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.
“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.
• 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