Doctors Today: Happy or Unhappy Doctors Day Presentation by Dr Vidushi Sharma at Indian Medical Association Kota India

1. Happy Doctors’ Day
JULY 1, 2014!
Dr. BC Roy – Physician, freedom fighter,
leader and Chief
minister of West Bengal for
14 years
Dr. Vidushi Sharma
www.suvieye.com

2. IMA Doctor’s Day 2014
Doctors Today– Happy or Unhappy?
Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK)
SuVi Eye Hospital & Research Centre,
Kota, Rajasthan, India
E-mail:suvieye@gmail.com

3. Are Doctors unhappy?
 They are not all unhappy all the time,
but when
doctors gather, their conversation
turns to misery and talk of early
retirement.
 Number of candidates taking AIPMT
vs AIEEE/ JEE
 Doctor kids

4. Public Reaction
 “Making money like bandits” and
reserve only scorn
 Unhappy compared to whom?
 Unequal relationship between doctor
and average patient – the poor,
miserable, unfortunate patient
 Unfortunate fact that we make money
because others are in misery
Dr. Vidushi Sharma
www.suvieye.com

5. US report
 Nine of 10 doctors discourage others
from joining the profession, and 300
commit suicide every year. (April ‘14)
 Medical students opt for high-paying
specialties so they can retire quickly.
Physician MBA programs—that
promise doctors a way into
management—are flourishing
Dr. Vidushi Sharma
www.suvieye.com

6. Causes
 Overworked and under-supported
(most practices are solo)
 Extremely long working hours,
emergency calls, lack of family time
 Unrealistic expectations by patients
and their inordinate demands
 Stories of errors outnumber tales of
triumph
 Increased paper-work
Dr. Vidushi Sharma
www.suvieye.com

7. But…..
 Can hire staff to manage
administrative hassles – part-time or
full-time – entrepreneurs
 Media, specially in India is negative in
general – sensationalism and tragedy
sell
 Working hours, lack of family time
and increased expectations remain a
problem
Dr. Vidushi Sharma
www.suvieye.com

8. Causes within the profession
 Poor record of the profession in giving
mutual support
 Skills in team-working are quite
uncommon in the profession
 Medicine values competition over
nurturing
 Workaholics are admired in medicine
 Doctors are obsessive-compulsive
perfectionists and individualistic
Dr. Vidushi Sharma
www.suvieye.com

9. Causes
 Lack of inspiring leadership – e.g. at
the national level of IMA or MCI – for
advancing our interests
 Senior Doctors – perceived as cynical,
authoritarian, aloof (helpful for them)
– attitude promoted in medical
colleges, look down on even the need
for help
 Medical Colleges – inadequate training
Dr. Vidushi Sharma
www.suvieye.com

10. Background Causes
 Changing society, aggressive
consumerism – increased
expectations, demand for extended
working hours and rapid access
 Decline in deference for all professions
 For many years, physicians enjoyed
the luxuries of answering primarily to
themselves, doing as they pleased
and living quite well
Dr. Vidushi Sharma
www.suvieye.com

11. So……..
 We probably did not do a very good
job of regulating ourselves
 Impossible to reverse the increasing
expectations and accountability
 The AIIMS PG test example
Dr. Vidushi Sharma
www.suvieye.com

12. Irrefutable universal concerns
 Doctors just can’t make mistakes
 Seeing too much pain and not enough
joy is unhealthy
 Too much adverse media coverage
 Growing blame culture – doctors take
the blame for all systemic ills
 Advancement in the science itself has
led to increased costs, work & demands
Dr. Vidushi Sharma
www.suvieye.com

13. Added concerns in India
 Inability to understand prognosis
 Poor socio-economic status
 High volume of patients
 Lack of facilities in Govt. set-up
 Working 24/7 with no week-ends
 Rural postings
 Political interference, petty politics
 Huge disparity in health care facilities
Dr. Vidushi Sharma
www.suvieye.com

14. Stress and Burnout in Residents
 Inadequate hostel/quarter facilities
 Overburdening with work
 Non-conducive environment for
clinical training and studies
 Lack of guidance for future
 Financial troubles
Rajan P, Bellare B. Work related stress and its anticipated solutions
among post-graduate medical resident doctors: A cross-
sectional survey conducted at a tertiary municipal hospital in
Mumbai, India. Indian J Med Sci 2011;65:100-6
Dr. Vidushi Sharma
www.suvieye.com

