I was visiting a hospital in Hyderabad for a seminar. One of the senior administrators was taking me around the hospital. India was shining, or so the slogan went. The waiting rooms were packed, and the business of caring seemed to be booming. “What is the malpractice situation like?” I asked. “Oh, that!” he replied, “It is street justice. They will assault the doctor, and try and burn the place down.” I thought he was joking, and chuckled. But he was dead serious.
The brutal, sickening assault of a senior gastroenterologist in Allahabad [on April 12], which went on for more than 20 minutes, witnessed by an apathetic hospital staff and caught on video, illustrates how serious he was. The incident, along with numerous others, has gotten some stray mention in the press, but nothing else. There appears to be a general public apathy towards the plight of doctors. No candlelight vigils and no outrage for a man who was supposed to be a saviour and a healer!
What does this say about the venerated medical profession in India? What does this say about the society that is supposed to put doctors and teachers on a pedestal? While these incidents reflect on society as a whole, they do not happen in a vacuum. They are the symptom of a disease, a frustrated society lashing out at a broken, corrupt system, and, as always, the innocent are caught in the crossfire.
This is a vicious cycle. The violence leads to a further breakdown in the doctor-patient relationship and trust, which, in turn, leads to further acts of violence. We, in the medical community, need to do some serious introspection to try and correct our part in this mess. Doctors are perceived as greedy, conniving and as people who are in the business of health and not in the business of healing.
There is a lot of truth to this perception. We have failed in regulating ourselves. Lack of empathy, pharmaceutical kickbacks, unnecessary surgery and tests and procedures for monetary gain and a “godlike” complex are some of the reasons that society is suspicious of us. Research shows that good communication and a good doctor-patient relationship help avoid lawsuits in the western world, and by inference it should reduce the incidence of assaults in India. That, however, is only one piece of the puzzle.
There appears to be either a fundamental lack of understanding of outcomes in medical science, or a rapidly developing industry of blatant extortion if there is a bad outcome. Doctors in India complain of routine harassment for any bad outcome. A gynaecologist told me of a patient who developed a bleeding complication, necessitating hospital admission. The husband of the lady began calling her repeatedly and threatening her. It came to the point that he even began threatening her children. It, of course, all boiled down to financial remuneration. She tried to go to the police, but could not get any action taken. The calls eventually ceased, but this has caused her to almost stop outpatient practice, especially outpatient procedures. The smaller hospitals and nursing homes, especially in smaller cities and towns, appear to be the biggest targets as they lack the bigger budget security services, legal services and political patronage that the corporate hospitals have. There have been routine cases of patient families demanding money for any perceived grievance.
The alternative is violence and threats of street protests, which would affect the credibility of the doctors and hospitals. There appears to be a growing disenchantment among doctors in India. The remuneration appears to be dropping, and there is constant pressure from hospital administrations on meeting targets. The hours are long, with evening clinics and night calls. Most physicians feel like they are missing out on life. Doctors are traditionally the best and brightest that society has to offer. They look a beaten and bitter lot today. Doctors are trained to deal with the intricacies of the human body. Like most citizens, they have no idea how to deal with physical and verbal assault and extortion. Most doctors put in these situations are permanently scarred and end up quitting the practice of medicine.
There has to be a basic decency in how people treat each other in society. Routine slapping and assaults for real or imagined grievances have to have consequences, both criminal and civil. While these incidents do not inflict physical damage, the mental damage can be lifelong. There has to be a better understanding of the limitations of modern medicine and a legitimate channel for grievances for both parties. At the end of the day, no amount of laws or security can protect a doctor. There has to be a shift in society’s perception of acceptable and unacceptable behaviour.
If we begin with the premise that death is inevitable, and that doctors and medicine are there to help you heal, the expectations of medicine can be more realistic. There are many issues in the health care industry, but you know you have hit a new low when a doctor answering an emergency at odd hours has to be afraid for his or her personal safety. The doctor-patient relationship is one of the most beautiful and, to an extent, selfless relationships, and we are in danger of irreversibly damaging it. To paraphrase Wilbur Smith, “There are heroes and villains, but most of us are mere mortals caught up in events too turbulent to fathom, and when the dust has settled, all we will inherit are the ashes of a once beautiful land.”
Arab is chairman, department of medicine, and director, division of cardiology, at Florida Hospital Memorial Medical Center in Daytona Beach in the US.
DOSE OF BLOWS
* Seventy-five per cent of doctors in India have faced one form of violence or other, say preliminary findings of an ongoing study by the Indian Medical Association.
* The study further says that 48.8 per cent of such assault cases take place in intensive care units or post surgery.
* As per data collected in the past five years, 68.3 per cent of the attacks were carried out by relatives or attendants of patients.
* On May 1, Dr Pankaj Gupta, a paediatrician from Gaya, and his wife, Subhra, were abducted while they were on their way home from a wedding in Jharkhand's Giridih district. They were held captive for five days in Lucknow, Uttar Pradesh, and were released on May 6. The IMA called a strike in Lucknow and other parts of Uttar Pradesh demanding safety to doctors.
* A state-wide strike was called by majority of private hospitals in Tamil Nadu on May 2 to protest a series of attacks against doctors and hospital staff in the last one year.
* The IMA wants a stringent law at the Centre to ensure protection of doctors and medical experts, and is preparing a draft bill for the consideration of the Union government.
* On April 30, Dr R.B. Choudhury of Gumla district in Jharkhand was abducted from his clinic. He was found dead in a forest in Raidih on May 4. There were widespread protests following his abduction.