Proposing changes to the On-Call duty at IGMH.
The current situation:
All clinical and allied departments at IGMH have at least one person on an On-Call duty at all times. The current role of this person is to attend to hospital if called for urgent work that needs his or her expertise. As a Pediatrician, I would therefore be called in - on my On-Call day - to attend to emergencies or urgent situations that the in-house Pediatric Medical Officer decides requires my expertise. I could therefore, open to interpretation, stay at home expecting to be called in only when a situation requires my presence.
The problem:
In few clinical areas, and perhaps in some allied fields too, the need to call in the On-Call doctor or technician is an infrequent event. This maybe true for fields like Dermatology (skin specialist) and Clinical Pathology. However, for many clinical speciality fields, like Internal Medicine, Pediatrics, Obstetrics, Surgery; just to mention a few, the need to call in the On-Call specialist maybe more frequent and more importantly Urgent!
Just consider these situations.
- If a woman needs to have her baby delivered urgently by C-Section, say for Fetal Distress (which suggests that fetal well being is being compromised), an Obstetrician and a Pediatrician needs to be available on the spot almost immediately.
- If a newborn baby, who prior to being born had not shown any sign of fetal compromise, does not initiate breathing spontaneously or even following the initial steps of care; a Pediatricians presence could mean the difference between survival and death.
- If an adult patient in ICU has a Cardiac Arrest; the presence of an Anaesthetists and/or a Physician could help manage the situation promptly and with expertise the situation demands!
Some may argue that in these situations the first emergency care could be provided by the in-house junior level Medical Officers until the Specialist could arrive at the site. Perhaps, considering the clinical expertise demonstrated by few of the junior Medical Officer, this may be valid in some situations, but from experience I find that the situation is not always that. Others may, on the other hand, argue that even if the specialist was available certain situations may not be reversed. Very true. There is a limit to what anyone can humanly do and some clinical condition are not reversed or correct even with best of efforts. BUT the best effort must be put in!
What I propose:
I believe it is only right for an On-Call person to be available around the clock, within the hospital premises to respond urgently to those situations that demand prompt attention.
Factor to consider in implementing this proposal:
- Willingness: First there must be willingness from those in the clinical fields and more importantly those in the administrative posts to get these changes to materialise. A strong political will would most definitely help too. Unfortunately a few individuals are quite comfortable with the way things work at present and this increased time at work would be challenged. I have little doubt that it would be.
- Facilities: At present, even if a doctor wishes to be in hospital for the duration of his On-Call duty, there is hardly any place to be in. While not immediately needed at the bedside or to attend an emergency it would be beneficial, to have a staff lounge or rest facility (toilets, shower facilities etc), within the hospital premises, where the duty doctor could stay. Then when the need arises the emergency could be promptly attended to.
- Pay issues: The current CSC practice of capping the overtime means that this extra time spent within the hospital would not be included in overtime payment. Being On-Call is a high demand, stressful duty for even the best of clinicians despite their decidedly calm appearance and confident aura. It would be much satisfying if the On-Call duties are rewarded with an extra allowance; especially if - as I propose - they have to stay in hospital for the duration of the duty.
- Meals: Many employees in other fields of work, where the working hours are long, get meal or food allowances. It would be appropriate to have such allowances especially for those who are On-Call.
- Length of On-Call: Being On-Call for 24 hour continuously is very challenging and could at times make a person physically and mentally exhausted to the extent of affecting his mental and physical capacity to perform effectively. It might therefore make the On-Call doctor or technician more productive in performance if the On-Call shift is shorter.
Do I really think this is possible?
I not only think it is possible, I think it is essential. Absolutely. However, I do foresee a great deal of opposition to this proposal, especially from some clinicians. At least initially. The inertia is expected. Change is always a challenge. But good change, one that benefits the purpose of our profession, whether difficult or not, must happen. Getting the rest of the work environment to be supportive of this change is however absolutely essential to make this work.
PS: This was one of the issues which a Group of Concerned Doctors proposed to the senior level management few years ago and proposed yet again in a more recent meeting.
The proposal makes very valid points. The priority should be given for the needs of the patients, together with just compensation for the clinicians. Capping overtime is very bad and a disincentive to work.
I also sometimes wonder, how come doctors are made to work continuous long hours where they have to make life or death decisions in split seconds.
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