Sleepless surgeons: YDA seeks emergency wards duty hours cut

LAHORE:

A post-graduate trainee at Mayo Hospital and office member of the Young Doctors’ Association, Dr Salman Kazmi, has written a letter to the Punjab Healthcare Commission in the absence of the current YDA secretary-general to reduce the working hours of house officers and post-graduate students. It states that many doctors he had seen had been sleep-deprived assisting lead surgeons at the emergency operation theater.

Dr Faisal Akram* said he had fallen asleep during a surgery. The assistant professor in-charge had then issued him a warning. Akram said “I had serving in surgical emergency for 48 hours without a break. I lost count of patients I had operated on”. Faisal is studying for a fellowship of the College of Physicians and Surgeons Pakistan (FCPS).

Faisal says he was not the first or the only doctor to have fallen asleep during a surgery. “Our seniors are quite used to this. Some of them direct heavy operation theatre lights at the post-graduate students’ faces to keep them awake. Post-graduate students routinely serve 36 hour to 48 hour shifts. Sometimes, if the next doctor on-duty doesn’t show up, a doctor has to be on duty for 52 hours” a senior registrar said at the hospital.

The letter proposed that duty hours be decreased to improve patient care. It said that the house officers and post-graduates should not be on duty for longer than 12 hours at a stretch. The letter also proposed that doctors be given at least a 10-hour break after night duty and should not treat patients after a 12-hour shift in the morning. It has argued that this is a requirement of the Pakistan Medical and Dental Council regulations 2011 and the National Health Service rules in the United Kingdom.  Many insurance companies refused to cover for doctors had been operating after night duty.

The letter further suggests that the emergency medical officers in the filter clinic of the emergency ward be replaced by the ward’s post graduate trainees and medical officers. The system is currently in place at the pediatrics ward of Mayo Hospital. Post-graduate residents of sub-specialties such as cardiology, neurosurgery, neurology, nephrology and urology should be included in the emergency duty roster, it says.

The letter proposes that patient treatment files, on the model of chart up files used at Mayo Hospital, should be mandatory at all wards. They should be available at photocopy shops in hospitals so that patients and doctors can both use it for proper documentation.

“We look forward to seeing these proposed reforms being implemented in the Punjab”, the letter stated.  A member of the Punjab Healthcare Commission said it would look into the recommendations and soon come to a decision.

*Names have been changed to protect identity

Published in The Express Tribune, February 16^th, 2014.