The untimely death of a 24-year-old postgraduate (PG) doctor in Chennai gave his peers a major jolt. M Kannan, who was in the first year of his PG residency, took his own life on Monday allegedly due to work stress and mental harassment at the workplace. His death prompted his peers as well as the medical community to speak about their mental wellbeing.
One of the major concerns that arose immediately after Kannan’s death was how PG residents in government medical college hospitals in Tamil Nadu are backed into a corner when it comes to mental health. Systemic harassment and the stigma over taking personal time off work due to mental health issues make lives more difficult for these PG residents; not to mention the hectic work schedule and the trauma they undergo during the course of their workday. Add to this the unorganised duty roster during the COVID-19 pandemic, scheduled based on the manpower required to manage wards in major district hospitals. This combination of workload and stress has driven young professionals to the brink.
The lack of the availability of a formal mental health support mechanism within the system only points to a deeper rot in the healthcare education system in the state.
It is a known fact within the medical community that doctors who are on their Compulsory Rotatory Residential Internship (CRRI), which is the last year of MBBS course and in the first year of PG residency, are usually overworked. It is not unusual for them to be posted on shifts that last at least 36 hours at a stretch in the hospitals; COVID-19 duty has only made it a little more complicated.
“To be honest, COVID-19 duty is much easier for us when compared to normal duty. We have seen worse during our normal duty days,” says Dr Arun*, a PG resident in a government medical college in Chennai. COVID-19 duty in hospitals across the state stretches at least six hours at any point in time. The repetition of the duty time depends on the strength of doctors available in the hospital.
Arun adds that this trend of dumping a major share of workload on the CRRIs and first-year PG residents is considered tradition. “It is an unsaid rule or a norm that the first-year PGs undergo all this. Some justify and normalise it by saying that this is what makes us tough,” Arun adds.
While most doctors learn to compartmentalise different aspects of work and personal life during the course of their study, it is not reasonable to expect everybody to have the same capacity to deal with the pressures or to have a similar support system to lean on, when the going gets tough.
The present system of COVID-19 duty for PG residents in government hospitals has evoked mixed responses from the community.
“I feel COVID-19 duty is easier because the duty time rarely goes beyond six hours in a roster and we are posted only for seven days at a stretch on this schedule. The only problem seems to be working in a hot environment in double-layered personal protection equipment (PPE) kit,” Arun points out.
In Chennai, doctors on COVID-19 duty are given seven days time to quarantine themselves after a work shift of seven days. They are accommodated in a hotel and all their needs are taken care of.
However, having to isolate themselves for seven days frequently during the course of their work can lead to stress, says Dr Vijaya*, an assistant professor in a government medical college in Tamil Nadu who completed her PG residency in Psychiatry.
“I am used to being around people all the time and for me, having to spend seven days in a hotel without meeting my family in person is stressful. I am sure there are many PG residents like me, who are going through this,” she says.
She adds that a buildup of this stress also might cause one to take impulsive decisions at some point in time.
While many PG residents on duty give a serious thought about seeking help, most of them hold themselves back considering the stigma associated with it.
While Dr Arun is bold enough to pop into the in-house psychiatry department in his college when he feels overwhelmed, Dr Ravi* usually tries to sneak out to another government college in the city to get mental health support.
A PG resident in Government Stanley Medical College Hospital, Dr Ravi says that it is hard for him to deal with the possible judgmental looks and the treatment from his peers and others if they see him emerging out of the psychiatry department of his college.
Dr Ronald Roy, a consultant psychiatrist from Trichy, says that while doctors like Arun have the courage to approach the in-house psychiatry department for help, not everyone has it in them to do that.
“While there are certain advantages to being trained with a certain rigour, it is equally important to have adequate support mechanisms for those who need it while working in the system. People are different and they come from different backgrounds. Hence, it is important to have a mechanism to cater to the lowest possible denominator in the system,” he explains.
“Generally suicides are preceded by an impulse. It can be the urge to talk to someone or make a phone call or write something down etc. When the person is provided with this intervention just before they take the extreme step, the chances are high that they might step back and reconsider their decision,” explains Ronald Roy.
Slamming the medical education system in Tamil Nadu, Ronald Roy says that just because the senior professionals did not have a mental health support system at their workplace when they were working as a resident, it doesn’t mean it shouldn’t be set up now. “Senior doctors in the system are not empathising with this idea. They are thinking that since they crossed a similar set-up, it is only reasonable that their juniors also go through the same grind,” he points out.
Adding that while overhauling the education system might be a long shot given the various intricacies associated with it, Ronald Roy says, “Set up an exclusive helpline only for PG residents who are at the COVID-19 frontline, so that students can use without having to think about the stigma or the repercussions of seeking help. This can be made possible even now and does not need a big overhaul.”
If setting up an exclusive helpline is a challenging task for the Department of Health and Family Welfare, Ravi suggests, “They can ask us to fill out forms once every six months or so to check where we stand in terms of mental health and then take it up from there. This is feasible.”
Speaking to TNM, J Radhakrishnan, Principal Secretary (Health) of Tamil Nadu, says that doing away with the stigma associated with seeking help for mental health issues is the first step towards addressing the problem. “PG residents, senior and junior nurses are all in stress. But in any kind of set-up, it is important for the students to come forward and talk about their problems without holding themselves back. So the first and the most crucial step is to break the taboo around it,” he points out.
“It is also important to bring in a systemic change in this aspect and I will take it up with the Director of Medical Education (DME),” he adds.
(*Names changed on request)