduation by the senior registrars in their time. Now, they are repeating the same with their own juniors. This has become the cry of the day and the powder keg of sheer intricacies for doctors.
It might have been noticed that more trainees fail in membership or fellowship examinations of the College of Physicians and Surgeons of Pakistan as there is no theoretical work found for successful post-graduation completion. Candidates enrolled are commonly in the thousands, and those who qualify are about 30 to 40 percent of overall enrolled doctors in postgraduation trainings. There is more practical work in fetching patients from hospitals where trainings are carried out, towards private clinics. This bears outcomes in the absence of fruitful results of post-graduation trainings. Doctors are thus in a quandary, finding themselves caught between the devil and deep blue sea.
In Japan, in 1999, research showed that long work hours cause hypertension. Surely, managing hundreds of patients is not possible. Even, it is not secret that postgraduate trainees treat patients at senior registrars’ clinics for winning their favour or trust to get their postgraduate training completed. This is not done secretly, and there is integration of doctors in referring patients to one and other for lucrative business of private clinics.
This powder keg for doctors has remained unsolved since the very beginning of the medical profession in Pakistan. The decision-making bodies evolve the solutions and issue utterances most commonly in society. Although their sanctimony is apparent, yet they are caught up the non-seriousness of their duties and responsibilities. The CPSP (College of Physicians and Surgeons Pakistan) is an institution for fellowships and memberships of 73 and 22 specialties respectively. The problems are burgeoning without timely cumulative minor or major uplift in the management of postgraduate training. The Higher Education Commission could play a fruitful in Medics-relaxation-and-sleep development, but does not.
Pakistan is a developing country-which requires the meeting of basic needs, including the best health system. A health system without the best postgraduates is unattainable. Doctors getting miseries and problems of badly-organized systematic postgraduate training will not produce fruits for Pakistan as they are themselves unhappy, wretched and suffering a disjuncture of theory and practical work. So, it is incumbent upon all health-related authorities to look into matter and reconcile doctors’ sleep and relaxation, so they can save the nation of 220 million people.