Once-up-a-time,
doctors were deeply revered and highly respected in society. They were idolized
and treated as God. With the passage of time, the situation has changed dramatically
and this type of deep respect for doctors is now extremely rare. Nowadays,
doctors and other healthcare professionals are increasingly being subjected to
violence at the workplace. Importantly, the situation in India is the worst in
the world.
The information
given below on the state of healthcare in India will help to understand the
crux of the problem:
Although violence
is perceived as only physical assault, there may be other forms too. These are
highlighted below:
It should be noted
that physical assaults can include slapping, spitting, punching, kicking,
scratching, biting, and even throwing excreta on doctors!
There appears to be
a gender difference in violence against doctors, with female doctors faring
better than their male colleagues. For example, in USA the incidence rate
of violence on female doctors is 34.2 percent. In China, male doctors suffer
equally as female doctors, with reference to verbal abuse. But they suffer more
physical (18.8% vs. 10.5%) and sexual (5.0% vs. 1.3%) assaults than their female
counterparts.
There have been
many instances of attacks on doctors in India of which some have been reported
by the media, while others have gone unreported or hushed-up. The major attacks
are briefly highlighted below:
The most recent violence took place
at the Nil Ratan Sircar (NRS) Medical College in Kolkata on 12
June 2019, where two doctors were brutally attacked by a mob of 200 people
following the death of a 75-year-old patient. The patient's family alleged
medical negligence as the cause of death.
Of the two doctors who were
attacked, Dr. Paribaha Mukhopadhyay sustained near-fatal head injuries,
requiring a craniotomy. The protests by doctors spread like wildfire from
Kolkata across the country and soon became a nationwide protest in which over
800,000 doctors went on strike. On 18
th June 2019, after 7 days of
protest, the junior doctors at NRS Medical College called off the strike after
the Chief Minister, Mamata Banerjee gave her assurance that stern steps would
be taken to counter violence against doctors in the future.
Violence against Doctors - A Global Pandemic?
The problem of
violence against doctors is not just limited to India, but worldwide! Globally,
on average, acts of violence have been reported to be mainly verbal and
physical, occurring both in hospitals and community clinics. Besides India,
some of the other countries with documented evidence of violence against
doctors include China, Turkey, Nepal, Myanmar, Pakistan, Israel, USA, UK,
Australia, and Germany.
Major Factors Influencing Violence against
Doctors in India
There are many
factors, both direct and indirect, that influence the occurrence of violence in
healthcare settings. Some of these are highlighted below:
- Healthcare
Budget: The budget for healthcare in the public sector is abysmal -
merely 1.15-1.5 percent of the gross domestic product (GDP). As per World
Bank data, the per capita expenditure on health in India is a meagre USD
60, compared to USD 300 in China or USD 1,000 in Brazil, not to mention
the developed nations in Western Europe and North America, which spend
much more
- Miscommunication:
There is a lack of communication from doctors to patients, regarding the
risks, costs, and complications of various medical procedures, especially
those involving surgery
- Lack of
Knowledge: Lack of health knowledge among patients and patient parties
is a major factor that contributes to simmering anger against the health
system, which erupts into violence especially when a patient dies. Most
often, it is the doctors who have to bear the brunt of the violence
- Ignorance:
Lack of awareness about preventive health measures often results in
patients being brought to the hospital when it's too late. If the patient
dies in hospital, violence against doctors is inevitable
- Health
Infrastructure: Poor health infrastructure is a major underlying
cause. If the primary health centers (PHCs) and subsidiary health centers
(SHCs), or even the district hospitals were adequately equipped with
trained medical staff and instrumentation to cater to the rural
population, then there would be much less pressure on medical colleges and
hospitals in cities and metros
- Lack of Trust:
There is a lack of trust in the health system in India. This stems from
doctor-patient mistrust, which is increasing day-by-day. Moreover, doctors
sometimes disregard patient and family concerns and apprehensions
- Misconduct
by Doctors: Doctors have been known to abuse women patients during
labor, which is termed as 'obstetric violence'. This is an umbrella term
that encompasses activities such as coercion, disrespectful behavior,
discrimination, bullying and sexual abuse by doctors and other health staff
during gynecological examination and delivery. This can lead to violence
against doctors
- Doctor's
Errors & Mistakes: As they say "to
err is human"; but for doctors, this may cost a life. Therefore,
errors, especially during surgery can cause the death of a patient, often
with dire consequences for the surgeon
- Overwork: Doctors
in government hospitals are overworked to an inhuman extent. The Central
Government directive to hospitals has fixed 12 hours as the maximum length
of work at a stretch (in reality - 36 hours), 48 hours of work per week
(in reality - 108 hours), and one weekly holiday (in reality - 2 per
month)
- Societal
Factors: Society is now more demanding and expectations of people are
very high. There is also more aggression in society, sometimes referred to
as 'mobocracy'. These include violence on the roads, at public places, in
schools and colleges, and now, in hospitals too!
