Mental Health among Future Digital Health Practitioners

The writing is on the wall. In a few years, healthcare in India will essentially be made up of all, that together come under the umbrella term Digital Health. With the rapid exponential embracement of HCIT, AI, and technology in healthcare there is a real risk that equal attention is not paid to those who will actually be deploying these powerful tools.

What Lars Leksell the inventor of the Gamma Knife (then the most sophisticated technology in Healthcare) stated in 1967– “A fool with a tool, is still a fool” is equally relevant today.

As the UG’s and PG’s of today are the consultants of tomorrow it was very disconcerting to read the report of the National Task Force on Mental Health and Well-being of Medical Students-2024.

The study revealed that 84% of PG medical students experience moderate to very high stress levels. 64% said that workload adversely affects their mental health and well-being. The nationwide online survey from 25,590 UG students, 5,337 PG students, and 7,035 faculty members showed that an “alarmingly high” 27.8% of UG medical students and 15.3% of PG students voluntarily indicated having a diagnosed mental health disorder. 16.2% of UG students and 31.2% of PG students reported having had suicidal ideation.

Long daily working hours, continuous duty days, and inadequate infrastructure and support were reported as the contributing stressors. 19% of PG students expressed the need to alleviate stress through substance use, including tobacco, alcohol, cannabis, and other drugs.

Around 60.1% of students felt that their stress and well-being were impacted by financial concerns. A large majority of 72.2% found their stipend insufficient.

Interestingly as per published data, the stipend alone of a 6th year PG at AIIMS New Delhi is up to 20 Lakhs per year (no doubt this is an outlier!). 45% of PG students surveyed, worked for more than 60 hours a week with over 56% not getting their weekly offs.

Now let us turn the clock back.

1968 to 1980 as a UG and PG. I joined the Madras Medical College in 1968 (At the Post centenary Platinum Jubilee Celebrations held in 2010 we got the “Best Batch of MMC Award).

I do not recollect a single classmate or immediate junior or senior having issues. The term “ mental health” was unknown then. To the best of my recollection a post called “Counsellor” did not exist then.

Every one of us enjoyed every day as a UG (it was 6.5 years then including House surgeoncy 1 year). We never went on strike because the INR 150 stipend was meager. We learned to adjust our wants to what we have.

When I joined a 5-year PG course in Neurosurgery (1975-1980) there was no stipend scheme. It was introduced several years later. As I was a good student, the HoD Prof B Ramamurthi appointed me as an ICMR Sr Research Fellow on a fellowship of INR 750 per month, in a project where he was the Principal Investigator.

This was a full time job by itself. My principal teacher Prof S Kalyanaraman requested me to help him with his private cases. This was almost another full time job. There were no special nurses at that time. I assisted him in surgery in a private nursing home and used to sleep in the duty doctors room whenever a major neurosurgical case was done.

I used to earn INR 3000 to 9000 monthly. Having three jobs concurrently, I would leave home at 05:30 hrs and return by 8 PM. At least thrice a week I would be doing “night duty” either at MMC/GH or in a nursing home. Of course, there was no post-duty off!! Not for a day did we even think that we were being exploited, our rights denied. There were no labor laws at least for us.

The term ‘work-life balance” was unknown. “Work” was our Life. Life was all about “working” We enjoyed every day. I was married with two children when I was a PG.

Retrospectively, the tremendous family support provided in a joint family milieu made all the difference. My parents looked after me till their very end – when I was 55.

Even after getting an M.Ch Neurosurgery degree, an MNAMS (Neuro), and a Ph.D in neurosurgery from the Madras University, for 15 years at the Govt General Hospital and Stanley Hospital Madras, I did weekly night duty, with no post duty off. This was in addition to Sunday night duty once in 6 weeks. We had our share of night duties on all National Holidays and festival days. When my student became my boss I accepted it. When my Student’s student was to become my boss I reluctantly resigned (probably as the world’s senior-most Asst Prof of Neurosurgery!)

The world has since turned upside down. We, of the 20th century, probably come from another planet, Night duty was an amazing learning experience. Every patient I saw I was instructed to inform my boss on a landline. Addl Professors of Neurosurgery Madras Medical College hardly slept at night on their admission days. After presenting in detail the history and the findings on physical examination I would be asked what I proposed to do and why. This was in the pre-CT era. The boss would agree or suggest an alternative. There would be at least 5 minutes discussion including suggestions for additional reading. This would happen at 10 PM and 4 AM and several other times as necessitated.

Once the boss had confidence in the PG, the number of calls reduced. When I was in my fifth year there would be a single call at 6 AM reporting all cases. This was education at its very best. What we learnt during night duties could never ever be replaced with ChatGPT5 or Perplexity. The more night duties we did the greater was the development of our clinical acumen.

Today the tools of Digital Health can ensure raising the bar and achieving results in healthcare outcomes unthinkable in the previous generations. The key message is to enjoy every moment of one’s occupation, profession, job, career, employment, service, pursuit, interest with passion. Dedication will automatically follow. Automation, semi automation, judicious deployment of AI, use of EMR, etc., will certainly reduce the considerable time that we spent – on what today is unnecessary.

Working hard is not the message. Today it is Working Smart. Today, using digital aids, for a clinician in training, physical night duty particularly in a large public teaching hospital would be amazing.

Mandatory post duty off will reduce chances of learning immediate follow up. As a PG one is expected to be mature enough to decide on whether on a particular night the work was so much that he/she is physically/mentally tired. Of course, he/she should be allowed to take off or leave earlier or come later. Flexibility and “contextual” should be the keywords. The boss also should be understanding and comply with genuine requests. It is assumed that every PG in healthcare sciences took up this avocation voluntarily and was not forced.

Trying to change the system to get more creature comforts should not be at the cost of learning. Every PG should realise that he/she belongs to the cream of the cream of society. It is a privilege to be among the few thousands (out of tens of millions) to do night duty!!

Today Distance has become meaningless. Geography has become History. If necessary a virtual visit can be made to anyone, anytime, anywhere from the beach or museum or wherever you are. Enjoy everything you do. Remember “this too will pass”.

The only thing that is constant in the universe is change. I want to do night duty again without post-duty off – alas no one wants me now!!