Courtesy:Expressindia » Story
Vidya Krishnan

New Delhi, September 11 Can our hospitals do without interns at night? Is it a learning experience? Newsline takes a look

When Safdarjang Hospital suddenly declared that interns would not be allowed to work night shifts, eyebrows were raised.

As Newsline reported on August 19, a hospital circular said this was done was humanitarian grounds — to save the interns from working long hours. The hospital, instead, was hiring more resident doctors.

The decision drew widespread criticism — for owing to a skeletal staff at nights, the shift offers the most learning opportunities to interns. While the Safdarjung authorities defended their decision, Newsline went to two other hospitals — GTB and LNJP — to observe the training patterns and see how the city’s doctors learn their skills.

Guru Tegh Bahadur Hospital
(Affiliated college: University College of Medical Sciences)
The interns report for duty at 9 am. Every alternative day brings a demanding 26-hour shift — from 9 am to noon the next day. And every intern gets three such shifts in a week.

In the Department of Surgery, the morning rounds on Sunday took almost an hour. Afterwards, the interns spent nearly six hours dressing the wounds of patients. Others collected blood and urine samples, filled investigative forms and fetched reports.

During the afternoon, a 60-year-old patient died due to hypotension. Only an intern was on duty at the time.

While such cases are not unusual, night is still the crunch time. “Once evening sets in, we wait around and keep hoping the shift goes by uneventfully,” said Istha, one of the interns.

The morning after, they have to update the postgrads about the patients’ condition and are relieved by noon the next day, she added.

But while the rounds were going on in the surgery ward, the Department of Obstetrics and Gynaecology spread over three floors with close to 150 patients — was completely unmanned. The nearest doctors were stationed in the Central Labour Room (CLR). “An intern and a senior resident doctor are in the CLR. If there is an emergency we call for them,” said a nurse outside the gynaecology ward.

The GTB Hospital has 100 interns — who shoulder the responsibility of PG students and senior resident doctors.

While students maintain that senior consultants, residents and post-graduate students leave the wards by 4 pm, Medical Superintendent Dr PC Dikshit denied the allegation.

“The interns are never left without guidance. We prepare rosters and teach interns under proper supervision. I am in constant contact with the faculty members and no one has brought up this matter,” said Dr Dikshit, insisting that the hospital was following all guidelines provided by Medical Council of India for medical education.

Lok Nayak Jai Prakash Hospital
(Affiliated college: Maulana Azad Medical College)
The stark difference between interns in GTB and LNJP is apparent when you venture into the Nescafe canteen in the premises.

At 3 am, students are sitting around, sipping coffee, struggling to stay awake.

Reason: There is hardly any work.

Unlike GTB hospital, the “night shift” does not mean being marooned with a ward full of patients and no superviser — rather, it involves doubling up as Nursing Orderlies, fetching test reports and X-rays.

“We usually run errands and get very little exposure to real patient care,” said Mayank Poddar, one of the interns.

“Blood sampling and BP recording is part of the learning process, but we hardly get to learn more. If anyone wants to set up private practice after completing MBBS, he would have no knowledge of patient care. All that we know is theoretical,” said Abhishek Bansal, who is in the ninth month of his internship.

After reporting to duty at 8 am, finishing the morning rounds in the Department of Obstetrics and Gynaecology, Bansal conducted blood pressure charting for 16 patients, fetched blood sample reports of six patients and waited out the rest of the shift.

The silver lining is the OPD duty twice a week, where they do get some exposure, he added. “But in the wards, little is explained to us. Sometimes duty stretches for 36 hours but at the end of it, we learn very little,” added Poddar.

To make matters worse, there is no timetable. “The attendance marking is ad-hoc and we usually follow instructions from first year post-graduate students who man the wards,” Poddar said.

Frustrated by the teaching pattern, the interns — 180 of them — have approached the health department for intervention.

Dr Arun Agarwal, Dean, MAMC said: “Students have to do all kinds of work during internship. In your house you do all types of work and this is the same. Running errands for senior doctors is not the norm but a few students have complained about it,” he added.

Another sore point is the stipend. Students at MAMC get Rs 5,700 per month and had recently approached Delhi government’s Health Department asking for a raise. “The Central government has to decide these things and they cannot happen overnight,” said Dr Agarwal.

THE SCHEDULE
Rural posting: 3 months
Medicine dept: 2 months
Surgery, including Orthopaedics dept: 2 months
Obstetrics and Gynaecology dept: 2 months
Welfare Planning: 15 days
Paediatrics dept: 15 days
Ophthalmology dept: 15 days
Otorhinolaryngology dept: 15 days

Casualty: 1 month