Doctors’ Day confession: The system is defeating its healers

By: Dr Fiaz Maqbool Fazili

On this Doctors’ Day, we salute the tireless, empathetic, and dedicated doctors who serve with integrity despite immense challenges.

In low- and middle-income State/Countries (LMICs) like ours, where futuristic opportunities are limited and resources stretched thin, the majority still uphold their oath—healing with heart, skill, and sacrifice. They persevere through long hours, insufficient infrastructure, and overwhelming patient loads  they still deliver with their best. Yet, behind the white coat often lies silent exhaustion and burnout.

Today, we honour not just their clinical excellence, but their unwavering spirit and humanity in the face of adversity. Their resilience is the backbone of our fragile healthcare system. As we pin roses on white coats this July first, Doctor’s Day, I confess we are celebrating a burnout system, too. Behind the ceremonial platitudes lies a truth we’ve normalized. Sadly, our healthcare system runs on the fatigue,exhausted minds and backs of its caregivers. Allow me to break the silence with reflections that invite debate and welcome critique.

Recent studies paint a grim picture of physician well-being in Kashmir,.79.8% of doctors at a Srinagar tertiary hospital exhibited clinical burnout post-COVID, with younger residents and female physicians at 2.3x higher risk due to dual caregiving roles. (Prevalence and Predictors of Burnout Among Healthcare Workers in Post-Conflict Kashmir: A Cross-Sectional Study, Journal of Clinical and Diagnostic Research (2022). A pan-India study found 45% emotional exhaustion and 66% depersonalization among medical practitioners, with Kashmir’s compounding stressors exacerbating these figures.

Critical faculty shortages plague institutions like SKIMS or GMCs, some of these operating at as low as 40% staffing capacity, acknowledged by none other than Honourable CM Omar Abdulla sahib, and Minister of Health Madam Sakina Yatoo at the annual function of SKIMs, promises made but partially fulfilled, forcing existing doctors to absorb unsustainable workloads. A growing healthcare crisis is being misunderstood. While some attribute doctor burnout to a modest 44-hour week after 9am-5pm with Saturdays half working day, residents often endure gruelling 30-hour shifts—akin to working under the influence, impairing critical judgment. Treating most of the times 50–60 patients daily in overcrowded OPDs is not a mark of dedication, but a systemic failure. Rushed diagnoses, 3-minute consultations, and unrealistic expectations compromise care quality. This isn’t sustainable medicine—it’s institutionalized neglect, falsely equating volume(quantity) with value(quality), while overlooking the cognitive and emotional toll on doctors and patients alike.

Calling 30-hour non-stop resident shifts a mere “duty rota” is a misleading euphemism. Working through sleepless nights isn’t just exhausting—it induces fatigue scientifically equivalent to a 0.1% blood alcohol level. At such an impairment, we wouldn’t allow a pilot to fly, yet healthcare systems permit doctors to make life-or-death decisions in this state. Would you trust a doctor—awake for 30 hours—treating your child or rushing through OPD queues in overcrowded, poorly equipped clinics?

Across Kashmir’s hospitals, this is the norm, doctors racing against time, giving barely three minutes per patient in cold/hot, unsanitary OPDs. Junior residents, cognitively impaired after marathon shifts, often return home on risky roads—fatigue making them vulnerable to accidents. This relentless cycle fuels a burnout epidemic, driven by structural neglect and urgently in need of reform.

Beyond the commonly cited reasons of extended working hours and patient overload, the deeper cause lies in the daily reality many doctors face—managing huge patient load amid chronic shortages of trained personnel, while striving to maintain meaningful doctor-patient relationships. This intense strain contributes to serious intellectual distress in nearly 45% of adult practitioners, with duties extending 13–16-hour shifts violating established global safety standards. WHO connections shift to 16 hours with 300% increase in medical errors.

Landrigan’s 2020 study confirms that nonstop shifts correlate with avoidable unwanted events and fatal error. Resident doctors are generally not permitted to work more than 13 continuous hours during night duty in the UK under the NHS working time directive, ensuring at least 11 hours rest before the next shift. In the US, ACGME limits continuous duty to 24 hours with 4 additional hours for handover. Studies (e.g., NEJM 2004) show that error rates significantly increase after 16–24 hours of wakefulness, equating fatigue to legal intoxication levels. Canada and Australia similarly cap night shifts at 12–24 hours. All systems emphasize scheduled rest to maintain cognitive function and patient safety. (References: NHS/BMA, NEJM)

A doctor refusing to burn out silently—my awakening came at a red light after a relentless day: over 40 OPD patients, ward rounds, and emergency surgery ending at 3 AM. Driving home on autopilot, I dozed off at the wheel. Blaring horns jolted me—I had fallen asleep, stunned by fatigue’s grip. In that humiliating instant, I grasped its danger: fatigue mimics intoxication, silently hijacking judgment and motor control. How can I trust myself to operate, diagnose, or even drive in that state?

Medicine demands precision, yet the system pushes us into cognitive free fall. That red light wasn’t just exhaustion—it was my brain sounding a survival alarm. When fatigue mimics 0.1% blood alcohol levels, everything becomes risky—missed diagnoses, surgical errors, even fatal crashes. This isn’t heroism; it’s human sacrifice.

The vulnerability to near-miss embodies why long like 30-hour shifts aren’t “dedication”—they’re systemic endangerment. We’d ground pilots or halt trains for such impairment yet expect surgeons to operate after 3AM. This isn’t medicine; it’s Russian roulette with patients’ lives and our own. Demand shift reforms before fatigue claims its next victim—in the OT or on the road. The paradox, the truth we avoid.

Why do Kashmir’s “burnt-out” doctors thrive abroad? Simple in Saudi Arabia biometric attendance plus 0digital hourly productivity logs validated by HODs is enriched with emoluments -none complains . In Kashmir: “Attendance marked”, chair empty, “gone for meeting with Sahib or prayers.” True accountability in healthcare is not oppression—it’s a mark of respect for the profession and its ethical commitments.

While junior doctors may endure 60+ hour weeks, some seniors avoid duties yet resist measures like biometrics that ensure transparency. “Patient first” slogans ring hollow when OPDs lack basic facilities and dangerous long duration more than 16 -hour shifts remain common.

Quality care demands systemic reform: cap shifts at 12 hours, implement globally proven models like night-float systems, and adopt digital activity logs to track real work, not just attendance. Productivity must be redefined to value outcomes—was the diagnosis correct, the patient counselled, and the illness resolved?

Heal our hospitals, no doctor should diagnose in 5°C winter rooms or 40°C summer saunas. heating/cooling isn’t luxury – it’s medical infrastructure. To have functional hygienic washrooms is basic human dignity. This Doctor’s Day, choose reform over ritual. Honouring doctors means fixing a system that pushes them to burnout, not offering token praise. Kashmir’s doctors aren’t broken by long hours, but by exploitative, unregulated conditions that ignore their humanity. Real change requires structured shifts, accountability, and dignity at work.

To colleagues: resilience shouldn’t mean self-destruction. To administrators: stop glorifying overloaded OPDs—fix the system. To society: demand rested, respected doctors—your life depends on them. Let’s stop treating healers like disposable candles and start building systems where they can save lives without losing their own.”A healer’s first duty is to stay alive – for tomorrow’s patients.”

(The author, with credentials in clinical auditing, brings extensive expertise in healthcare quality, safety benchmarks, and policy reform analysis. Can be reached at [email protected])