- Demand &
Supply Gap: In India, one government doctor serves 10,189 people, as
opposed to WHO's recommendation of one doctor for every thousand patients.
This translates into a shortfall of 600,000 doctors. The nurse:patient
ratio is equally dismal. Here, the ratio is 1:483, which means a shortage
of two million nurses
Consequences of Violence on Doctors
Doctors and other
health professionals who have been subjected to violence at the workplace have
been reported to develop psychiatric conditions that often result in
absenteeism from work. Some of these disorders are listed below:
The Way Forward
Some of the ways
for averting violence in healthcare settings are briefly discussed below:
- Health
Policies & Legislations: Although 18 states in India have laws for
violence against doctors, poor implementation, weak clauses, and
inadequate knowledge of police, make these state-level Medicare Acts
ineffective. Therefore, the Central Government is in the process of
framing a new law along similar lines to bolster the states in the fight
against violence on doctors
- Knowledge
Dissipation: Knowledge about various diseases and other health issues
should be dissipated through print media, TV, radio, social media, and
health portals, which will enlighten patients and their families
- Strengthening
Primary Healthcare: Primary health centers (PHCs) and subsidiary
health centers (SHCs) in rural areas and their equivalents in urban areas,
for example, Delhi's Mohalla Clinics and Mumbai's Swasth Clinics should be
strengthened to reduce the load on tertiary care hospitals and improve
doctor-patient relationships for greater patient satisfaction
- Awareness
Generation: Doctors are instrumental in generating awareness among
their patients. Spending a little more time with patients to explain
different issues regarding treatment is very helpful for them
- Safe
Workplace: A safe work environment and congenial atmosphere for
doctors will help them tremendously to deliver quality healthcare to their
patients
- Media
Responsibility: The role of the media is instrumental in bringing
health issues to the public eye. Therefore, the media should cover the
positive news and achievements of the medical profession alongside the
negative news and should desist from sensationalization of news
- Security
& Monitoring: There is a need to deploy more guards in hospitals
to maintain order and enforce restricted entry for those visitors who only
have passes, in order to keep the size of the patient parties small.
Installment of CCTVs for better monitoring should be made mandatory in all
hospitals. Moreover, if violence occurs, the police should respond
swiftly. Also, warnings about violence against doctors should be displayed
in hospitals to deter miscreants
- Political
Will: This will help to maintain law and order in hospitals and create
a congenial environment so that the doctor-patient relationship remains on
good terms. Moreover, the 'VIP Culture' prevalent in government hospitals
should be stopped, as the kins of politicians often perpetrate acts of
violence on doctors
- Strict
Punishment: There should be strict convictions and fast track
proceedings in courts of justice to punish the culprits. Also, violence
against doctors should be regarded as a non-bailable offense.
Interestingly, in Australia, the law is very strict about the punishment
of miscreants for attacking health personnel, who receive a 14-year prison
term
- Doctor's
Attitudes: The attitude of the doctors is crucial for their own
safety. In case of difficult situations where violence can erupt, doctors
should not respond to anger with anger. They should calmly address the
grievances, but at the same time be prepared and call for back-up support
Conclusion
In conclusion, it
may be said that doctors and patients need to develop a better understanding of
each other in order to improve healthcare. Both doctors and patients have a
role to play in avoiding unnecessary violence against doctors. So, on one hand,
doctors should focus on curing, caring, and continuously communicating with
patients and their families. On the other hand, patients should understand that
medicine is not magic and a doctor is not God. Doctors, who are trying to
defend patients' lives, should not be forced into a situation in which they
have to defend their own lives.
So, let the fight be against diseases, not
against doctors!
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Source: Medindia