Logistics and administration-related stressors among young physicians working in the emergency medicine (EM) department and their perceived job satisfaction in EM department across hospitals of India: a nationwide multicentric digital survey.

OBJECTIVE: Emergency medicine (EM) is a growing specialty in India with the board approving training programme commencing only since 2009. This study aimed to identify the challenges faced by EM department personnel in the country and to obtain valuable insight into the concerns and problems experienced by them. METHODS: This study was a cross-sectional digital survey conducted among EM department personnel in teaching institutions across India. The study involved 170 respondents, who completed an online questionnaire that covered various aspects of their work and identified the challenges they faced. It also captured potential solutions as perceived by the respondents. RESULTS: A total of n=170 participants completed the survey of which N=164 fulfilled the eligibility criteria. The study revealed significant challenges faced by EM personnel in India. Administrative and clerical work consumed a considerable amount of respondents' time. Understaffing (n=144/164; 87.8%), followed by complains about delay due to hospital administrative processes and policies (n=141/164; 85.9%), and delay in interhospital transfers (n=139/164; 84.8%) were the primary concerns spelt out by the respondents. Additionally, respondents experienced interpersonal conflicts, and verbal/physical abuse and inappropriate behaviour from patients and their family members. Potential key solutions suggested were to improve resources including manpower and take steps to prevent violence against EM staff. CONCLUSION: The study's results call for policy-makers and hospital administrators to address the issues faced by EM department staff. Improving EM department operations can improve patient care and staff well-being. Future research should examine challenges in non-teaching institutions and potential solutions.

Socio-Cultural Factors Delaying Treatment in a Patient with Late-Onset Schizophrenia.

Up to 23.5% of patients with schizophrenia have onset of illness after the age of 40. We report a case of a 57-year-old lady who had been sitting continuously on the toilet for 2.5 years because of persecutory delusions and somatic passivity symptoms. She was diagnosed with late-onset schizophrenia and her symptoms improved with risperidone. In this case report, we describe the phenomenology of her psychotic symptoms and explore the socio-cultural factors behind the long duration of untreated psychosis (DUP). We conclude that more can be done to improve mental health awareness and reduce the social stigma associated with mental illness.

The ties that bind - A case report about restraining a mentally unwell family member at home for over a decade.

This is a case report describing a patient, with schizophrenia, who was physically chained by her mother in their house for more a decade. Illness factors, family dynamics, stigma, lack of mental health literacy and cultural roles contributed to her chaining. To our knowledge, this is the first case report that examines the prolonged use of physical restraints by family members on a patient in a developed urban setting and that explores the cultural and ethical issues surrounding this phenomenon. We have concluded that there remains a need for a national level approach to increase mental health literacy, reduce stigma and promote existing psychiatric community health services in a culturally sensitive manner.