It was a cold winter morning; I was enjoying the morning sun. I was on a short vacation to a small town where my father in-law was posted. As I had just come from Delhi, the noise free and pollution free environment was adding to the pleasure. Suddenly I heard loud voices from a distance, some person was scolding in a filthy language, there were intermittent sounds of a scuffle and fighting and screaming.
“What happened there?” I asked a boy standing near me.
“I’ll just find out” the boy replied and ran to the scene. He returned after a while and told: “they are beating the Doctor”.
“But who is beating a Doctor and why?” I enquired.
“Jaggu is beating him, he seems to be very angry, I don’t know why” the boy replied.
Later on that day I learned more about the incident; The Doctor, who was newly posted in the local Primary Health Center, wrote a prescription to one of his patient, ‘Jaggu’, the local chemist sold the patient some alternatives, of a sub standard company, this was his regular practice. The patient went back to the doctor and showed the medicines given by the chemist which the doctor did not approve and insisted that patient should get the correct brand of medicine. The chemist, who was also a local goon got annoyed and came to the hospital, arguments took place and the chemist and his accomplices assaulted the doctor.
Next day, I learned that the police did not even lodge a FIR; – the chemist had some political connections. The doctor ultimately left the job.
As time passed, I came to know about many more incidents of violence against Doctors, Nurses and Hospital staff narrated by my some of my fellow batch mates and seniors from my Medical College. As I had joined military services than, I was feeling safe and lucky, but at the same time I have been feeling very sad about it.
Why is it happening? What happened to the people and the citizens? How have the values of the society deteriorated so much? Who is to be blamed for all this? The answers are not straightforward, the reasons seem to be many, and the situations are diverse.
Voltaire once said that – “the physician amuses the patient while nature cures the disease”. But today’s scenario is not so amusing. Even as this article was being written, a doctor is being assaulted somewhere. Law Encyclopaedia states that “Assault is an act that creates an apprehension in another of an imminent, harmful, or offensive contact. The act consists of a threat of harm accompanied by an apparent, present ability to carry out the threat”. The Health and Safety Executive define violence as “any incident in which an employee is threatened or assaulted by a member of the public in circumstances arising out of the course of his/her employment, involving an explicit or implicit challenge to their safety, well-being, and health”.
Of all work settings, medical sites carry the greatest risk to staff of verbal abuse and threats, with 73% of staff on medical premises suffering abuse, compared to 65% on recreational premises and 63% for transport and public administration. The common types of violence are Telephone threats, Intimidation, Oral abuses and Physical Manhandling.
India is not alone in this, statistics show that in the US, Gynecologists often receive threats and even actual murder takes place over abortion. More than half of Emergency Room Nurses experienced physical violence, spitting and kicking. 57 % of all Emergency Room employees threatened by a weapon, says a five year period survey of 170 University Hospitals. (Journal of Medicine · July 2010)
In the UK, Half of all doctors experienced some degree of violence or abuse, 20 % of which are physical (BMJ – 2003). Among GPs, the threat of violence is at 1 in 500 consultations.
In China, in 2006, more than 5,500 medical workers were injured by patients or their relatives. In June 2010, a Doctor was stabbed to death by the son of a patient who died of liver cancer, 3 doctors were burned alive when their office was set on fire by the patients, a pediatrician jumped through the window to escape angry relative of a dead newborn. In Fujian, when a patient died, the relatives took a Doctor hostage and the hospital paid $ 31,000 to the family for his release.
In Kuwait, 86% of Doctors received an insult or imminent violence, 28% of which are physical. In Australia, half of the Doctors were physically attacked at least once. The list goes on and on, in almost every country, the health care workers have been facing violence in one form or other. It has become a global scenario.
The causes can be generally attributed to:
- The society has become more demanding than ever before. The expectations are very high.
- There is the free availability of medical knowledge, people often read and acquire incomplete knowledge which they want to use to judge the efficiency of a Doctor or the line of treatment.
- In general, there is a growing intolerance in the society which is reflected by violence on roads, public places and even in schools, this is directed towards medical profession also.
