From the experts: is your doctor healthy enough?
'So, Doc, before you use that scalpel on me, how's your health?' It's a valid question for patients to ask, writes Dr Krishnan Ganapathy
A patient who is about to be wheeled into the operating theatre looks up at the doctor and says: "Hi, Doc, as per National Accreditation Directives and the Joint Commission International, may I review your current medical records, any medications you are taking, and the pre-op assessment for your fitness to operate on me? Also, I hope there were no tiffs at home or at work. All the best."
This could happen in the future. Several years ago, in a study carried out in the All India Institute of Medical Sciences' neurosurgery department in New Delhi, scientists monitored each neurosurgeon's pulse rate, electrocardiogram activity (ECG) and blood pressure while they were operating, and correlated the data with the actual surgical steps in different procedures.
It was observed that the pulse rate and blood pressure of the primary surgeon sometimes reached more than 200 beats per minute. Transient changes in the surgeon's ECG were occasionally recorded. These changes occurred in healthy neurosurgeons of varying levels of experience.
The implications of this are twofold. One is a concern for the surgeon's health, especially if she or he is on medication. The second concern is this physical and emotional stress will have a bearing on the decision-making process, and may ultimately influence the surgical outcome.
When the risk in a procedure is computed, the location and nature of the tumour, patient's age, the presence or absence of diabetes, hypertension, renal status, previous myocardial infarction and medication are all taken into account.
But what about the surgeon's weight? Should it be considered among "comorbid medical conditions"? What about their emotional status?
People forget that doctors are often under stress. It is assumed that they are superhuman, always on call, and familiar with all science and technology. They are expected to be a repository of information and mental athletes who will always take the best, cost-effective decision in the patient's interests.
Medicine is a physically and mentally demanding profession. It entails long hours, night calls, and the treatment of serious and critically ill patients. Doctors deal with terminally ill patients and their relatives. They must also try to keep abreast of recent developments. All this contributes to the pressure.
Doctors have to be good at recalling knowledge, have good judgment and problem-solving abilities. Fine-motor skills, co-ordination and an ability to work for prolonged periods, handling emergencies and complications, are all prerequisites. Further compounding the problem are conflicting time demands, professional responsibilities, systems in which resources are often deficient, and threats of legal action.
The incidence of chronic disease and mental health problems among doctors is no different to that of the general population. In the West, published literature indicates depression, anxiety and drug abuse are actually higher. Does this affect patients?
Doctors do not want patients or colleagues to know that they are not healthy. A "sick" doctor treating a patient would normally be unacceptable. It could have an impact on the doctor's career development. Western literature describes this as "the conspiracy of silence".
The European Working Time Directive allows doctors to work only 50 hours a week. This supposedly provides them with quality time for themselves and gives them enough compulsory rest periods. It is yet to be documented whether this provision for the doctor's mental and physical well-being actually translates into a better outcome for the patient.
There is an acute shortage of doctors, so is this practical, desirable or even relevant? Most doctors are conscientious and aware of the repercussions of managing patients in situations in which their own judgment could be impaired, or their skills compromised.
Wisdom is knowing one's limitations. As a judge excuses himself from certain cases, doctors need to do likewise.
Dr Krishnan Ganapathy is a neurosurgeon and telemedicine specialist
This article first appeared in the British Medical Journal Blog