January 18, 2009

High stress turning doctors into patients

It looks like doctors are sitting on the other side of the table. Physicians across specialties in Bangalore are seeking help from
other physicians or psychiatrists for depression, anxiety and various health problems.

Psychiatrists are seeing more cases where the patient is another doctor seeking counsel and treatment. The trend is being attributed to the trauma of being in a profession where there's a lot of stress and constant contact with misery and death, worries over remuneration and easy access to drugs.

According to psychiatrists, many doctors suffer from chronic fatigue wherein disturbed sleep, loss of appetite and headache are a few symptoms. It is commonly seen among ICU specialists, who work for long hours or do night duty. Consultant psychiatrist B R Madhukar says many doctors first try self-medication before opting for consultation.

Oncologists, who come across patients with advanced stages of cancer, sometimes feel helpless as there's a limit to what they can do to help. This, in the long run, can lead to depression among physicians.

Another cause of concern is the slow rate of career progression. To be successful and survive in the metros, doctors aim for specialization. After six years of MBBS, they can go for three years of post-graduate courses (MD/ MS), followed by super specialization for another three years (DM/MCh). For admission to these courses, they have to clear tough entrance examinations. Failure also leads to depression in many ambitious doctors.

Moreover, a doctor takes 12 years to become a specialist. By then, he would have crossed 30 years and started his family. When they compare their salaries and lifestyle with people from high-paying sectors, they feel depressed and frustrated. In India, doctors at the early stages (after MBBS) are not paid well compared to those in other countries. It is only around 30 years that they actually start earning well.

Assistant professor in the department of psychiatry, NIMHANS, Shivarama Varambally, says suicide rate among doctors and pharmacists is particularly high. "One reason is that both have easy access to drugs. They know the exact dosage of these drugs that can prove fatal. The rates of alcohol and other substance abuse are also quite high among doctors."

CASE STUDY

A cardiac surgeon in a reputed hospital operated on at least five patients a day. Working for long hours and handling many cases at a time, he couldn't remember patients' names or case history. This also affected his health and couldn't handle the pressure. When he got an opportunity to practise abroad, he opted for it.

POLICY

Given the seriousness of the issue, central and state medical councils along with the government need to evolve a policy for providing evaluation and support for ill doctors. This is in place in many countries already. For instance, the medical board of the state of Victoria in Australia has a well-developed policy. It is important not only for the safety of doctors but also the patients they treat.

TREATMENT

Physicians who seek help are counselled, advised for psychotherapy and lifestyle modification for milder forms of depression. In more severe forms, they are put on medication along with supportive therapy.

WORK-RELATED PROBLEMS

* Chronic fatigue among doctors working late hours, ICU specialists or those working night shifts

* Depression, anxiety and stress, especially among those who work in areas like cancer and psychiatry

* Orthopaedicians and surgeons who operate long hours suffer from back pain

* Dentists who stand for long hours suffer from spine
problems

2 comments:

Vaishnavi Srinivasan said...

When its traumatic to see a relative/friend suffer in pain, how do doctors not succumb to mental trauma and agony on seeing innumerable patients and families? The blog clearly answers my question. But what could the government possibly do academically and professionally?Don't courses abroad take time as much as ours?

Dr.Prahalathan KK said...

It's even worser abroad! but Docs are paid much better too :)

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