Outside view of Islamabad High Court

ISLAMABAD: The Islamabad High Court (IHC) on Tuesday directed the Pakistan Medical and Dental Council (PMDC) to examine the issue of excessive working hours for doctors and submit recommendations to the government, observing that requiring doctors to work up to 102 hours a week was inhuman.

Justice Raja Inaam Ameen Minhas heard a petition concerning doctors’ working hours and, with the consent of the parties, converted the writ petition into a representation before the PMDC.

The court directed the medical regulator to decide the representation and forward its recommendations to the federal and provincial governments for appropriate action.

The issue has gained importance following comments submitted by the College of Physicians and Surgeons Pakistan (CPSP), which highlighted the potential impact of prolonged duty hours on both doctors and patients.

According to material submitted by the CPSP, doctors can develop significant psychomotor impairment after prolonged periods of work. The document stated that after around 18 hours of duty, impairment could be comparable to a blood alcohol level of 0.05, while after 24 hours of continuous duty, it could be equivalent to a blood alcohol level of 0.1.

The CPSP questioned whether an exhausted doctor could safely make critical medical decisions or perform procedures after such prolonged duty.

The document further stated that fatigued doctors make more mistakes than those who are adequately rested, alert and properly supervised.

According to the CPSP, the objective should be to reduce working hours to a level that supports a healthy work-life balance for medical staff while ensuring safe patient care.

International limits on doctors’ working hours

The CPSP material placed before the court also referred to international practices governing doctors’ working hours.

It noted that the European Working Time Directive provides for a maximum average working week of 48 hours, at least 11 consecutive hours of daily rest and minimum weekly rest periods.

In the United States, the document cited an 80-hour weekly limit, averaged over four weeks, along with provisions for weekly rest and restrictions on continuous duty.

The CPSP also referred to arrangements in India, where, following directions from the Supreme Court, junior residents should ordinarily work 48 hours a week and no more than 12 hours at a stretch.

In Iran, the Iranian Council for Graduate Medical Education has set a minimum of 50 hours per week, with restrictions on night duties, according to the document.

The CPSP itself has recommended a minimum of 48 duty hours per week for clinical residency programmes, excluding emergency duties and Sundays on call.

It further recommended that trainees should not be required to undertake more than two 12-hour night or emergency duties in a week. Trainees working in emergency departments should also not be assigned shifts exceeding 12 hours.

CPSP clarifies its role

The CPSP clarified in its comments that it does not employ doctors and therefore does not determine their working hours.

According to the college, doctors’ working hours fall within the jurisdiction of provincial governments or private organisations, while the CPSP’s role is related to postgraduate training programmes conducted at accredited institutions.

The document also pointed out that there is considerable variation in how limits on doctors’ working hours are implemented, as well as in working conditions and supervision available to young doctors.

The CPSP noted that reducing the duty hours of resident doctors would require hospitals and other healthcare facilities to arrange additional doctors to manage the workload.

It also highlighted that fatigue depends not only on the number of hours worked but also on environmental conditions.

Hot weather, non-air-conditioned workplaces and other difficult working conditions can further contribute to physical and mental fatigue, according to the CPSP material.

The IHC’s directions now require the PMDC to examine the concerns raised in the representation and submit its recommendations to the relevant governments for consideration.