Time to limit working hours for our stressed out doctors?

Judging from the statistics, the risk of doctors falling into legal problems has risen dramatically. 

Victims of suspected malpractice have loud complaints about doctors and say any wrong move during treatment can change their lives for the worse. In the eyes of many patients, doctors are often seen as aloof, passionless and often too busy to look carefully into each case.

But the truth is that doctors, particularly those at state hospitals, are overwhelmed with their workloads. 

Quality problems, incorrect decisions or wrong diagnoses are probably a result of long working hours. 

A foreign patient was upset when his doctor at a private hospital appeared reluctant to discuss his ailment. He switched to another private hospital, where the doctor was willing to answer his questions until he felt satisfied. 

Indeed, he was lucky to have got the chance for a long chat with a doctor. Most Thais have one to two minutes –particularly those who can’t afford pricey service charges at private hospitals – for each medical visit. Many complain that doctors at public hospitals spend too little time with patients. Is it true?

According to the Medical Council of Thailand, doctors at public hospitals have to perform about 180 million outpatient consultations a year. It estimated that in each shift in outpatients department, a doctor has to see 100-200 patients, leaving just a few minutes for each person. 

Government data shows there are 47,000 physicians in Thailand, but only 13,500 work at public hospitals. It is estimated that in 2015, 2,000 medical students will graduate. About 2,000 will be assigned to work at over 840 public hospitals nationwide under the Public Health Ministry’s care. Of these, some will pursue studies after completing their residency. Meanwhile, physicians’ permanent jobs need endorsement from the Civil Servant Commission, which can do that only on a yearly basis.

The World Health Organisation says Qatar has the highest ratio of doctors to patients of any country, at 7.7 per 1,000 population. That is higher than the 2.3 per 1,000 in Japan or 1.9 per 1,000 in Singapore and 1.2 per 1,000 in Malaysia. 

In Thailand, there are 0.4 doctors for every 1,000 patients. That’s the average rate. The proportion is lower in small provinces, as most doctors are in big cities, which have more private hospitals.

Medical Council secretary-general Ittaporn Khanacharoen says some countries have introduced a Working Time Directive, to limit the service hours each doctor has to perform each week, to ensure quality service. He believes this practice would be good here, particularly at public hospitals in the provinces, which have fewer doctors. 

Ideally, each doctor should see only 30 patients a day. This would allow quality time with patients and doctors to work on preventive care, to reduce ailments in areas they treat. 

Ittaporn acknowledged this could be done without depriving others’ rights to see doctors. 

He has a good point. Several doctors at public hospitals that I know often complain about their long work hours. 

Meanwhile, patients sent to the wards feel they have to wait too long. 

Few people know or want to acknowledge that some doctors have to work for up to 30 hours in a shift. With that long at work, it is difficult for any individual to keep perfect sense, let alone someone who has to take care of another’s health condition. 

Here is a story from a neurosurgeon working at a public hospital: On one day, he was scheduled to operate on four patients. After he completed his daily assignment, he learnt that another surgeon had taken sick leave. 

“I was assigned to take over his cases. What could I do? If I refused, saying I had done enough, what would happen to the four patients? They would have been dead by now,” he said.

Another heart surgeon said he had to be on call for seven nights in a row. Each morning in the week, he had to make rounds as usual.

While I admired his dedication, I could not help feeling concerned about the quality of his work. What if a patient died under his care? 

What if the diagnosis was wrong? Who would take responsibility?

Doctors are human. When they lack sleep or adequate rest, there is a risk their judgement might not be as sharp as usual. As their service directly affects the health of others, all relevant authorities should give serious attention to this issue.

The National Legislative Assembly should review the law concerning treatment liability. Given the increasing pressure on doctors, many must want to flee to private hospitals, which pay better and offer less work. In the end, without the work time limit, it is the general public who will suffer the consequences.

In the United Kingdom, the Working Time Directive stipulates that a doctor must serve no more than 56 hours a week and the longest shift must not exceed 14 hours. After four hours of work, doctors earn a break of at least 30 minutes. 

In the US, there is a similar directive for specialist doctors. 

Ittaporn is right to say such a directive would answer the quality issue. It remains to be seen how the council will ensure that the directive does not deprive others’ rights to get medical services from doctors. 

There have been complaints that the number of doctors is insufficient, leading to poor quality work. For decades, we have never been able to address both issues. If the directive can tackle the quality issue, it should be implemented.

Hopefully, we can deal with the quantity issue later. Public health bosses don’t need to focus on producing new doctors alone – they also need to get the public to take better care of their health.

The best scenario is that all people do their best to keep themselves in good health. This way, their need for medical care would be minimised. And when they really need medical help, they will get the full attention of quality doctors.