[5] whereas 57% of emergency care workers had been
threatened with a weapon. In the UK, 52% of doctors reported some kind
of violence [6]. An ongoing study by Indian Medical Association (IMA)
reports that 75% of doctors in India have faced violence at some point
of time [7].
Healthcare workers are four times more likely to be
injured and away from work as compared to other professionals,
particularly because a doctor often deals with a person when he/she is
in a stressful and emotionally taxing situation [8]. Even though it is
difficult to differentiate between the true rise in such incidents and
increased awareness in the era of electronic mass media, the ultimate
impact of such violence on the mindset of health care workers as well as
public at large is a matter of deep concern. Doctors often do not report
all cases of violence, especially verbal abuse, as they understand the
distressed condition of patients.
Violence against doctors in India may comprise of
telephonic or verbal threats, physical assaults, and vandalism. The
relatives of a patient, aggressive bystanders, political party members,
local goons or persons in power may attack doctors – mostly in the
waiting area, consulting room/clinic, intensive care unit (ICU) or
outside the operation theater (OT). They may even attack a doctor after
a careful planning for taking revenge for their grievances. Doctors
facing violence may suffer from depression, insomnia, stress, fear and
anxiety – causing absenteeism [9]. Due to these incidents, many doctors
have lost their clinics, injured themselves, or lost lives directly due
to violence or due to suicide after the loss of reputation as a
professional [8]. More importantly, the medical community is in state of
panic and is in regret mode of choosing a career where the society does
not stand besides them. Majority of doctors are unwilling to send their
children to a profession that was revered by the society, not long ago.
Causes of Violence Against Doctors
Violence against doctors is a multifactorial problem
resulting from forces of economic aspirations, greed, extreme stress and
frustration of modern living, competition-driven society, distorted
religious, cultural, educational and social values, and increasing
intolerance in the society as a whole [10]. The possible causes of
worsening doctor-patient relationship in the society are outlined in
Box 1 [8,9,11,12].
|
BOX 1 Causes of Worsening Doctor-Patient
Relationship in the Society
• Misconception in society that every
death result from failure of doctors, avoiding one’s duties,
inordinate delay in referral, etc.
• Sensationalizing by media about doctors
overcharging for various tests and commission business, and biased
reporting by media in case of allegations of medical negligence
• Economic shock for the patient/relatives
in absence of health insurance and rising cost of healthcare
• Unrealistic expectation that paying more
money should always save one’s life
• Poor infrastructure, including intensive
care, crucial investigations, blood products and drugs, especially
in government set-up
• Poor communication regarding the
severity and adverse outcome possibility owing to lack of proper
training of medical and paramedical personnel in communication
skills
• Increasing intolerance and restlessness,
especially in youth, and lack of civic sense in public
• Insensitive and uncontrolled electronic and
social media leading to spread of false accusations and negative
image creation of doctor
• Lack of laws and their implementation
leading to perpetrators of violence escaping without punishment
• Political interference by the local
politicians as a show of strength and support to the public
• Grievance redressal system being poor
and slow
• Low health literacy in population
perpetuated by myths and false beliefs, leading failure to
understand a rational view
• Lack of adequate security and crowd
control measures in most of the hospitals, especially in the
government sector
• Psychopathology of transfer of one’s
guilt to another source – often healthcare system and doctors
|
What are the Solutions?
Role of Society
The society must understand that adverse outcomes and
death in cases of diseases and accident are expected, and not always are
the result of negligence.
As members of a profession that is supposed to
respond to human suffering, doctors have a social responsibility. But
will society reciprocate? There is an outrage when it comes to violence
against women, children or the common man. But have we seen an outrage
(except from health professionals), even when a doctor is grievously
injured by a mindless mob? Why don’t we see people on the streets
holding placards and seeking action against those unleashing violence on
the medical fraternity? Barring very few articles in print media and
occasional support by television anchor or politicians, this burning
issue has been largely ignored. Society should understand that vandalism
and violence in a hospital or clinic is a criminal offense, and any
civilized society should not indulge in such heinous acts.
Community fines and proscriptions should be enforced
for violence against doctors. Those who assault doctors should be
blacklisted and debarred from state subsidies and facilities, including
in hospitals.
Role of Government
It is impossible to curb violence against doctors
unless there is a complete overhaul of the existing economic system and
healthcare system. Our country’s health budget spending is meagre
(approximately 2%) as compared to that of Western countries. Raising
budget to address the problem of poor doctor-population ratio is the
need of the hour. Assault on any doctor should be equated with assault
on a government officer on duty. Existing laws should be amended to
prevent future incidents of violence against doctors. Though about 19
states of India have some kind of Act for protection of medical
professionals and healthcare establishments, the implementation and
prosecution rate are extremely poor. Protective mechanisms should exist
to prevent counter-filing of complaints by patient or the relatives in
case proof of violence by them is provided by the doctor.
