When I received a picture message from one of the friends from medical college in India, my curiosity skyrocketed. We have never texted each other before, and hardly called once a year. I opened that picture, and it was filled with sad news and a picture of a young doctor. The headline in local language says, “A surgery resident jumped from the hospital roof and killed himself.” More I read in detail, my sad past enlightened; the entire picture started scrolling in front of my eyes. I had goose bumps. When I joined surgery residency as a first year, I could not contain my happiness in my heart. It was very short lasting. Senior residents forced me to start a month before official joining date, even before I arrange for my daily living.
Well-Being of Resident Doctors!
I vaguely remember the very first day of joining training in general surgery. The day starts with taking patients vitals with few other parameters we learned during rotations. We were two first-year residents for patients' numbers ranging between 20 to 80 surgical floor. It was the task given on the very first day. Followed by preparing for patients for elective surgeries, running around to fulfill each patient's prerequisite for surgery, including blood work, tools and accessories. Making sure that anesthesia team was aware and well-equipped with proper staffing. Followed by preparing operating room and keep them ready for each patient going for surgery and required instrumentations. In short, making sure that when attending and senior resident would have shown up for surgery they had everything needed to operate including a stepping stool for a shorter surgeon!
Entire dynamic ran in the total non-learning, and un-educational manner rather was laborious routine. For seniors, completion of exhaustive work was more important than outcome, patient's quality of life or a resident’s health in general. Unconventionally, I was allowed to go for laundry, shower or anything to align in my life for just an hour in a week, especially Sundays. If a casualty falls on Sunday, that day evaporates right away. There was no space for emotions. We were working like a machine. Only primary thing is work protocols, generated since ages and never modified. Situation like scarce residency training positions and abundance of patients was making junior doctor’s life immeasurable.
Patient Prognosis and Outcome!
I precisely remember that I was stationed in the emergency department on behalf of the department of surgery. I was six months new in the junior residency training in surgery. I received a consult from the on-duty medical officer about a patient with more than 60% of burns. Survival rate for that patient was already bleak. I started with basic fluid support and protective dressing at the same time minute surgical intervention to gain access of her vascular systems. Soon patient was hemodynamically stable; I transferred her to the floor, specially equipped to handle patients with burns. On the floor, a senior resident decided to insert central line while she was coherent, maintaining blood pressure and tolerating treatment. His reasoning was more demeaning than noble intents. He wanted to learn and practice before patient succumbs to iatrogenic and unreasonably enthusiastic doctors.
Another senior resident would show up next day that was working on a paper involving patients with burns and early skin allograft. I remember that when he presented the objective to program director, instead of primarily putting under extensive testing and proper reasoning, he accepted the topic. He did not care to add obvious limitations to avoid the rapid decline in outcome because of a suggested process. The resident scheduled her for allograft over a burnt area. In doing so he added extra burden of exposed skin, on top of her already 60% burned area. She succumbed to death in next 24 hours.
There were many examples, especially in critical patients with varied diagnoses, who could have been saved and spared from detrimental consequences. There were no scopes of discussion or reaching out to references in case of complicated cases. Only thing driving was laborious work, finger-pointing and blaming juniors for their own failures. The frequent tantrums and punishing juniors by rejecting their down time and depriving them from learning were driving them to step up in the career path.
Conclusion:
The medical education system in India is not optimal in a majority of teaching institutes in my view. They still overlook the value as a human being. What they are interested in volume and numbers of patients rather than quality of care. The medical procedures and management are never evolving. In some cases, they still manage the same way; patients were being treated hundred of years before. Exclusively all teachers in medicine have big fat ego and think that whatever they know is the end of knowledge and there could be no more than that. This ego creates a huge wall of non-learning and non-receptive to fresh ideas or even new research modalities.
The training is so inhumane for any first-year resident who; few of them choose to die than face and survive. Mental health of the trainee is considered as a taboo if expressed while residency training and expressed more or less publicly. Many survive this enormous hard work at the loss of personal health.
Inadequate sleep, poor judgement and blindly following the protocols set without involvement of education, research, and developments, widely undervalue human well beings. I doubt that this process is healing any humans without hurting short-term or long term, in the worst case it is killing more than saving.
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