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Physician burnout, stress taking its toll on Indian doctor’s performance?

Physician burnout may be driving Indian doctors away in droves.

Chronic understaffing in Indian hospitals and healthcare institutions often leads to doctors working long hours. These long hours can result in doctors underperforming due to fatigue. It may lead to more errors occurring. In an occupation in which lives are on the line, errors due to fatigue could lead to loss of life.

Caesareans, surgery Copyright: megaflopp / 123RF Stock Photo
Fatigued doctors are far more likely to make mistakes, this can possibly lead to fatal consequences.

India is seeing many young doctors put off from the profession. Many consider quitting. The reasons behind this are the stress of the job, long hours and a poor work-life balance. This can result in physician burnout: a low sense of personal accomplishment, emotional exhaustion, cynicism and depersonalisation (lack of empathy for a patient).

Dr Nand Kumar, professor of psychiatry at AIIMS, sees two to three medical students and doctors a month for consultations. In comments to the Times of India he says that physician burnout is referred to in psychological terms as subclinical depression. Though, if the situation is not addressed, it can lead to severe cases of depression.

The problem is not exclusive to India. The British Medical Journal (BMJ) identifies it as being present in health systems all over the world. In the United Kingdom, for example, as many as two thirds of doctors suffer from dangerous stress levels. What sets India apart from other countries is its large population and high burden of both infectious and noncommunicable disease. This can be seen as providing the foundation for a public health crisis in the short and long term – one staffing shortages will only make a lot worse.

Dr Kumar also believes that technology has alleviated the problem, rather than reduced it. He mentions that during his junior years as a doctor the others in the community would gather together to party and share problems with friends, and that these activities greatly helped with the problem.

With the newest generations of young doctors, focus on social media and other technology based activities has driven people away from social interaction. This has left many people, amongst both doctors and the public, to face issues such as depression alone. Social media and the ability to connect to anyone, anywhere should in theory increase the links between people. In reality what has occurred seems to be the opposite.

Almost 45% of surveyed doctors scored high on emotional exhaustion and 66% suffered from depersonalization. The figures were generated by a survey conducted by Dr Pranav Modi and Amit Gharpure. The survey involved 500 Indian doctors responding to a questionnaire assessing their feelings on their work.

High levels of burnout amongst doctors may lead to reduced decision making capacity, and a lack of engagement with patients. The capacity for doctors to have reduced judgement and lower levels of empathy towards their patients is worrying said Dr Sanjay Nagral, a liver surgeon and editor of the Indian Journal of Medical Ethics.

Though the levels and effects of physician burnout are relatively unstudied in India, US studies have shown the effects to be linked with loss of life. Medical errors are linked with upwards of 250,000 deaths in the US every year. Physician burnout is also a common phenomenon in the US and has been speculated to play a role in this. Adding to the loss of life is the suicide risk associated with the resultant depression.

Calls of medical negligence have been rife in India over the past few months, spurred on by child deaths occurring in Gorakhpur and elsewhere. There has been a frenzy to place blame. As a result, reasons why doctors may be underperforming, such as long hours and understaffing, have failed to reach the media’s attention.


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