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Violence Against Doctors: A Frightening New Epidemic

The majority of doctors decide to go into the medical profession with the best of intentions. They want to help people, ease suffering and save lives. Despite these noble intentions, many doctors and nurses put their own lives on the line in the course of their jobs, facing attacks from the very people they are trying to help.

Violence Against Doctors

“Allow us to treat you without fear. Allow us to save lives without fear of losing ours.” — Dr Pillai Vishnu

Violence against doctors has reached such an extreme in India that the medical staff is afraid to come to work and they need a police presence in the hospitals where they work. More than 75% of the population of doctors have had to deal with some degree of violence or aggression directed at them, according to the Indian Medical Association (IMA). Those committing the violence are usually family members, friends or attendants of the patients and violent events peak during visiting hours. Almost half of all the violent incidents occur in intensive care units or when a patient is in recovery after a surgical procedure.

Shockingly, a large proportion of doctors don’t report such incidents, believing them to be a part of the job so the true figures are likely to be higher. Incidents vary from minor verbal abuse all the way through to the murder or attempted murder of staff.

Murder of a Staff Member

In 2012, a grieving and irate husband in Chennai reportedly used a sword to stab to death a surgeon he blamed for his pregnant wife’s death during an operation that the surgeon had carried out.

In the same year, a group of disgruntled relatives reportedly restrained and beat up six doctors after a female patient died. Surprisingly, the beatings weren’t inflicted because she had died, but because the doctors had attempted to give her cardiopulmonary resuscitation and this was deemed by the relatives as inappropriate sexual touching.

Bouncers Hired to Protect Doctors

Some hospital administrators have begun to hire muscular looking bouncers, whose imposing presence deters patients’ relatives from aggressive behaviour. The Maharashtra government has taken it one step further and has reportedly pledged to provide all hospitals in its region with bouncers to protect doctors.

Why Do Patient’s Kin Attack Doctors?

There are multiple reasons for the deterioration in the doctor-patient relationship and the escalation of violence against doctors. Delay in attending the patient is one of the main reasons that relatives become angry, as well as not including them in decision-making processes about patient care. The profit driven set up of modern medicine also plays a role. As medical school and city life is so expensive, some doctors order more tests than are needed, to booster their wages. This means that it is not uncommon for patients to be subjected to unnecessary laboratory investigations or radiology and to experience unintended side-effects from those procedures, triggering anger in their loved ones. They may also be angry at the doctor’s involvement with drug companies — including pharmaceutical company incentives such as lunches, tours abroad and expensive gifts. These benefits are not given to patients who are involved in research and the patient will typically have to pay a lot more for a medication than the doctor does. For instance, an anti-clotting agent may cost Rs 27,000 to a patient but only Rs 21,000 to a doctor who ordered it. For patients who can ill afford their treatment and who have no choice in an emergency, this can feel like exploitation.

Requesting advance payments before agreeing to any treatment can cause considerable tension as can refusing to release a body from the morgue until the bill has been settled. This practice only adds to the grief that families feel on the death of their loved one.

The problem, however, isn’t only how doctors financially manage the practice of medicine. Those in receipt of the service can be equally to blame. Violent attacks are common in private hospitals and aggression more likely after a death because relatives feel they have paid for a service and if the patient dies, they didn’t get what they paid for. Unfortunately, no amount of money will save a person who is beyond repair. If a well-known patient dies, such as a politician or a journalist — doctors can expect retaliation. When Shiv Sena leader Anand Dighe was admitted to a hospital with a leg fracture and subsequently died of cardiac arrest from a probable pulmonary embolus, a mob of angry Sena supporters allegedly arrived at the hospital to smash up equipment and furniture as punishment for his death. Politicians have also been known to interfere with a doctor’s admissions process for political reasons and to make scapegoats of doctors when high profile patients die.

Curbing Violence Against Doctors

While security needs to be better, strengthening the doctor-patient relationship is undoubtedly the most important factor in reducing violence. Involving patients’ attendants in decisions regarding the patient so that they feel like part of the process can diffuse tense situations. Today’s patients are more aware of their rights and more assertive as a result.

Improving the quality of medical facilities and reducing the financial burden on patient’s families is also important as large payments may be catastrophic for poorer people and if they then encounter poor facilities too, this may engender a feeling of corruption.

While it may be difficult for doctors to distance themselves from drug companies, since they often sponsor medical conferences and frequently ‘educate’ doctors about new drugs, it may be possible to choose what incentives they accept and avoid conflicts of interest. Accountability and openness will lead to a restoration of trust and that is what is missing in today’s doctor-patient relationship.

