Dangers of fatigue

Dear Editor,

Dr. Fiona Godlee probably makes everyone sit up and read and act on whatever she has to say. I am an avid reader of all articles by Dr. Fiona Godlee, and I have read this article as well [1]. Then I went on to read some more new articles from BMJ as well, including this one by Abi Rimmer [2], which brings to the attention a study that suggests public spending cuts are linked to 120 000 excess deaths in England in just a few years from 2010 to 2017. Surely this sort of picture would be very disturbing for your country and your people, as we are out here in a developing country. Looks like our story. It is not that more money saves people, but a few more bucks wherever needed, and at the right time, can help save patients lives. It is really so unfortunate that so many people are attributed to have died in a country like yours over just a few years, due to cuts in public spending. These figures are definitely going to make the rest of the world sit up. For all we know and imagine, our situation in the developing world may be further grave, and we definitely have a lot to learn from your country.

For example, a doctor may forget that it is the last day to fill the absolutely essential form for their child in the school, but forgetting anything about a patient, however inconsequential, could send one in a tizzy, and maybe with some administrative and legal repercussions as well. Doctors and para-medical staff are also human beings, and that needs to be understood, accepted and accommodated as well by everyone that we too have our own limitations. There will be times when fatigue will set in. When your horse is tired, would you normally still flog your tired horse, or give it some rest or maybe tie the saddle onto a fresh horse? And would you still just be using one single horse to do a job requiring a total of 10 horse-power job? Unfortunately, we continue to save pennies, and that’s the problem. To overcome the shortcomings and limitations, governments must increase the healthcare budget and consider the option of employing 20 % more staff and doctors.

Alongside, mobile healthcare (by land, air, water) would be beneficial, where a fully equipped medical team along with facilities for basic investigations, x-rays and ultrasound, and dental facilities, etc, keep touring and visiting a defined geographical area on specific days, and also attend to emergencies. Retired medical fraternity may perhaps be willingly supportive of this idea, and may be ready to volunteer their services at an honorarium. Construction of more hospitals at different locations, rather than adding to existing facilities will be needed. Encouragement of online internet medical consultations, especially for the elderly, may be quite rewarding if done with caution and along with a dedicated follow up.

Finally, there is a need to develop newer ways of managing common chronic medical problems, cutting the costs and making the treatment more affordable. Maybe there will be a need to also employ some newer ways of managing multi-morbidities in elderly patients. Breakthrough of sorts is already there, and the world needs to move on from that point onward. The Ministry of Health of the Government of India had shown some interest recently and has seen my presentation on 25 October 2017 on the 35 innovative novel medical techniques that have accidentally been developed by me, howsoever nascent presently that they are.

Possibly a rethink, some concerted research activities, and necessary changes could be in the offing now. On a personal level I feel quite satisfied and contended to an extent that have done whatever I could for the mankind. Knowing that I would not be around for the eternity, I am also happy that I have managed to pen down my ideas in four books that have already been published, before I bid my farewell to the world. Obviously there remains the feeling of the lack of any support from anyone, which could have made a lot of difference by now and perhaps might have saved many lives as well. During this meeting with the Health Ministry, I have given copies of some of my editorials along with some of my other publications that carry my views on how to improve health care, together with the first three of my books that have been published by an international publisher. Not that I never wanted help, support, motivation, or encouragement, etc, but none was offered or made available to me. Notwithstanding, still I have done whatever I could for the whole world without any help, support, guidance, motivation, or encouragement, etc, and only from my humble pension. Perhaps one day all of these new innovative medical techniques by me for managing common chronic morbidities will be used all over the world. That said, there is definitely a requirement of more research so as to make all of these 35 innovative techniques more effective, acceptable, with long lasting results, and also be made free from any adverse consequences even if used by novices. All of this can possibly improve the results and also manage to offset the onset of fatigue in the long run, but a fresh start has to be made.

Best regards,

Dr (Lieutenant Colonel) Rajesh Chauhan
Honorary National Professor, IMA CGP, India.
MBBS (AFMC Pune), Masters in Medicine in Family Medicine (CMC Vellore), PGDGM (Geriatric Medicine), DFM (Family Medicine, PGIM Colombo), FISCD (Communicable Diseases), FCGP (Family Medicine), ADHA (Hospital Administration), AFIH (Industrial Health), LLB (II)

References:

1. Godlee Fiona. Dangers of fatigue BMJ 2017; 359 :j5294
2. Rimmer Abi. Public spending cuts are linked to 120 000 excess deaths in England, study suggests. BMJ 2017; 359 :j5332