Friday, August 2, 2019

Physician suicide is a public health crisis: Suicidal ideation should not be ignored (Part 3)

Dr KK Aggarwal

A 30-year-old resident doctor of Safdarjung Hospital here was found dead on Tuesday morning in his room at a rented accommodation in southeast Delhi's Lajpat Nagar area, police said, as reported in Times of India. He was found lying on a mattress with an intravenous drip in his arm. The victim was rushed to a hospital, where he was declared brought dead. He was pursuing a post-graduation in anesthesia from Safdarjung Hospital.

Doctors have the highest suicide rate among all the professions. Suicides among doctors are increasing at an alarming rate in India. Doctors are about 1.87 times more likely to commit suicide compared to those in other areas of work. This is indicative of the rising levels of frustration and stress among doctors.

Several factors have been cited as reasons for this - unregulated duty hours, punishing work load, poor working and living conditions. Last month, resident doctors across India joined hands to start a unique campaign called – “I am overworked” to highlight these very issues.

Doctors face media trial for any medical error that may have occurred, even though inadvertently. As a result, they continue to suffer the ignominy or personal public humiliation in silence, sometimes for the rest of their lives.

In the last two days, we have discussed what our ancient texts have to say about suicidal ideation.

Sri Ramcharitmanas has described 14 traits, which if present, makes a person like dead even if he or she is alive in the Angad-Ravan conversation (samvad).

These 14 traits or the types of indirect death are: Vama Margi (Kaul or the one who follows the path of tantra); Kamuk (full of Vasanas]; Krapan (Maha Kanjoos); Vimud (Murkha); Dradra (poor); Ajasi (Badnami); old (no intellect left); ever sick; Santata Krodhi (always angry); Vishnu Vimukh (abuses Vishnu); Shrutu and Sant Virodhi (opposes Vedas); Tanu Poshak (Swartha) and adh Khani (the one who earns by sins)

जौं अस करौं तदपि  बड़ाई। 
मुएहि बधें नहिं कछु मनुसाई॥
कौल कामबस कृपिन बिमूढ़ा। 
अति दरिद्र अजसी अति बूढ़ा॥1 

भावार्थ:- यदि ऐसा करूँतो भी इसमें कोई बड़ाई नहीं है। मरे हुए को मारने में कुछ भी पुरुषत्व (बहादुरीनहीं है। वाममार्गीकामीकंजूसअत्यंत मूढ़अति दरिद्र, बदनाम, बहुत बूढ़ा,1

In Vidura Niti, a dialogue (samvad) between Vidura and Dhritarashtra enlightens us on the reasons for insomnia or sleeplessness.

King Dhritarashtra said: “O Vidura, Sanjaya has come back. He has gone away after rebuking me. Tomorrow he will deliver, in the midst of the court, Ajatashatru’s message. I have not been able today to ascertain what the message is of the Kuru hero. Therefore, my body is burning, and that has produced sleeplessness.  Tell us what may be good for a person that is sleepless and burning.”

“My body is burning, and that has produced sleeplessness”; this statement is a classical depiction of the state of anxiety and stress and sleeplessness arising out of it.

Vidura then goes on to enumerate the five basic reasons for insomnia. He said: “Sleeplessness overtakes thief, a lustful person, him that has lost all his wealth, him that has failed to achieve success, and him also that is weak and has been attacked by a strong person.”

According to Chapter 2 of the Bhagawad Gita, non-fulfillment of desire leads to anger, which can be 'anger in' (suppressive) or 'anger out'(expressive). Both are dangerous. 'Anger out' leads to aggression and 'anger in' leads to suppression of emotions; if not expressed or managed, then ‘anger-in’ leads to depression, anxiety, feelings of despondency, guilt and then to suicidal ideation.

Of the various reasons enumerated above, the following factors come to light concerning suicides among doctors. They are: dishonor or public humiliation due to any allegation, failure to achieve success or a person who is weak and has been attacked by a strong person.

Suicide among doctors has become a public health crisis and needs urgent attention to manage it.

The concerns and apprehensions of students and healthcare professionals alike should be addressed. The signs of depression and suicidal ideation should be detected right in the early stages, if suicides are to be prevented. 

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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