As violence against medical professionals in India rises, Dr. AP Setia shares 7 preventive strategies to save the doctors and the nation. He writes that it is high time to realise the consequences of this social evil and analyse as to what has gone wrong and how one can curb this menace.

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The word doctor, symbolises compassion, dedication, humility, honesty, inspiration, idealism, and sacrifice. But in the current milieu the demi-god of the yesteryears is being viewed as a devil by the society. And the trust deficit between the doctor and patient has increased manifolds, leading to frequent incidences of assault on doctors. Hardly any day passes, without bad news of such an incident in the nation.

It is high time that the intellectuals, opinion makers in the society, NGOs and policy makers realise the consequences of this social evil and analyse as to what has gone wrong and how to curb this menace. As a result of these assaults, a good number of doctors in private practice have changed their attitude and pattern of practice. The critical patients are being referred to higher centres; for fear of mortality and consequent violence.

The next generation of students are not keen to take up this profession. Medical profession as a career option, in general, has been pushed to the lower side of the scale. After all, who would like to become a doctor to work under such a charged atmosphere of violence. One's personal safety is more important than saving human lives. All this, despite the fact that one has to be brilliant and study five and a half to eleven and half years to be a qualified and specialist doctor in modern medicine.

It has been aptly remarked, "It is a blessing to be a doctor but to practice as one, in India is worse than sailing through turbulent waters." If the present trend of violence against doctors continues; it would be difficult to find good doctors in a decade or two. Many existing doctors may migrate to safer work environments abroad. Those staying back may have to say, goodbye to medical practice.

The violence in clinical establishments not only affects the doctors, paramedics but involves damages to vital equipment and infrastructure as well. There is interruption in medical care to other hospitalised patients in the same institution. The consequences of such a mishap on those who are under intensive care or undergoing surgical treatment at that moment of time are difficult to imagine.

How can doctors provide their services in a state of unexpected riot-like situation at the hospital created by angry mobs, who may reach the hospital in truck loads within a few minutes? Even the limited number of security personnel present there may not be able to control them. By the time the police arrives, extensive damage may have taken place.

A recent phenomenon of abusing, spitting, pelting stones on medical teams, working for tracking of COVID-19 suspected patients, social discrimination in housing societies, and last but not the least obstructing last rites of COVID-19 positive doctors, who laid their lives on the line for their professional duties, is being experienced. Words fail to explain such extreme humiliation. It is difficult to imagine, how heartless people have become, towards the saviour of the masses.

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What are the possible preventive strategies?

Central law

A stringent central law, to punish those who indulge in such violent activities and vandalism is the need of the hour. The law ought to be notified with suitable amendments in the Indian Penal Code as well as Code of Criminal Procedure.

A new section say e.g. I.P.C. Section 51×××× may be added to cover offences under this Act with detailed description of the procedure to be followed in C.P.C. Imprisonment of 7 years to 12 years along with penalty for damages to equipment, infrastructure, building and compensation to those who suffered physical assault, psychological trauma and setback in their career.

Though a good number of states have notified such Acts in the last few years, just because their provisions are not as per I.P.C., there is lot of difficulty in getting the same executed. For example, 'The Haryana Medicare Persons and Medicare Services Institutions (damage to property and prevention of violence) Act 2009'. In it, the rules as per Section 7 (1) need to be framed and Standard Operating Procedure (SOP) too needs to be defined. One must carry the copy of the said Act along with other documents to the police station for its implementation.

A clear and precise Central Law shall act as a deterrent for potential miscreants, and will be useful to curb the social evil of violence in hospitals.

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Health education

Lack of health education among the masses is also a reason behind this malady. Even educated people are not knowledgeable about the prevalent systems of healthcare and the limitations under which doctors have to work. The expectations of the patients and their attendants are exceeding beyond any logic. The doctor can make efforts but it is not possible to save everyone, who reaches the hospital. The response to treatment as well as the extent of recovery is specific for each patient. It depends on the stage of illness at which the patient reaches the hospital as well as on the type of illness.

Though medical science has advanced a lot, we don't have sure-fire methods of recovery for many ailments. But, somehow the attendants of the patients have an impression that once a patient has entered the hospital, he or she must survive, irrespective of the illness concerned. And if those expectations are not met, there is suspicion of medical negligence and consequent raised tempers. It is high time that preliminary education about health is imparted at the high school level.

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Lack of awareness

If the patients or the attendants have some doubts about medical negligence, they should clear their doubts first. In a few unfortunate complicated cases of death, post-mortem can be done. There is an option to file a complaint with the Chief Medical Officer of the District Government Hospital to get the alleged case of medical negligence examined by a board.

In Haryana, District Medical Boards had been notified on 31st May 2017 vide No25/10/2017-6HB1, Haryana Government, Health Department; in pursuance of Hon. Apex Court orders dated 5.8.2005 in Jacob Mathew's case, passed in Appeal (Crl) 144-145of 2004. There is yet another option to file a complaint in the Consumer Protection Forum. These are civilised ways to get one's grievances addressed. But, in no situation, should attendants or patients take the law into their own hands. The 'Lakshman Rekha' of decency; need not be crossed, under any circumstances.

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Health insurance

The ever increasing, 'out of pocket' expenditure on healthcare is yet another factor responsible for the strained relationship between doctors and patients. Very few families, plan a budget for their health needs and even lesser numbers have medical insurance covers. Therefore, on one hand there is anxiety because of the illness and on the other hand, there is the tension to pay bills. This leads to misunderstanding and consequent violence.

There is a need to educate masses about the concept of health insurance. The insurance companies too ought to modify the terms and include expenses incurred on outdoor treatment as well apart from those being clubbed with hospitalisation. This way, more people shall be able to get benefits of health insurance, thus making these insurance plans more inclusive.

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Role of society

The opinion leaders, the social scientists, the government, health administrators and medical associations need to come together to devise ways to decrease the trust deficit between the doctors and their patients.

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Family doctor concept

The old concept of family doctor should be revived and a need-based referral system for consultation with specialist and super-specialist doctors should be formulated to change the current practice of 'organ' treatment; to 'whole body and mind' approach.

The MBBS graduate can effectively play the role of a coordinator and family doctor. Thus, there would be less chances of missing some findings in the clinical diagnosis as well lesser need for costly investigation by modern high-tech gadgets. The latter is a boon as well as bane of the modern era; depending on how they are deployed.

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Role of media

The media too can play a significant role in diffusing the tense situation between patients, their attendants and the treating doctors. Only evidence-based news should be published about any controversy regarding medical negligence. The media ought to exercise self-restraint, regarding publishing any analysis or conclusions, till the matter is under investigation. Such a policy shall go a long way in keeping the peace.

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Building good relations between patients and doctors is the need of the hour. It can be done by patience, understanding, and positive attitude. All the stakeholders need to pay heed to the issues raised vide supra, so that doctors may be able to serve the ailing masses in less stressful environments, devoid of the fear of sudden violence.
Let us SAVE DOCTORS and SAVE THE NATION!

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This article was originally published on April 29, 2020.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. A.P. Setia is a General Surgeon from Haryana.