ISLAMABAD(National Times)- The Islamabad High Court (IHC) on Tuesday directed the Pakistan Medical and Dental Council (PMDC) to examine the issue of excessive working hours for doctors and place its recommendations before the government, observing that requiring doctors to work up to 102 hours a week was inhuman.
Justice Raja Inaam Ameen Minhas heard at length a petition concerning the working hours of doctors and, with the consent of the parties, converted the writ petition into a representation before the PMDC.
The court directed the PMDC to decide the representation and place its recommendations before the federal and provincial governments for appropriate action.
The issue assumes significance as comments submitted by the College of Physicians and Surgeons Pakistan (CPSP) before the court have highlighted the serious consequences of prolonged duty hours for both doctors and patients.
According to the CPSP material placed before the court, after approximately 18 hours of work, doctors develop psychomotor dysfunction equivalent to a blood alcohol level of 0.05. At 24 hours of continuous duty, the impairment was stated to be equivalent to a blood alcohol level of 0.1. The document questioned the safety of expecting an exhausted doctor to make critical decisions or perform medical procedures after such prolonged duty.
The CPSP comments also state that tired doctors make more mistakes than doctors who are fresh, alert and properly supervised. The stated objective, according to the document, should therefore be to reduce working hours to a level that allows for a healthy work-life balance for staff and ensures safe care for patients.
The material submitted before the court refers to international practices governing doctors’ working hours. It says the European Working Time Directive provides for a maximum average working week of 48 hours, at least 11 consecutive hours of daily rest and minimum weekly rest periods.
In the US, the document notes a maximum of 80 duty hours per week, averaged over four weeks, along with a minimum of one day free of patient-care responsibilities in seven days and limits on continuous duty.
The CPSP document further states that in India, following directions from the Supreme Court, junior residents should ordinarily work 48 hours a week and not more than 12 hours at a stretch, while a total of 48 hours per week has been prescribed.
In Iran, the Iranian Council for Graduate Medical Education has determined a minimum of 50 hours per week, with restrictions on night duties.
The CPSP itself has recommended that residency programmes require a minimum of 48 duty hours per week for clinical specialties, excluding emergency duties and Sundays on call.
It also states that a trainee should not be required to undertake more than two night or emergency duties of 12 hours each in a week, while trainees assigned to emergency departments should not work shifts exceeding 12 hours.
Interestingly, the CPSP clarified in its para-wise comments that it does not employ doctors and, therefore, does not prescribe their working hours, which fall within the domain of the respective provincial governments or private organisations. It said its role relates to the training programmes conducted at accredited institutions.
The document also notes that there is considerable variation in the implementation of limits on doctors’ actual working hours, working conditions and the level of supervision available to young doctors. It points out that reducing the duty hours of resident doctors would require health facilities to arrange additional doctors to cover the workload.
It further observes that fatigue does not depend solely on the number of hours worked but also on environmental conditions. The CPSP material refers to hot weather, non-air-conditioned workplaces and other environmental factors that may aggravate physical and mental fatigue.
