Violence against docs: system needs reforms

In May, Dr Ajay Bansal was brutally assaulted in a Jaipur hospital by his patient’s relatives; he sustained head injuries and a broken nose. Only weeks earlier, a spate of attacks on doctors in Maharashtra led to a state-wide strike by junior doctors supported by the Indian Medical Association (IMA).

The strike ended only after Chief Minister Devendra Fadnavis promised security at all government hospitals. In an earlier incident, post-graduate residents were beaten with a chair and blood pressure apparatus at Sassoon Hospital in Pune.

These chilling accounts are the most recent in a wave of violence and vandalism against medical professionals and hospitals that continues unabated. While there is universal condemnation and call for zero-tolerance of such crimes, it is critical for society to introspect on this disturbing phenomenon.
Large segments of the population are dissatisfied with the current situation in healthcare. The government hospitals are woefully inadequate in staffing and infrastructure, forcing the patients to turn to private hospitals where costs can be prohibitive. Without medical insurance, most of these patients pay out-of-pocket, or use debt to settle hospital dues.

Catastrophic expenditure on health is the leading reason that pushes people into poverty. The budget for health has stagnated at a dismal 1% of GDP for years, resulting in a complete mismatch of needs and services. The private sector has been allowed to fill this gap in health services without due regulations and rationalising of costs.

Limited resources invested in screening and prevention means that patients often arrive at the hospital at later stages of illness, need complex interventions and extended hospital stay, and face mounting costs and poor outcomes. This abdication of the government’s sovereign duty to provide access to health services can lead to helplessness and simmering discontent.

No purpose is served by attacking health personnel and hospitals. Violent behaviour in a facility holding sick and suffering patients is a disgraceful lack of civility and consideration. These outbursts of anger could be pathognomonic of frustration in society at the general breakdown of services, widening social disparities and corruption.

Taking the law into your hands displays disregard for social norms and human life. Who will be next? The tax official, discom engineer, policeman or professor?

There is need for introspection by medical professionals and hospital management even as they toughen security and create ‘defence protocols.’ Whatever happened to the ‘doctor-patient relationship’ and ‘trust’ in medical care?

Low doctor-patient ratios and high patient loads leaves minimal time with each patient; too little to form a relationship, allow for patient decisions or adequate information. The resulting confusion, helplessness and distrust can be counter-productive. Doctors say if they sp­end more time with each patie­nt, many will be left unattended.

Systemic malfunction

This again is a systemic malfunction that proper central planning and budgeting can overcome. The ‘medicalisation’ of healthcare has replaced health promotion and the art of medicine with diagnostics, drugs and technology that has dehumanised the experience, bringing in a consumer mentality and litigation. Also to blame are unreasonable expectations of relatives of terminally ill patients; doctors merely have a duty to care, and cannot always cure.

Are we doctors so focused on technical competence and competition for post graduation seats that we have forgotten our raison d’être? The compassionate doctor is at the service of suffering humanity. The objective of medical education as articulated by the Medical Council of India (MCI) is the ‘creation of doctors who are not only knowledgeable and skilled but ethical, responsive and accountable to patients and the community.’

Unless the MCI mandates training in ethics, communication and public health imperatives, we risk producing incomplete professionals. An IMA study revealed that most incidents of violence occurred in emergency care or intensive care situations, for reasons like response delays or demise of the patient. Breaking bad news and managing grieving relatives are communication skills that can be learnt, if integrated into medical training.

A 2015 government committee is evaluating a specific law to protect caregivers, classing such offences as non-bailable. Hospitals are on alert, even mulling an emergency ‘Code Grey’ that will mobilise help for the victimised doctor, summoning the police and IMA officials. The society must eschew violence and join with medical professionals in advocating reform of a patently dysfunctional health system.

(The writer is Adjunct Professor, Department of Health and Humanities, St Johns Research Institute, Bengaluru)