The reason for the violence against Doctors and Medical professional are:
- Perceived lack of care: the patients perceive that the doctors are not available on time. The patient and family concerns are often discounted. Many times there are poor communication and delivery of information.
- A good number of the misconceptions and aggressions are triggered by criticism and misguidance by rival health professionals.
- In India, this is often the result of unrealistic expectations by poor families who, having traveled far and having exhausted their savings, expect ‘Medical miracles’.
- Formerly, when religion was strong and science was weak, men mistook ‘magic’ for medicine; now, when science is strong and religion is weak, men mistake ‘medicine’ for magic; both of which are not true.
In Indian scenario, the Mumbai Hospital Journal (2009) considered the following:
- Many such incidences occur in emergency department and casualty words where there are bleeding patients, delay in attention, a serious condition of the patient and delay in admission etc. The relatives and friends of the patient are invariably full of worry, emotions, and fear of losing the patient and they expect the whole expectation of the hospital staff.
- For the patients admitted in ICU, there is always a restriction of access to the relatives. Although this is necessary for the smooth management of ICU, the relatives often get agitated and in case the patient dies while in ICU, the matter gets worse.
- For the sake of confidentiality, the case papers of indoor patients are not disclosed to the relatives and friends. This also creates unwanted doubt in them.
- There are either insufficient or no security arrangements in the hospitals. Even if the security personnel is employed, they seldom are useful in such conflicting situations. Sometimes, they themselves create a nuisance.
- The existing laws are insufficient to deal with the assault on medical professionals. The accused often get relief due to various loopholes.
- The majority of Govt. Hospitals have systemic problems; lack of or insufficient equipment, lack of sufficient trained staff creates frustrations among the workers. Almost all government hospitals are overburdened with a huge patient turnover due to which the staff cannot give quality service to all.
- There are some petty politicians and self-styled leaders who can be found everywhere. They often show some pseudo-sympathy for the patient and mobilize the mob to attack the Doctor or hospital staff. They always try to gain easy and cheap popularity for which they target the hospital, which is always vulnerable. Adding to this, the media persons and reporters quickly smell the scene and make the news viral; in whatever way they want to because negative news quickly becomes sensational. The leaders of the mob also get instant publicity.
Having said all this, it must be realized that the medical staff is working to the best of their ability to address the needs of each and every patient who comes to them. In almost all cases, the Doctors or the hospital staff cannot be directly blamed for the deterioration of patient’s condition. However, there are always scope for improvement, which are:
- One cannot tackle anger with an anger; it will only aggravate the situation. One must remember that in such situations, the emotion among the relatives runs very high. Often, the simple arguments escalated to heated exchanges, physical assaults and manhandling.
- There must be some dedicated staff having good communication skill to listen to the patient and their relatives, address their grievances. Meanwhile, external help from security agencies or police must be sought in order to avert possible unwanted situations. Once the critical phase is passed, the situation will automatically be under control.
- Doctors and other staff must form groups and associations. The group so formed will take over in such situations, be of much help in seeking attention from appropriate authorities and will be united to fight for the justice in case it is needed.
- It is said that Doctors who cannot communicate well are more likely to land in the court. It is also said, “In the sick room, ten cents’ worth of human understanding equals ten dollars’ worth of medical practice”. It must not be forgotten that we are dealing with human beings undergoing extraordinary moments of fear, anxiety, and doubt.
- It must be communicated from the beginning that medical science has its own limitations and that doctors are not gods. The possible outcomes of the disease, both positive and negative must be clearly explained to the patient and in no circumstances, any false assurance is The patient can get satisfaction only when he perceives that he is being heard and understood. They must be helped to adjust to the sickness, pain, and death that are central to being human.
- The patient always expects that his doctor :-
- Doesn’t make me feel inferior,
- Doesn’t make me feel it’s my mistake,
- Doesn’t rush me,
- Is respectful and sensitive and
- Knows my medical history.
The most burning issue right now is security to our Doctors and Hospitals and sincerity from Govts is completely lacking in tackling it.
Respond to a SLAP now, or we have to wait till one of us gets KILLED