Opinion I have seen the damage that Narayana Murthy’s ’70-hour work week’ philosophy has done to India’s medical sector

While social media users have cited a variety of unskilled and semi-skilled jobs where work hours inevitably cross the 70-hour limit, most have skipped medicine from the list. As an intern in one of India’s premiere medical institutes, I have witnessed the scary work hours resident doctors in clinical branches have. It can go anywhere from 36-72 hours in a go, easily crossing the 100-hour limit every week. The residents gulp cups of tea, eat pouches of coffee, or even smoke to prevent their eyes from shutting close. But even that often doesn’t suffice. Far from being praised for their perseverance, they are scolded for the most inane mistakes.

While it is a no-brainer that such long hours of work can blunt any active mind leading to gross mistakes, most of these errors remain beyond the logical control of a resident. Take, for example, getting an urgent CT of a patient planned for an operation the next day. You request the Emergency Radiology senior resident for the CT but despite all your persuasion, they are not convinced. You go to the main department where the usual wait time for a CT is a year and a half and an MRI close to two years. But because it’s an admitted patient (and you the “doctor saab” have gone there), they will oblige you with a few months’ later date. You then go to the radiology consultant who’ll look at the requisition form with suspicious eyes, ask you a volley of questions, and then at the end, depending on their mood, give you an earlier date. Even if you succeed in getting a scan done, the radiologist will not dispatch the report quickly or let you record the scan video. Your consultant is hard-pressed for time, and pissing them off can cost you your degree, so what option are you left with except to run, flatter relevant people and sacrifice your sleep.

Almost half of the residents in the medicine department get tuberculosis themselves because of a dysfunctional eat-and-sleep schedule. General Surgery residents in some places like Maharashtra have reported developing plantar fasciitis and varicose veins owing to the barbaric practice of not letting them sit during duty hours.

The toxic work culture is justified by saying that abuse is a rite of passage. Everybody has to go through it and repeat it when they become seniors. Medicine was considered holy — no profession came close to the amount of financial freedom and upward social mobility that it offered. Even now, incidents such as a full-blown strike against workplace harassment meted out by the dean of Grant Medical College are a rare occurrence. They come to notice only when things boil over and residents finally decide to quit — either the branch or the medical profession entirely. Calling out poor behaviour can have a detrimental impact on one’s career causing more emotional abuse and psychological stress. Added to this are parental pressure and one’s sense of distorted morals where “suffering silently” is equated with “being strong”.

In this era of AI, most government colleges rely on baba-azam-ke-zamane-ka infrastructure. The interdepartmental fracas such as referrals, and ECHO dates should be dealt with through an online system and not through the hamstrings of a resident. Few private colleges, especially in South India, such as Kasturba Gandhi Medical College have used technology to their benefit. The central transportation system where blood vials are put into pipes from various wards, received in the labs, processed and online reports received on the doctor’s computer is one interesting example.

But most of all, there is a serious need to increase the MD seats. There are very few MBBS seats, with a selection rate that is lesser than any world-ranking university. MD seats are only two-thirds of the MBBS seats. This was done to ensure strict control of the merit of doctors. In my opinion, however, such a regulation only deprives poor medical graduates of studying further. Rich kids, irrespective of their intelligence, are likely to get admission to a private university.

Moreover, medicine is an applied science. While each patient might be new, and the manifestation of the disease unique, the treatment protocols are pretty fixed and tabular. It is only because of this fact that a variety of Registered Medical Practitioners, nurses and chemists end up treating a fair number of common milder diseases.

The health ministry has declared that it will reduce the gap within the next three to four years by adding more Diplomate of National Board (DNB) seats. Some have objected to it by saying that it would weaken the concept of a family physician. While the concept of a family physician would be ideal to triage patients, we have moved far from it. The current course has failed to offer the graduate doctors the required aptitude to handle patients all by themselves. With increased awareness and easier availability, patients with even a minor stomachache prefer consulting a super-specialist rather than a specialist. A general physician is even out of the question.

But trying to even up this skewed supply-demand ratio with more DNB seats wouldn’t be an intelligent move. The general public believes that DNB doctors are less qualified than MD ones. It will, if at all, create another level of hierarchy. The sole problem of the disproportionate number of MD residents as compared to patients in government hospitals, whose suffering would significantly reduce with more brains at work, is left unattended. The government seems to insist on reservations having breached the 50 per cent cap. Why not increase the number of seats so that everyone benefits?

Kinshuk Gupta is a writer and medical student