Violence, overwork, Mismanagement of patients, non-availability of medicines, recruitment issues: IHBAS Doctors to go on strike, warn of complete shutdown

New Delhi: The resident doctors belonging to the Delhi-based Institute of Human Behaviour and Allied Sciences (IHBAS) have given a call for strike from tomorrow onwards while urging the authorities to address the critical concerns for patients and resident doctors at the institute.

Writing to the Director of IHBAS, the Resident Doctors Association (RDA) of the institute has pointed out several problems faced by the resident doctors and the patients including the problems faced by resident doctors during emergency duties, OPD mismanagement of patients, non-availability of essential and basic medicines, inconsistency in ad-hoc non-academic JR and SR recruitment and their salaries etc.

From tomorrow onwards, the resident doctors have decided to withdraw from OPD and ward services. However, the emergency and ICU services will continue. However, if the concerns remain unanswered, the doctors have decided to withdraw from the emergency services as well from September 01, 2023.

"We, the resident doctors of IHBAS, Delhi, are committed to delivering the best possible patient care. However, the current situation is untenable for effective care delivery, thereby compelling as to take action. Regrettably, in the absence of concrete responses and positive developments from the administration, we have no choice but to withdraw from OPD and ward services starting August 29th, 2023. Emergency and ICU services will continue. Should our concerns continue to go unanswered, we will proceed to withdraw from emergency services from September 1st, 2023," the letter directed to the Director of IHBAS mentioned.

"We humbly request your immediate intervention and resolution of these pressing issues, which will not only restore effective patient care but also safeguard the mental and physical well-being of our dedicated resident doctors," it further added.

In the letter, the resident doctors pointed out how despite their collective efforts, the challenges that the patient and resident doctors face remain unresolved. "The unfortunate result is an ongoing situation where patients suffer, and the resident doctors work tirelessly amidst conditions that hardly befit a healthcare institution of IHBAS's stature. It is with a heavy heart that we write this letter as a reminder of our concems, seeking your immediate intervention and action," mentioned the letter.

Problems faced by Resident Doctors during Emergency Duties: 

Referring to the problems that the resident doctors face during emergency duties, the letter pointed out, "The mismanagement of patient inflow within the emergency department has further exacerbated an already dire situation. As a result, the department struggles to adequately manage and provide necessary counseling to patients and their families. The prolonged waiting times have led to heightened agitation among patients and their relatives. Regrettably, verbal assaults and threats have become a daily occurrence, with past instances of physical assault heightening concems for the safety of all involved."

The letter further referred to the consistent influx of non-neurological and non-psychiatric cases, including those requiring multi-specialty care from other government hospitals and pointed out how it places an undue burden on the specialized neurology and psychiatry emergency services.

"This inevitably compromises efficient patient care, stretching the capacity of our already overworked resident doctors and paramedical staff beyond their limits," the doctors pointed out in the letter and claimed that the ongoing situation jeopardizes the physical and mental well-being of our medical personnel.

Another concern that the doctors raised was the handling of medico-legal and brought-dead cases that regularly present themselves at the IHBAS SOF in neurology and psychiatry. They pointed out that the absence of a designated Casualty Medical Officer has created a gap in efficient management. This results in a situation where on-call senior residents are left with the task of managing these cases alongside their emergency responsibilities.

"In light of these challenges, we strongly propose the creation of a dedicated medical team comprising doctors, nursing staff, and para-medical personnel, overseen by a Casualty Medical Officer. Such a team could serve as the primary point of contact for patients, streamlining their categorization and routing to the respective departments as necessary. This approach would also address brought-dead cases and medico-legal cases more effectively," mentioned the letter.

OPD Mismanagement of Patients: 

The doctors pointed out that the unique nature of neurology as a super-specialty field necessitates a system where patients are initially seen by MBBS-qualified doctors before being referred to neurology. Unlike general medicine, proper history-taking and patient examination in neurology require dedicated time.

However, they pointed out that the direct influx of patients into the Neurology OPD strains their limited resources and negatively impacts the allocation of time and attention for complex neurological cases.

"To mitigate this issue, we propose the establishment of a screening OPD led by a Senior Resident in the Medicine department, staffed by MBBS-qualified doctors. This would allow efficient management of non-neurological cases and straightforward issues like tension-type headaches. Consequently, our primary neurological cases would receive the specialized attention they deserve, enhancing the overall quality of care," the letter pointed out.

The doctors referred to the practices at other tertiary govemment hospitals with neurology departments, such as AIIMS Delhi, GB Pant Hospital, RML Hospital, Safdarjung Hospital, SGPGI Lucknow, and NIMHANS Bangalore. These institutions employ strategies such as referral systems, screening OPDs, or limitations on the number of cases per day to optimize patient care, they mentioned.

"Given the dedicated focus of IHBAS on neuropsychiatry, the lack of patient screening in both OPD and SOF is resulting in an unnecessary burden on resident doctors. This inefficiency adversely affects patient care and the mental and physical health of our committed resident doctors. In light of these cumulative challenges, we earnestly urge you to prioritize the resolution of these pressing issues. The escalating workload, coupled with the consistent verbal abuses and threats from patients' relatives due to extended waiting times and essential drug unavailability, necessitates immediate attention," read the letter.

Non-availability of essential and basic medicines: 

"The extended unavailability of essential medications including Tetrabenazine. Olanzapine. Aripiprazole, Clomipramine, Lithium, Botulinum injection. Levetiracetam Injection, IVIG. Antibiotics, Interferon, as well as fundamental medical supplies such as gloves, syringes, and ECG paper rolls in both the OPD and SOF has significantly compromised patient management. This scarcity not only disrupts patient care but also leads to unfortunate confrontations between patients and medical staff due to the lack of medicines and basic supplies," mentioned the letter.

"Furthermore, the inactive IHBAS account, catering to underprivileged patients who do not meet the criteria for the OAK scheme, has further hindered patient care by impeding access to radiological and other vital investigations," it further added.

Inconsistencies in Adhoc Non-academic JR and SR Recruitment and their salaries: 

In the letter, the resident doctors referred to the ongoing delays in recruiting non-academic Junior and Senior Residents coupled with inconsistencies in extending their contracts and processing salaries, are undermining the efficient functioning of the institution.

"These prolonged administrative issues lead to a shortage of medical staff, thereby straining the capacity of working doctors, affecting their mental and physical well-being, and ultimately impeding patient care. Moreover, the majority of non-academic resident doctors recruited on an ad-hoc basis are grappling with pending or partially paid salaries, creating additional stress," they pointed out.

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