Long and unending work hours and tending to patients' every need is vital for providing a comprehensive 24-hour health service. Not surprisingly, resident and junior doctors often work non-stop for 36 to 48 hours, and it's finally reached a tipping point.

 

 

Doctors across the country are fatigued, and they are finally asking for help. But is anyone listening? Resident Doctor Partha Gupta works the graveyard shift (defined as a work shift running through the late hours of the evening to the early hours of the morning, typically from midnight until 8 am) and spends whatever little time he gets, sleeping. “I am always on my feet. I work 18-20 hour shifts and sometimes sleep in the hospital only because I am too tired to go home”, he said. 

In 2016, 800 resident doctors from four medical colleges in Mumbai were surveyed to assess the stress levels, and the results were quite disturbing. "50% resident doctors said that they felt stressed out often, while 25% stated that they often felt that difficulties are piling up so much that they are not able to overcome them”, quoted Dr Sagar Mundada, President of Maharashtra Association of Resident Doctors (MARD) to a local newspaper. 

The Long, Hard Road 

The truth is, the road to becoming a doctor is tough as the sense of “selfless service” is ingrained since the first day of medical school and endless and erratic work hours have been a principal characteristic of medical training for centuries. In fact, the term "resident" is a vestige of times when physicians in postgraduate training lived at the hospital.

The Road to ‘Selflessness.' Is Paved Wih Side Effects 

Multiple studies focusing upon the impact of night shift work upon healthcare professionals have demonstrated association with negative consequences such as:

•    Sleep problems
•    Decreased performance 
•    Increased accident risk
•    Cardiovascular disease
•    Gastrointestinal disease
•    Metabolic disturbances
•    Depression
•    Reproductive dysfunction
•    Impaired family and social life 
•    Lack of job satisfaction 

 

Shift Work Tolerance

A study by BMJ Journal investigated whether shift work tolerance could be predicted by the personality variables morningness, flexibility, languidity and hardiness. The results revealed that night shift tolerance is positively associated with the peak of alertness later in the day (eveningness), the ability to sleep and work at odd times of the day (flexibility) and resilience to coping with stress and illness (hardiness). Difficulty overcoming drowsiness following reduced sleep (languidity) is negatively associated.

 

Putting Patients at Risk 

Dr Shiksha Doshi, a Gynaecologist, believes that the ability to work long hours depends on the capability of the doctor itself. “I used to do 24 hours shifts without too much hassle, so it depends on the individual. But yes, I do notice that junior doctors seem exhausted most of the times, but it’s a price you pay”. 

 

Even though the price may seem small on the surface, the impact of such long hours is less than pleasant for the doctors and their patients.

 

A breakthrough study published in the New England Journal of Medicine (NEJM) by Harvard Work Hours, Health and Safety Group revealed that resident doctors made 35.9 percent more severe errors when working 24 hours-or-more schedules, compared to “every-third-night” call schedules.

An Internet questionnaire answered by over 2,700 doctors revealed that residents in their first year of post-graduate residency, overshot stipulated hours in a month everytime they worked night shifts, which increased their risk of suffering a motor vehicle crash by 9.1 percent. In months with five or more extended shifts, “the risk that they would fall asleep while driving or while stopped in traffic was significantly increased” — by ratios of 2.39 and 3.69 respectively, the study found.

 

Rules That Help?

In 2015, the Delhi government had issued a circular restricting duty hour of resident doctors in all hospitals in the city to not more than 12 hours per shift per day. In the circular published on March 16, Director (hospital services) Dr Sanjay Agrawal wrote: “All director/medical superintendents and heads of clinical departments of hospitals/institutions/departments are advised that in case resident doctors are assigned continuous duties across multiple shifts in their hospitals/institutions/departments, then this practice must stop forthwith and duty rosters for resident doctors are prepared in a way that they are out on clinical duties not exceeding 12 hours in a shift in a day.”

Even though the intention is right, the rule is far from being implemented, and the ground reality is vastly different. A resident at a government hospital in Kolkata,  Payal Saha ( name changed) says she’s expected to be on her feet no matter the time or day. “I don’t get a day off, usually work 18-19 hours a day and its standard. I don’t have fixed eating hours so I am usually tired and a bit disoriented, but I try and do my best”, she said. 

 

Coping with the Graveyard Shifts

Before waiting for the system to do its work, there are some ways to deal with night shift to help stay you alert:

1. Off-duty sleep accompanied by on-duty naps is an effective strategy for sustaining vigilance, learning, and memory when working the night shift. An additional two-hour sleep in the afternoon before a shift, and 20 to 45-minute naps during the evening shift can minimise sleep debt. 
2. Alertness-enhancing agents help alleviate the symptoms of sleep deprivation while sleep-promoting agents contribute to sleep during daytime.
3. Aromatherapy is a complementary therapy that is beneficial for mental relaxation. A study has demonstrated that short-term aromatherapy can alleviate endothelial dysfunction in night shift medical staff.

 

Some may argue that residents need to learn and thus, the long hours are a part of the learning process. But action must be taken before a sense of disillusionment sets in, and they find greener pastures where they are in demand.