Role of Media
Doctors are almost always portrayed negatively by the
media. There are sensational news reports of death and sting operations
against doctors. Such sensationalism not only is detrimental to doctors,
but also to the society as a whole as healthcare professionals become
reluctant to handle serious cases and challenging procedures and
surgeries [8]. Media needs to understand that the practice of medicine
is not a black-and-white subject. Rather than intimidating the doctors
and nurses by barging into wards and shelling them with a barrage of
questions even as they grapple with the high patient inflow in available
infrastructure, it is important for the media to play a responsible role
in bringing out the best of the doctors and project them as role models
so that the others are inspired to be ethical.
Responsibilities of the Institutions
Improvement of services in a global fashion;
employment of adequate number of doctors and other steps to ease the
rush of patients and long waiting hours; use of technology to prevent
long queues in the hospital; ensuring regular communication with the
patients; transparent billing systems; and installation of CCTV and a
zero tolerance policy towards workplace violence are the essential steps
to prevent violence against healthcare professionals. Hospital security
should be strengthened and it needs to be properly interlocked with
nearby police station. Also, there should be a proper complaint
redressal system in the hospital.
If violence occurs despite taking all precautions, it
is important for the institution to protect the doctors involved, but at
the same time not meet anger with anger. A standard operating procedure
(SOP), such as Code Purple [8] used worldwide to alert medical staff to
potential violence, should be developed. It includes the following
measures to be taken in case of violence:
1. An announcement on the hospital’s public
address system indicating location of violence, at the start and
also after it is over
2. Security staff to respond immediately
3. All the staff (except that of ICU and OT) to
come to aid, and form a human chain using restraint
4. A senior member of staff not involved in
treatment may try to communicate with the patient’s relatives and
try de-escalating the situation
5. The practice of this drill should be done
monthly in every medical establishment
Role of Doctors
Doctors should play a proactive role and ensure
ethical medical practice. Rightly, there has been a proposal of
including soft-skills and communication skills in the medical curriculum
that will help medicos to empathize, remain calm, and be patient
irrespective of repeated prodding by the anxious patients. The training
should help in assertiveness, refusal skills, anger management, and
stress management
1. Simon RI. Patient violence against health care
professionals. JAMA. 1892;18:399-400.
2. Ambesh P. Violence against doctors in the Indian
subcontinent: A rising bane. Indian Heart J. 2016;68: 749-50.
3. Phillips JP. Workplace violence against health
care workers in the United States. N Engl J Med. 2016;374:1661-9.
4. Peng W, Ding G,Tang Q, Xu L. Continuing violence
against medical personnel in China: A flagrant violation of Chinese law.
Biosci Trends. 2016;10:240-3.
5. Goodman RA, Jenkins EL, Mercy JA.
Workplace-related homicide among health care workers in the United
States, 1980 through 1990. JAMA. 1994;272:1686-8.
6. Pitcher G. BMA survey finds one-third of doctors
attacked physically or verbally in 2007. Available from:
www.personne/today.com/hr/bma-survey-finds-one-third-of-doctors-attacked-physically-or-verbally-in-2007/.
Accessed July 25, 2019.
7. The Times of India. Dey S. Over 75% of doctors
have faced violence at work, study finds. IMA study. Available from:
https://m.timesofindia.com/india/Over-75-of-doctors-have-faced-violence-at-work-study-finds/articleshow/47143806.cms.
Accessed July 10, 2019.
8. Reddy IR, Ukrani J, Indla V, Ukrani V. Violence
against doctors: A viral epidemic? Indian J Psychiatry. 2019;61, Suppl
S4:782-5
9. Nagpal N. Incidents of violence against doctors in
India: Can these be prevented? Nat Med J India. 2017;30:97-100.
10. Gupta VK. Is changing curriculum sufficient to
curb violence against doctors? Indian Heart J. 2016;68:231-3.
11. Live mint. Kumar SAK. Fixing India’s Healthcare
System: Strong Political Commitment is Needed to Build a System of
Universal Health Coverage and Better Regulations. Available from:
http://www.livemint.com/0pinion/pl58bANi9zaF0AR2MkUYuN/Fixing-Indias-healthcare-system.html.
Accessed July 11, 2019
12. Madhok P. Violence against doctors. Bombay Hosp
J. 2009;51:301-2.
13. Eurek Alert! STAMP System can help professionals
to identify potentially violent individuals. Available from:
https://www.eurekalert.org/pub_releases/2007-06/bpl-ssc062007.php.
Accessed July 11, 2019.
14. Healthy Practice. Incidents of violence against doctors in India:
Can these be prevented? Available from: http://healthypractice.in/index.php/2017/09/05/incidents-of-violence-against-doctors-in-india-can-these-be-prevented.
Accessed July 11, 2019.