References:

Violence Against Doctors in India, The Lancet, Volume 384, Issue 9947, 955-956
• Indian Journal of Medical Ethics, Volume 9, number 4 (2001)
• Violence Against Doctors, J Medicine 2010; 11: 167-169
The New Indian Express, Maharashtra Government Provides Bouncers to Protect Doctors in Hospitals, 1st April 2016
• Youth KI AWAAZ, 29th January 2016
The Times of India, Over 75% of Doctors have Faced Violence at Work, Study Finds, 4th May 2016
• Recovery.org, accessed 31st May 2016

by Sally Gold

Be First to Comment

  1. Dr S K Joshi Dr S K Joshi Friday, June 3, 2016

    Violence against the hospital staff is becoming a common occurrence regardless of the anti-violence laws enacted in many states. And the causes are all too well known.
    Apart from the above another common situation observed in recent times is that some relatives who don’t want to pay the bills, start finding faults with the treatment or food or linen or the nurses or doctors as the patient reaches the discharge stage so as to avoid paying the bills. Suddenly a crowd of rowdies will start picking fights with security people, start accusing the hospital of poor services or malpractices and start breaking window panes at the slightest pretext to pressurise the hospital to slash the bills.
    Bouncers may be present and visible but used only in rare uncontrollable situations to prevent damages to property. The purpose is never to compete with the miscreants but to speedily deescalate and defuse the situation. Because any ruckus in the hospital would not only disturb the functioning but also spread a bad image among the public who may never know the real cause, and the media ever so hungry for the bytes. As quickly as possible the dissatisfied attendants may be moved to a quiet non-public area of the hospital where the attendants may vent their grievances and the administrator may quietly listen.
    A good administrator, therefore, would handle such situations in a smart way. He would do well to have a good rapport with the area police who can be very handy and effective in such difficult situations. Similarly, cultivating the media to keep them on your right side also pays well.
    But having said all that, the last but not the least would be the efforts to prevent such situations. It is often noticed that these situations happen more in hospitals with poor doctor-patient communication. There is a need to understand the psychology of patients/relatives undergoing tremendous stress, emotional as well as financial. Having honest and frequent doctor-patient communication, having patient counsellors and keeping a sincere check at the cost of services can go a long way. A good administrator would pre-empt and prevent the conflict between the patient and the hospital and never let a situation develop where a client may start suspecting your sincerity because that would be the beginning of trouble. It would be good to remember that more often than not the patient is right……………………….Dr S K Joshi

  2. Dr sri harsha Dr sri harsha Friday, June 3, 2016

    My proposed solutions for the above mentioned problems:
    1) delay in attending patients is a direct effect of shortage of staff. too many patients and too few doctors and long working hours for doctors. there has to be regulations in place to check if a particular hospital is adequately staffed or not, and their license should be cancelled if found inadequate.No doctor should be working for more than 12 hours at a stretch especially residents.
    2) demonstrating good communication skills and empathy towards patients should be a part of practical assessments in final mbbs and post graduation exams.
    3) Never leave junior doctors alone in the casualty or ICU, its time senior doctors also start taking night calls even in teaching hospitals and hospitals with high patient load, and they should be adequately paid for, however note that this is not at the expense of making doctors overwork. it is just that the presence of a senior consultant at night can actually relieve patients and make them feel that they are in safe hands.
    4) appointing GRIEF counsellors and adequate security in all ICUs and casualties, right now these people are only there in cases of organ donation after death , however they should be present for all cases. patients counsellors. patients need to be spoken to properly in times of grief and if the situation is going out of control then protect the doctor by having proper security systems and bouncers if necessary.
    5) in cases of problems arising due to politicians and media personnel and celebrities, this is where unity amongst all doctors plays a major role. and unity means from the seniormost high profile consultants to the junior residents, everyone should be united.THIS WILL NEVER HAPPEN IN MEDICINE especially in our country. senior doctors and professors never care for the problems of junior doctors.
    6) Finally a sincere appeal to all doctors and public, stop this god complex and stop telling bullshit like doctors are next to gods. stop inculcating this false beliefs in young students. the moment you elevate yourself to that level it is very difficult to tolerate even slightest criticism. medicine is another science thats it and let it be that way. a doctor is not more valuable than an eminent scientist in any field.
    7) patients who come at 2AM or 3AM in the night for trivial complaints are not fools to do so. i have very often seen doctors not treating them properly and asking them to come to opd next day. i have also seen doctors whining about such patients with nurses saying why do these people come now and spoil our sleep. FOR THE KIND INFORMATION OF SUCH DOCTORS EVEN THE PATIENT WOULD PREFER TO ACTUALLY SLEEP IN HIS HOME AT THAT TIME, NOT ONLY YOU. HE/SHE DOESNT KNOW WHAT IS SERIOUS AND WHAT IS NOT. SECONDLY PATIENT IS NOT AWARE THAT YOU HAVE NOT SLEPT FOR THE LAST 24 HOURS OR EVEN MORE. if you have the guts go and talk to the administration about reducing night shifts. do not show your frustration on the patient.

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