In India, doctors have traditionally been regarded highly by society. The present impression of private business-mindedness of some in the profession has led to a poor image of doctors. However, one of the factors that contribute to this poor image of doctors is the sensationalization of every news item, often ignoring information that would gloss over mundane details, exonerating a doctor in an incident of alleged medical negligence. There are many causes for the increase in violence against medical personnel, not restricted to a general increase in aggression in society as evidenced by incidents of road rage and other acts of violence witnessed in schools and colleges across India. Violence against doctors and other medical practitioners in India has been reported as an increasing problem. On an average, one in 2 doctors faces violence at hospitals. Violence is much more common in healthcare industry compared to any other, taking up a variety of forms. There are many ways to reduce the potential for violence and total episodes. One of the most serious problems in worldwide healthcare, it needs to be addressed in a well-thought-out way. Violence may stem from patient dissatisfaction with care, costs associated with insurance premiums, unrealistic expectations, and overworked and underpaid hospital staff, as well as the rising cost of health care due to the government’s inability to subsidize hospital operations. Lack of a third-party formal dispute resolution system in many hospitals has been suggested as a factor, and the acceptance of bribes or good-faith money in the form of red packets has been implicated. Media coverage, and a lack of health literacy amongst the population are also some of the contributory factors.
Violence against doctors – Global Phenomenon
Violence against doctors and hospital is not only restricted to India, but a global phenomenon. In the USA, between 1980 and 1990, over 100 healthcare workers died as a result of violence. Another survey conducted in 170 university hospitals revealed that 57% of all emergency room employees had been threatened with a weapon over a 5-year period before the survey. The main reason behind violence is ignorance about disease and prognosis, lack of knowledge regarding medical science. Today mob mentality has become a pre-dominant trait. Among other causes of violence against doctors in India are the pathetic conditions in which patients are treated in government hospitals. There is overcrowding, long waiting time to meet doctors, absence of a congenial environment, multiple visits to get investigations done as well as consult doctors, sharing a bed by two and sometimes three patients, and poor hygiene and sanitation.
Causes of violence
There is lack of communication and overwork leading to numerous patients and understaffing of doctors. The junior doctors mostly get attacked as first responders in critical situation, because they lack training in proper communication. There is also lack of surveillance, security and restriction on movement of multiple attendants inside hospital premises. The government should be very transparent with lack of institutional/organisational policies, and prepare action plans to deal with such violence. There are various types of healthcare violence like verbal abuse, mobbing, threats, psychological harassment, physical violence, vandalism and cyber trolling.
Put an End – The solution
Aspects of patient–doctor communication such as ‘receiving an explanation for the occurrence of the symptom/ sign, likely duration of treatment and the lack of unmet expectations’ were found to be key predictors of patient satisfaction. Caregivers must be trained in breaking bad news, empathizing and communicating with their patients. Given the patient load, lack of time, gross deficiency of staff and other resources, these issues receive only lip service in India, especially in the government sector. The relationship between a doctor and a patient is paternalistic where patients are still not considered equal partners by their caregivers. This at time leads to arrogant behaviour, condescending attitude and use of jargon by doctors, which confuses the patient. This is an area where much emphasis needs to be laid especially during medical training. Doctors are taught clinical behaviour but not empathy. Effective patient–doctor communication has been shown to correlate with patient satisfaction with healthcare services.
( The author is former National President, Indian Medical Association and Chairman, Pushpanjali Medical Centre, New Delhi. Views are his own)