The silent code blue- a call for health worker’s safety

(Credit: Unsplash)

This article was exclusively written for The European Sting by Ms. Nefal Numair, a 3rd year student of Bachelor of Medicine and Bachelor of Surgery at Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

What is the limit to your caregiving? When the best of your abilities limits your duty in the face of the blaring sirens of mundane chaos, your back drenched with drops of sweat dribbling down, your tongue parched, your drained out form giving in to its ephemerality, your growling stomach reminding you of your own mortality-do you still stand tall and give your all?

For an emergency physician called on for surgery at 2 am, a paramedic assisting in trauma just moments after he received the call of an ailing relative at home, an OB nurse called in for labor when she finally got some time to video call her kids -the answer is yes and its not surprising. Healthcare workers often, in fact, repeatedly face situations where their own limits to physical, mental and emotional health are constantly tested1. Working in a service to people, not only are healthcare workers responsible and expected to give their maximum in terms of clinical skills, job expertise, professional care but at the same time do it with courtesy, empathy, and minimal chances of error at every consultation. Have you ever wondered if and how these long duty hours, complicated surgeries, stressful work environment can be affecting an individual’s own wellbeing?

Studies show that more than 40% of physicians experience burnout and depression2 whereas 8 to 38% experience some form of physical or verbal violence3. This calls for a need to address the safety of healthcare workers. Occupational stressors, long working hours, administrative workload, high expectations, work-life imbalance, lack of workplace security, sleep deprivation, and inadequate salaries are additional contributing factors.

Physical, mental exhaustion can result in physician burnout affecting professional conduct and causing personal consequences. This could have a direct impact on the time and attention given to the patients resulting in negligence at work, higher chances of error, malpractice and decrease the overall efficiency and expertise that a competent physician/healthcare worker might provide otherwise4.

In addition, it can also cause depersonalization, feeling of incompetency, constant stress and fatigue5.

It also results in physicians quitting their professions early, high suicide rates, more patient workload and a negative impact on the economy and work output of a healthcare system already gaspingg for breaths amidst the clouds of impending pandemics and lack of workforce.

 For a country like Pakistan with an already doctor population ratio of 1:1300, with more than 50% of the population having no access to healthcare, an alarming rise in cases of suicides among physicians, doctors quitting due to lack of facilities, stressful working hours, gender hierarchy and workplace harassment more common among women, a brain drain due to lack of resources and peer support, increasing political instability and insufficient rewards, health worker’s safety is in a dire need of prioritization. Optimization of working hours, bonuses, promoting peer support, access to mental health services and practicing mindfulness can help provide a safe and secure working environment and respond positively to the silent blue code of our frontliners.


  1. Panari C, Caricati L, Pelosi A, Rossi C. Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment. Acta Biomed. 2019;90(6-S):60-67. Published 2019 Jul 8. doi:10.23750/abm.v90i6-S.8481   
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019
  3. WHO Violence Against Healthcare workers
  4. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). 2018;8(11):98. Published 2018 Oct 25. doi:10.3390/bs8110098
  5. Philip Salen and Kenneth Norman (December 20th 2017). The Impact of Fatigue on Medical Error and Clinician Wellness: A Vignette-Based Discussion, Vignettes in Patient Safety – Volume 2, Michael S. Firstenberg and Stanislaw P. Stawicki, IntechOpen, DOI: 10.5772/intechopen.70712. 

About the author

Nefal Numair is a 3 rd year student of Bachelor of Medicine and Bachelor of Surgery at Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore. She is a member of SKZMDC-LC.

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  1. Shakeela Rasheed says:

    Good job, worth reading.

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