What hospitals must do now

The recent episode of attack on doctors in a Kolkata hospital and the subsequent strike by doctors across the country put the spotlight on the issue of violence against medical personnel. A study conducted by the Indian Medical Association a few years ago found that a whopping 75% of surveyed doctors had suffered some form of physical violence while on official duty. A majority of these assaults are reported from ICUs or Emergency Room, where critically ill patients are admitted.

At the root of this problem is the paucity of healthcare resources. Shortage of human resources, medical infrastructure and the number of beds are problems that must be addressed at the policy level. Saddled with a meagre healthcare budget and limited resources, public hospitals present a dismal picture where overcrowding and a long waiting time are the norm. A limited number of doctors and nurses are constantly struggling to meet the needs of a large number of patients. Lack of sufficient security and protection for doctors also embolden mobs to violence.

This disturbing trend is also symptomatic of the changing relationship between doctors and patients. With the proliferation of private clinics and the emergence of corporate hospitals, there is a growing perception that doctors are operating with the intention of fleecing.

The mistrust has also been fuelled by constant media scrutiny that highlights malpractices and corruption by medical practitioners. There is an interpersonal angle to the erosion of trust as well. Overwhelmed by the rush of patients, busy doctors often do not have enough time to invest in in-depth conversation with patients.

With doctors busy in clinical work, there is a need to have adequate number of managers to provide administrative and managerial support so as to allow doctors to perform their duties without fear or distraction. The officials responsible for hospital administration must not only have managerial skills but also adequate soft skills, a compassionate approach and understanding of social and behavioural issues. Here are a few necessary elements of sound hospital management:

Consent, communication

At no point should the relatives of patients be misinformed or given unreasonable expectations of recovery when the patient is critical. It is important that in case of critical patients, treating doctors meet families every day, more than once if required, and clearly explain to them the prognosis. Having a regular and honest communication ensures that they have no false expectations.

Informed consent is another significant step in preventing violence. While attendants are always made to sign documents before a medical procedure, doctors or hospital managements hardly explain the contents of the documents to medically illiterate families.

The golden rule of consent taking is “The person (doctor) who holds the knife holds the pen.” In other words, consent should be taken only by the doctors treating a patient after explaining in detail and in a language understood by the patient/family. Not to forget the need to have proper documentation of the patient’s course of treatment so as to be secure in case a matter goes to court.

Compassion

It is essential for hospital managers to inculcate compassion and care among all staff members. For doctors and medical staff witnessing serious illnesses and mortality, it is an everyday affair. However, for families that lose a member, it is nothing less than an earth-shaking event. It is important to be considerate to them, make processes smooth and quick and eliminate unnecessary hassle. Care must be taken that attendants of critically ill patients are not pestered too frequently to pay bills. Doctors and staff members must try to console grief-stricken families and counsellors for emotional support should also be made available. Compassionate treatment can go a long way in pre-empting any kind of unrest.

Be prepared

While all efforts must be made to pre-empt violence, it is also important to be prepared to deal with a violent situation, much like you are prepared to handle emergencies such as a fire or earthquake. One of the most important steps to prevent violence inside a hospital premise is to restrict entry of attendants through passes. Security guards must be placed not just at the hospital gates but also at sensitive areas such as ICUs and emergency units. Staff members at such locations must also be trained to stay alert to signs of possible unrest. A standard operating procedure must be developed and each staff member should be aware of the do’s and don’ts of such situations. If signs of aggression are noticed, senior management must immediately reach the spot and intervene.

Rebuild trust

For the medical community at large, it is important to make efforts to rebuild the lost trust between doctors and patients. They must also make efforts to not just treat patients physically but also assuage their concerns, remove their doubts and help reduce stress. The corporate houses that are investing in the field of medicine must pay attention to creating affordable healthcare facilities.

(The writer is MD, Paras Healthcare)