102-hour weeks for doctors are 'inhuman', says Islamabad High Court, asking medical council to act

The Islamabad High Court (IHC) has directed the Pakistan Medical and Dental Council (PMDC) to examine the problem of excessive working hours for doctors and recommend action to the government, observing that requiring doctors to work up to 102 hours a week is inhuman.

Justice Raja Inaam Ameen Minhas heard a petition on doctors’ working hours at length on Tuesday. With the consent of both sides, he converted the petition into a representation before the PMDC, which must now decide on it and send its recommendations to the federal and provincial governments.

What fatigue does to a doctor

The case has drawn attention because of evidence submitted to the court by the College of Physicians and Surgeons Pakistan (CPSP), the body that oversees postgraduate medical training.

According to the CPSP, after around 18 hours of work, a doctor’s psychomotor performance is impaired to a degree equivalent to a blood alcohol level of 0.05. After 24 hours of continuous duty, the impairment is equivalent to a blood alcohol level of 0.1. The CPSP questioned whether it is safe to expect an exhausted doctor to make critical decisions or carry out procedures in that condition, and noted that tired doctors make more mistakes than those who are rested, alert and properly supervised.

It said the goal should be to reduce working hours to a level that allows staff a healthy work-life balance and ensures safe care for patients.

How other countries set limits

The CPSP’s submission compared Pakistan with other health systems:

• Europe: The European Working Time Directive sets a maximum average working week of 48 hours, with at least 11 consecutive hours of rest each day and minimum weekly rest.
• United States: Doctors in training can work a maximum of 80 duty hours a week, averaged over four weeks, with at least one day in seven free of patient care and limits on continuous duty.
• India: After the Supreme Court intervened, the norm for junior residents became a 48-hour week, with no single shift longer than 12 hours.
• Iran: The country’s council for graduate medical education sets a minimum of 50 hours a week, with restrictions on night duty.

The CPSP’s own recommendations

For its own training programmes, the CPSP recommends a minimum of 48 duty hours a week in clinical specialties, excluding emergency duties and Sunday on-call. It says trainees should not be required to do more than two night or emergency duties of 12 hours each per week, and that shifts in emergency departments should not exceed 12 hours.

The college also made clear that it does not employ doctors and therefore cannot set their working hours, which are the responsibility of provincial governments and private employers. Its role, it said, is limited to training programmes at accredited institutions.

Not just about hours

The CPSP’s submission acknowledged that cutting resident doctors’ hours would require hospitals to hire more doctors to cover the workload. It also pointed out that fatigue depends on conditions as well as hours: hot weather, workplaces without air conditioning and other environmental factors can make physical and mental exhaustion worse, a significant issue in many Pakistani hospitals.

Why it matters for patients

Long shifts for young doctors are common in Pakistan’s public hospitals, where staff shortages are widespread and lapses in patient safety continue to surface. The court’s intervention puts the issue formally before the medical regulator and the government. Any new limits would need to be matched by more staff and better working conditions, but the evidence before the court makes a clear case that doctors’ exhaustion is not only a welfare issue for medical staff, but a question of patient safety.

Reporting draws on accounts published by Dawn.