{"id":24536,"date":"2013-02-15T15:38:42","date_gmt":"2013-02-15T14:38:42","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=24536"},"modified":"2013-02-16T10:48:22","modified_gmt":"2013-02-16T09:48:22","slug":"krishnan-ganapathy-is-your-doctor-healthy-enough","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2013\/02\/15\/krishnan-ganapathy-is-your-doctor-healthy-enough\/","title":{"rendered":"Krishnan Ganapathy: Is your doctor healthy enough?"},"content":{"rendered":"

\"Ganapathy<\/a>Several years ago in a study carried out at the Dept of Neurosurgery in AIIMS\u00a0 New Delhi, the authors continuously monitored the pulse rate, blood pressure and ECG of neurosurgeons while they were operating, and correlated it with the actual surgical steps in different procedures.<\/p>\n

It was observed\u00a0 that the pulse rate and blood pressure of the primary\u00a0 surgeon sometimes reached up to\u00a0200+ . Transient changes in the surgeon\u2019s\u00a0 ECG were occasionally recorded. These changes occurred in\u00a0 healthy neurosurgeons of varying levels of experience .<\/p>\n

The implications of this are twofold. One is concern for the surgeon\u2019s health, particularly if s\/he was already on medication. The second is, will this\u00a0physical and emotional stress\u00a0 have a bearing on the decision making process and\u00a0will this ultimately influence the patient\u2019s health outcome?<\/p>\n

While computing the risk of a surgical procedure, the location and nature\u00a0 of the tumour, the patient\u2019s age, presence or absence of diabetes, hypertension, renal status, previous myocardial infarction,\u00a0 medication being taken, etc are all taken into account.<\/p>\n

Should\u00a0 weight\u00a0 be given to the presence of “comorbid medical conditions” which\u00a0\u00a0 the surgeon\u00a0 may have? What about the\u00a0 emotional status of the surgeon during the surgery?\u00a0 Today’s “consumer,” who\u00a0always wants\u00a0better than the best,\u00a0forgets that doctors are often under stress. It is assumed that doctors are\u00a0 superhumans, always on call, familiar and adept with tomorrow\u2019s science and technology, a Mr Know it All, a repository of information, who will always\u00a0 take the best,cost effective decision only\u00a0 in the patient\u2019s interests.<\/p>\n

Do we ever ponder the doctor\u2019s\u00a0 frailties, his physical and mental health, when his cortex quickly reviews an algorithm with all the patient\u2019s data. Medicine is physically and mentally a demanding profession. Long working hours, night calls, treating serious and critically ill patients, dealing with terminally ill patients and their relatives, keeping abreast of recent developments, striving to fulfil personal development plans and aiming to achieve higher goals; all\u00a0\u00a0contribute to the pressure. Obsessive, conscientious personalities do not help.\u00a0 Healthcare\u00a0 needs well- honed knowledge recall, judgement and problem solving abilities. Precise motor skills, coordination, and an ability to work for prolonged periods, handling\u00a0 emergencies and unexpected complications are a prerequisite. Conflicting time demands,\u00a0 professional responsibility, often in systems where physical and social resources are deficient and\u00a0 threats of medico legal action further compound the problem. Often, doctors have no power to alter the conditions under which they work.<\/p>\n

The incidence of chronic diseases and mental health problems among doctors\u00a0 is no different than in the general population. In the west,\u00a0 published literature\u00a0 indicates that depression, anxiety and\u00a0 drug abuse are\u00a0 actually\u00a0 higher.\u00a0 Will this have a repercussion on\u00a0 patients treated? Doctors do not want\u00a0patients\u00a0 or colleagues to know that they are not healthy.\u00a0 A\u00a0“sick” doctor treating a patient would\u00a0 normally be “unacceptable” for the patient.\u00a0There could be a direct immediate impact on the doctor\u2019s career development, Western literature describes this as “the conspiracy of silence.”<\/p>\n

The European Working Time Directive (EWTD) mandates\u00a0 doctors to work\u00a0for only 50\u00a0 hours a week . This supposedly provides quality time for themselves and\u00a0their families, sufficient compulsory\u00a0rest periods, and reduces working\u00a0 at unsocial hours.\u00a0 It is yet to be documented whether this provsion for\u00a0 the doctor’s mental and physical wellbeing actually translates into a better health outcome\u00a0 for the patient.<\/p>\n

With an acute shortage of doctors in India, is this practical,\u00a0 desirable or even relevant? Doctors\u00a0 are generally conscientious, and fully aware of the repercussions of managing patients in situations where their own judgement could be impaired\u00a0or\u00a0their motor skills compromised.\u00a0 Wisdom is an awareness of one\u2019s limitations. As a judge excuses himself from participating in certain\u00a0 cases, doctors need to do likewise.<\/p>\n

Epilogue: May\u00a0 26 2015<\/strong><\/p>\n

A patient is about to be wheeled into the operating theatre and says:\u00a0“Hi doc, as per National Accreditation Directives and the Joint Commission International, can I review\u00a0 your\u00a0 current medical records , medications you are on and pre op assessment for your fitness to operate on me? I\u00a0hope there were no tiffs\u00a0 at home or at work \u2013 all the best!<\/p>\n

Krishnan Ganapathy<\/strong> is\u00a0a\u00a0 neurosurgeon and\u00a0 telemedicine specialist was a\u00a0 former Secretary and Past President of the Neurological Society of India . He was also Secretary General of the Asian Australasian Society of Neurological Surgery. A Past President of the Telemedicine Society of India, he is currently President of the Indian Society of Stereotactic and Functional Neurosurgery See www.kganapathy.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Several years ago in a study carried out at the Dept of Neurosurgery in AIIMS\u00a0 New Delhi, the authors continuously monitored the pulse rate, blood pressure and ECG of neurosurgeons while they were operating, and correlated it with the actual surgical steps in different procedures. It was observed\u00a0 that the pulse rate and blood pressure […]<\/p>\n

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