india

Updated: Jun 07, 2015 07:48 IST

Four out of every 10 doctors in India suffer from moderate to severe stress levels owing to shortage of specialists at hospitals. A study published in the Indian Journal of Critical Care Medicine revealed 21% doctors use alcohol, 18% anxiolytic or antidepressants and 14% smoke to cope with the stress.

Data was captured from 700 critical care specialists, but only the completely filled 242 responses – 205 men and 37 women – were utilised for comparative and correlation analysis. Most of the respondents (33%) were from the specialty of anaesthesia, followed by intensivists (32%), internal medicine (19%), pulmonologists (7%) and paediatricians (3%), among others.

The authors of the study found that the critical care specialists have higher stress levels owing to long working hours, high mortality rates in the ICU and the responsibility of having to care for VIP patients.

“Stress today is all prevalent in modern life. Medicine is not an exception. Especially specialities of acute care medicine such as emergency medicine, anaesthesia, critical care, obstetrics, paediatrics and trauma are more stressful. We in the health care industry are more prone to stress as we deal with human life,” said Dr PB Gopal, one of the authors of the study and a consultant critical care specialist from Hyderabad.

“In modern corporate medicine, the customer expects delivery of goods for payment, which we can’t guarantee in our trade. In the pseudo-corporate (I still feel it is feudal) structure of our society, everybody wants special [VIP] status.”

Although most of these doctors have other responsibilities too, the study said they spent most of their time in the ICUs. Out of the 62 hours of weekly work, nearly 49 hours were being spent in the ICU. Intensivists spend the most time (57.7 hours) in a week in the ICU, followed by pulmonologists (51.4 hours) and anaesthetists (48 hours).

On the basis of hierarchy, registrars (doctors pursuing post-graduate courses) spent the most time (52.9 hours) in the ICU, followed by consultants (47.5 hours), head of departments (47.1 hours) and directors (43.8), revealed the study.

“The medical profession is quite stressful and there are certain departments where stress levels are much higher. Critical care department tops the list as you are racing against time, and dealing with the expectations of the patient’s family,” said Dr Arun Dewan, director, department of medicine and critical care at Saket City Hospital, New Delhi.

In addition, the study also found that, on an average, critical care specialists manned 13 beds each in the ICUs. The heavy work load is owing to a paucity of specialists. “In 2005, there were 2,000 qualified intensivists. It is estimated that there is likely to be a 35% shortage of critical care doctors by 2020 as a result of the ageing population and the growing demand. By 2013, around 1,114 students passed their training programs, but still their number is not enough for the ever increasing need,” Dr Kartik Munta, co-author of the study, told HT in an email response.

However, there is a section of specialists who feel stress has always been part of their jobs. “It’s not a new thing. My MD thesis in 1985 was on stress factors operating in intensive care and I had been successfully able to establish the fact. People in the ICU setting are known to develop auditory hallucinations, meaning they hear the beep even off duty,” said a senior intensive care specialist at New Delhi’s All India Institute of Medical Sciences (AIIMS).

“ICU settings are extremely stressful not just for the doctors, but also nurses and even patients. In fact, nurses are far more stressed because they are in maximum contact with patients. Intensive care is an area where the mortality rate is high. A patient who may seem fine one moment could be dead the next moment. Also, one may have spent 3-4 days continuously in the ICU before getting a break.”

The study also highlights that the patient-doctor ratio in developing countries such as India is poor and the patient-super-specialist doctor ratio is even worse. “In any modern hospital, around 20%-25% of beds are in critical care units. To man these beds, currently, the departments of anaesthesia, internal medicine and pulmonology share the responsibility,” said Gopal.

Interestingly, this is a problem prevalent across the world. “Nowhere in the world will we have adequate patient-doctor or patient-nurse ratio. We may open more colleges in India, but where are the teachers?” said a senior doctor from the emergency department at New Delhi’s RML Hospital.

Medical experts blamed the paucity of training programmes for specialists and a lack of teaching staff for the sorry state of affairs. “It is time the Medical Council of India (MCI) and the health ministry change the definition of medical teacher in our system. There is a huge body of expertise out there, in the private and corporate sector, willing to participate in training and teaching,” said Gopal.