COVER STORY

Doctor is hurt

Frequent attacks on hospitals and physicians. Sceptical public. Accusations of apathy

INDIA-HEALTHCARE/STRIKE Safety concerns: Doctors wear helmets during a protest outside AIIMS Hospital in New Delhi to highlight the lack of security offered to them | Reuters

With broken furniture, damaged equipment and blood stains all over the floor, the Holy Cross Hospital at Kalyan in Mumbai looked like a battlefield. A mob of 500 vandalised the hospital, after Rohit Bhoir, 22, died during treatment two months ago. Seven people were injured in the attack, of which five were hospital staff. Patients and hospital staff were held hostage by relatives of the patient for about three hours.

Bhoir was admitted at the Holy Cross Hospital after a heart attack. Though he showed signs of improvement after being admitted, he died the next day following multiple heart attacks. Bhoir's relatives who thronged the hospital accused the doctor of negligence. They also alleged that the doctor did not allow the patient to be transferred to another hospital. According to the doctors, the patient was too ill to be shifted.

Doctors are a worried lot. Patients are not only losing their trust in doctors—a deficit arising from a variety of reasons—but they also manhandle and sue them if something goes wrong. Hospitals being vandalised by disgruntled bystanders, have become a common occurrence. Three out of four medicos who took part in a survey by the Indian Medical Association in 2013 reported that they had experienced violence at work. “Things have only got worse. Many hospitals hire security guards to protect doctors from physical harm,” says Dr Sagar Mundada, 28, chairman of the youth wing of the Indian Medical Association.

Violence against healthcare workers in the ICUs is on the rise, too. In case the condition of a patient in the ICU gets worse, doctors and nurses get beaten up. “Many a time it happens on the spur of the moment. But, there have been instances when local politicians came to nursing homes or hospitals and threatened to assault the doctors, just to strengthen their hold in the locality,” says Mundada. “Verbal abuse has become very common. A lot of doctors face physical abuse also,” he adds.

To survive in today's service industry, a doctor needs to acquire self-defence skills, says Dr Bhavana Badrinarayan, a dental professional in Bengaluru. “If patients do not trust the doctor, they will not have faith in treatment outcomes either. I myself have had unpleasant experiences. Once a person walked in with intense pain and asked me to cure his pain immediately. When he was told that the analgesic would take at least half an hour to act and also if there is an infection it may not immediately act, he got furious. Without a second thought, he pulled a knife on me,” she adds.

Mob justice: People vandalised the CMRI Hospital in Kolkata following allegations of negligence. Mob justice: People vandalised the CMRI Hospital in Kolkata following allegations of negligence.

In government hospitals, abuse is a way of life. Tempers soar as doctors and nurses struggle with the unmanageable patient load. Shortage of hands makes matters worse. If a critically ill patient is allowed to jump the queue, others get annoyed, raise a ruckus and assault the nursing staff. In corporate hospitals, the incidence of physical abuse is comparatively less, but verbal abuse and medico-legal cases are common. These patients spend a lot of money and their expectations are high. “They get very upset if they don't get a positive result. When things don't work out, they start finding fault with the treatment or something or the other,” says Mundada. “Suppose a patient had fever and the doctor came five minutes late, the relatives attack the doctor. Many of my colleagues have faced it,” he adds.

Three out of four medicos who took part in a survey by the Indian Medical Association in 2013 reported that they had experienced violence at work.

The patient-doctor relationship is no longer sweet, says Dr Pradeep Gadge, a diabetologist in Mumbai. “Doctors get abused and attacked over trivial issues. The triggers could be dissatisfaction with the treatment, unrealistic patient expectations, long waiting hours, patient feeling the bills are inflated and sometimes unethical behaviour of the doctor. About four months ago, a patient's son got violent with our reception staff for having kept him waiting for long and he verbally abused the female staff as well,” he says.

Instances of vandalism by angry patients and their relatives leave healthcare professionals demoralised. “Sometimes they force us into defensive mode,” rues a doctor on condition of anonymity. “For instance, in very high risk cases, doctors hesitate to take risks. Sometimes if the doctor takes a chance, the patient could benefit from it. But if the outcomes are bad, people are going to get upset, even though they are told beforehand that the chances are less. In such situations, doctors may choose to get into defensive practice.They think, 'Why take a chance?',” he says.

Of course, doctors are not always right either. Dr Arvind H. Kate, a pulmonologist working with Zen Multispecialty hospital, Mumbai, has no qualms in admitting that doctors do err and also fail to respond to the emotional needs of patients' kin. “Relatives of critically ill patients often need reassurance from the treating doctor.Their faith should be restored with our mannerisms and conduct,” he says.

Gadge categorises patients into three groups. “Some patients treat us like God. We go out of our way to help them. But it could be difficult to handle these patients as they have unrealistic expectations. They believe we can do miracles, like God. Then there are patients who treat us and respect us as doctors. They are the best. We give them friendly advice. Category 3 patients are those with low trust. We wish such patients would leave us and go to someone else. Earlier I used to treat them like friends, but probably with years of experience, I have realised that it is better to let them go. They will give you stress and headache. The more you interact with them, the more demotivated you become,” he says.

The psyche plays an important role in the causation of most diseases and in healing. Gadge says patients must trust doctors for their own good. “If things don't change, it will be the beginning of an era of a robot treating another robot,” he says.

His father's stay in the ICU for two months changed Kate's approach to clinical practice. It taught him some valuable lessons on how to counsel a critically ill patient's attendants.The cornerstones of a good doctor-patient relationship are care, respect and mutual trust. “While talking to relatives of a seriously ill patient, doctors should not indulge in texting. Insensitive comments and attitude could also trigger violence,” he says.

Dr Mundada also talks about the other things that worry doctors apart from violence. “A super-specialist doctor spends 14 years studying medicine, which itself is a test of patience. He has a whole lot of challenges to deal with once he starts his practice. These range from unrealistic expectations of patients and constant threat of contracting deadly diseases, especially in hospitals where hygeine is not maintained, to inhuman working hours, patients turning to the internet and the government coming up with policies which are populist but which consider doctors to be guilty right from the outset. That we earn handsomely is a media-created myth. In fact, we attain financial security very late in our careers,” he says.

Mundada doesn't give up easily. So what does he propose to stop violence against doctors? “Proper enforcement of Doctors Protection Act 2010, setting up doctor-patient communication skills workshops for doctors, restricting number of relatives in hospital, increasing the number of doctors in the country.... The list is endless,” says Mundada, who specialises in psychiatry.

As per the Maharashtra Medicare Service Persons and Medicare Service(Prevention of Violence and Damage of Property) Act 2010, any act of violence against healthcare professionals like doctors, nurses, paramedics and medical students, is punishable by law. It could attract an imprisonment of up to three years with a fine of Rs 50,000. In the event of a medical institution being vandalised, the miscreants would be made liable to pay twice the amount of damages they caused. Several states have passed their own acts to stop violence against healthcare professionals. Nonetheless, there has been an alarming increase in the number of such instances across the country in recent times.

In the following pages, medical professionals put forward suggestions to improve the doctor-patient relationship like curbing commercialisation of medical education and improving facilities at the government hospitals.

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