15. Stress and Burnout in Residents
 Residency is a formative time when
schemata of patient relationships, work
habits and self-care are developed – too
disconnected to future lives in India
 ACGME (US) mandates competency in
professionalism and residents must
demonstrate “responsiveness to patient
needs that supersedes self-interest”
Dr. Vidushi Sharma
www.suvieye.com

16. Causes
 Can we reach this goal / practical
“responsiveness to patient needs that
supersedes self-interest”
 Tales of resident scuffles with patients
 Emotional detachment
 The idea that self-care is secondary is
pervasive, specially in media, and also
in academic medicine
Dr. Vidushi Sharma
www.suvieye.com

17. In India
 Burnout is an exhausted condition at
emotional level where person gives
up completely and feels no personal
attachment towards his profession
 Survey in Rajasthan – demanding
attitude of patient, time urgency,
regular need of developing new skills,
work-home imbalance, low paid
salaries, and rural postings
Dr. Vidushi, MD, FRCS
(Khanna R, Khanna R. Is medicine turning into unhappy
profession?. Indian J Occup Environ Med 2013;17:2-6)

18. Burnout
 Physician burnout is well defined in the
literature as a state of emotional exhaustion,
depersonalization, and decreased feelings of
personal accomplishment.
 Younger doctors and females more prone to
burnout (Rajasthan Survey)
 Satisfied physicians were male, over age 45,
and anesthesiologists, dermatologists, or
pediatric or surgical subspecialists. (US
report)
Dr. Vidushi Sharma
www.suvieye.com

19. Causes to be happy
 We have employability/ self-
employability for life (an increasingly
rare commodity these days)
 Still enjoy high status, though not
unquestioned (as before)
 Majority of patients are still grateful,
but even the rare disgruntled ones
can make life hell (more intra-
profession support needed)
Dr. Vidushi Sharma
www.suvieye.com

20. Solutions
 Communication and interpersonal
skills to keep patients satisfied or at
least not get antagnistic
 Physician support groups – not CMEs
to show your clout – but actual, deep
and compassionate understanding
and support – smaller & friendlier
 If needed, learn to say No to requests
on your time and declare your limits
Dr. Vidushi Sharma
www.suvieye.com

21. Solutions
 Delegate – Nurse Practitioners and
Physician Assistants – Support staff,
Counselors for (repeated) explanations
 Can’t delegate core work
 Difficult patient panels – empathy
 Communication – about limitations
 The usual – exercise, family time,
recreation and relaxation
Dr. Vidushi Sharma
www.suvieye.com

22. Solutions
 Sort out the problems within the
profession to earn public trust
 Facing constantly changing reality is a
necessary part of growing up
 Honesty is the key to making all this
less uncomfortable
 Remember a physician’s greatest joy
is the patient relationship.
Dr. Vidushi Sharma
www.suvieye.com

23. So….
 There is definitely cause for concern
 Medicine as a profession has not kept
pace with many others vis-à-vis all
round satisfaction and balanced life
 Demands on doctors’ time and
emergencies definitely take a toll
 Doctor’s desires have changed too as
with the rest of the society – need
time for rest and recreation
Dr. Vidushi Sharma
www.suvieye.com

24. Solutions
 Doctors need to realize that many of
the problems they face are rampant
in India – aggressive, demanding
consumers, competition, long working
hours, poor infrastructure
 Some of the problems are inherent to
the profession like emergency calls
 Difficult to escape public scrutiny as
the largest dealing with public
Dr. Vidushi Sharma
www.suvieye.com

25. Solutions
 Need to learn team-work and evolve
methods to share the burden of
emergency calls, leave cover etc.
 Solo practitioners less common and
even they need to invest in good
quality support staff
 Form support groups and stand up for
our colleagues in need and also
ensure to clean up our own act
Dr. Vidushi Sharma
www.suvieye.com

26. Solution
 Patients need to realize that doctors
have a life and family too
 Compensation often doesn't make up
for the hours and stress
 Doctors not to blame for lack of
resources
 Sickness & death are part of life,
medical science is amazing, not magic
Dr. Vidushi Sharma
www.suvieye.com

27. Conclusions
 Lots of gadgets to save time today,
yet we are far more busy than we
were 30-40 years ago
 Similarly, technological advances,
better results, more money and yet
unhappier doctors and patients
 “We are never so happy nor so
unhappy as we imagine”
Dr. Vidushi Sharma
www.suvieye.com

28. IMA Doctor’s Day 2014
Doctors Today– Happy or Unhappy?
Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK)
SuVi Eye Hospital & Research Centre,
Kota, Rajasthan, India
E-mail:suvieye@gmail.com