Indian doctors- Are we the burnt-out, but silent warriors?: Dr. Apurva Jain
M3 India Newsdesk Jun 27, 2020
Dr. Apurva Jain speaks about burnout faced by Indian physicians in present times at the workplace and how it impacts both the healthcare workers and patients.
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The term ‘Burnout Syndrome’ was first described by Freudenberger, in 1974 as, “becoming exhausted by making excessive demands on energy, strength, or resources in the workplace.” Since then many definitions of burnout have come to being.
Physical symptoms include exhaustion, fatigue, frequent headaches, and gastrointestinal disorders, sleeplessness, and shortness of breath while behavioral patterns of frustration, anger, a suspicious attitude, cynicism, and signs of depression are noted.
Burnout is now included in the 11th Revision of the International Classification of Diseases (ICD), not as an illness or a disease but under ‘factors influencing health status or contact with health services.’ The definition in the ICD remains more or less similar with the addition of an important aspect of ‘reduced work efficiency.’
A doctor’s casualty
Executive burnout i.e. burnout in the corporate culture is well acknowledged. However, the same is highly un-noticed when it comes to the medical profession. The ongoing pandemic, though an extreme case, is the best reflection of the status quo of doctors in the country – long working hours with inadequate incentives, and a threat to their own lives, not only by the infection but also by the people who pose violent attacks on them- is not new for the doctors.
In a study done by Dhusia et al (2019),  56.66 percent of the doctors interviewed from public hospitals in Mumbai experienced burnout. The study used the Copenhagen Burnout Inventory which is a pre-validated questionnaire with nineteen questions catering to personal, work-related, and client-related workout.
Langade et al (2016)  in their cross-sectional study conducted on doctors across the country inferred that 45.02 percent and 65.98 percent of the participants showed emotional exhaustion and depersonalisation respectively while 87.14 per cent was low on a feeling of personal accomplishment. Similar studies conducted in various regions of the country at different points in time have demonstrated the high level of burnout among healthcare providers in India.
The National Health Profile 2019  reported that there is only one allopathic doctor in the public sector for a population of 10,926. Such skewed ratios increase the workload leaving doctors exhausted, and reducing their efficiency. Commercial and corporately managed hospitals with compulsory, standard, pre-fixed protocols sharply curtail a doctor's ability to make independent judgments for the best treatment of individual clients leaving little room for making autonomous decisions and demonstrating professional acumen.
Doctors pursuing post-graduate education, in addition to academic stress have duties of 24 or 48 hours. In the study by Dhusia et al.  50% of the respondents had ‘on call’ duties of three days or more in a week, hence working more than 80 hours per week. The Central Residency Scheme of 1992, restricts the number of working hours for a resident doctor to 48 hrs a week with a maximum of 12-hour at a stretch duty. Even after 28 years, this scheme has never found implementation.
Into the bargain, is the unrealistic expectations from doctors, which has led to physical and verbal attacks on them, to an extent of death. To address the violent attacks on the doctors, The Protection of Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act also known as the Medical Protection Act, though passed in at least 19 states does not prove to be helpful. Offenders should get a jail term of up to three years and a fine of Rs. 50,000. However, the act does not find mention in either the Indian Penal Court or the Code of Criminal Procedure, making it difficult to file a case. No adequate measures of security are in place to avoid such attacks even after repeated incidences in different parts of the country.
The way forward
Burnout being multi-dimensional, tackling strategies should also involve aspects of physical exhaustion, emotional exhaustion and depersonalisation. Increasing the human resources to decrease the workload could be a prime strategy to deal with burnout among doctors, more so in the public sector. Increased spending on human resources and their welfare in primary, secondary as well as tertiary sector public hospitals will not only help increase the quantity of human resources, but also aid in incentivising doctors for overtime work, thus increasing job satisfaction.
Attempts can be made to provide a positive work environment, thus making people look forward to attending work – insisting on proper breaks and rest, providing meaningful recognition, enable comfortable facilitating interaction between seniors and junior doctors, regularly assessing the mental health of doctors and providing in-house counselling for managing work stress, having yoga sessions, organising Continuing Medical Education workshops to enable professional development are a few possible solutions. Studies have proved that playing soft music in hospital environment, especially in wards and operation theatres calms the doctors.
It is important for the state and its citizens to realise that doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. The laws and regulations made for the safety and betterment of doctors should not just be made to pacify strikes and protests but be well implemented to genuinely improve the conditions of the doctors. The onus also lies on the community to understand a doctor’s limitation and ‘Do No Harm’ to the Saviors.
 Dhusia AH, Dhaimade PA, Jain AA, Shemna SS, Dubey PN. Prevalence of Occupational Burnout among Resident Doctors Working in Public Sector Hospitals in Mumbai. Indian J Community Med. 2019;44(4):352-356. doi:10.4103/ijcm.IJCM_78_19
 Langade D, Modi PD, Sidhwa YF, et al. Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey. Cureus. 2016;8(9):e771. Published 2016 Sep 8. doi:10.7759/cureus.771
 National Health Profile 2019. Central Bureau of Health Intelligenee. Issue 14. Available from: http://www.cbhidghs.nic.in/showfile.php?lid=1147
Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
Dr. Apurva Jain is a dentist and an aspiring public health professional. She can be reached at email@example.com
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