Dr Sanjay Kumar Bhasin
The violence against two interns (under training MBBS) in NRS Medical College Kolkata once again triggered a hot debate on both social media and mainstream media. Violent posts started pouring in on face book and whatsapp, both favourable and unfavourable to doctors. Politicisation of the issue by few quarters with a hope that Central Government may impose Governor’s rule in Bengal further made environment of the country more volatile. It compelled me to think many a time why there was not such outcry on the death of Dr. Payal Tadvi who died of organised and calculative violence by her own colleagues. It is worth mentioning here that violence against doctors is not a new phenomenon and there is hardly any state or union territory in India where one or the other day we do not find violence against doctors.
As was expected, it triggered a debate on main stream media and both good writers from medical and non medical fraternity tried to put forth their narratives as per their experiences. The medical fraternity tried to develop its narratives on the basis of their experience in the profession and the epicentre of their justification for violence against doctors was, “The unfortunate trends of assault on doctors that is becoming more frequent with every coming day, seems to be the result of public’s anger against the healthcare sector that is not adequately fulfilling the needs and expectations of the public.” There were further recommendations that henceforth private Medical Colleges should be shut down, merit should be sole criteria for selections and reservations in medical entrance tests should be scrapped. Second narrative of another medico was, “the Mobocracy has to be suppressed if we want democracy to survive or else, Medical fraternity has to wait for next Babasaheb Ambedkar who will fight for rights of these second class citizens of Mobocracy”.
Another view point of a non medico bureaucrat had self contradictions within his write up. He accepted that pharmaceutical lobby is very powerful across the globe and being a retired bureaucrats he very well knows that it is more powerful in India due to largely corrupt bureauctico-political system which he himself failed to curtail as a long serving bureaucrat. He found his base in the greed of doctors due to reasons of wrongly diagnosing patient to earn money. He failed to find his faith in both meritorious cardiologists of AIIMS private sector and ultimately rested his faith on an NRI doctor. Another experience of his was again with another meritorious orthopaedic surgeon, whose advice he rejected. The narrative of this retired bureaucrat negates the merit argument of the medico above. In spite of his very limited experience with the profession restricted up to 3 patients and 10 doctors, he universalised the greed as cause of violence against doctors. But, he kept 07 out of 10 narrated doctors on high esteems, thereby negating his own arguments. Stories form contents of the narratives rather than extensively touching real issues of “What Ails Medical Profession” that leads to Violence against doctors.
Now let me narrate my point of view on the subject, it is almost 34 years since I joined this profession as a student. For almost twenty years I remained actively involved in students, residents and senior doctors associations as well as academic bodies of my profession. In last 34 years, I have seen 35 strikes of medical students/junior doctors and none from senior doctors, the reason in almost all the strikes was violence against resident doctors by attendants/passer bys triggered by non availability of BP apparatus, emergency medicine, oxygen, no counselling from the CMO/administration representative. So the narrative of merit and its associates finds no justifications. The uncalled for violence against doctors all over India compelled IMA to report that, “82.7 percent of the doctors in India are stressed out, major reason being fear of violence & to be sued as well as lack of sleep. It further added that 56% do not get 7 hrs required sleep during all days of week and 62.7% exam patients under the fear of violence.” Narrative of approaching doctor with Faith & Fear as well as Hope & Hostility also gets negated with the said report of IMA. But if both takers and providers are under stress, what are the reasons of ailing of medical profession ultimately leading to violence by takers against the providers.
Causes of Increased Violence against Doctors:
* Poor Govt. Investments and heavy workload.
* Lack of supervision on Corporate Hospitals to curtail Profit Driven Attitude.
* Lack of empathy and communication with patients.
* Lack of trusts in doctors and hospitals due to induced demands and high medical fees.
Studies have shown emergency situations as originating point of maximum violence and strikes due to maximum “friction” between providers and recipients of health care. The staff working there endures maximum stress coupled with extremely high emotional quotient as all stake holders are “charged up.”
Solutions:
* Doctors should show empathy towards patients/relatives with regular introspections. Regular CMEs and credit courses on improving doctor-patient relationships.
* Communication is the key factor and Patient’s relatives should be kept in loop from the beginning telling them truth about adverse affects.
* Given option for second or alternate treatment.
* Meticulous Record keeping by the Resident Doctors and regular monitoring by the seniors.
* PGs/Residents, new recruits must undergo pre-placement and periodic appropriate training regarding the risk factors for violence in the health care environment, skills in aggressive behaviour identification and management by showing recorded videos of actual incidents and mock drills.
* Streamline processes in hospitals and other healthcare delivery centres by way of written workplace violence prevention policy and implementation.
* Employees’ involvement in policy development, preferably joint management-service providers violence prevention committees.
* Immediate post assault counselling and debriefing.
Conclusion: Ever since the medical profession was brought under the ambit of Consumer Law, technically profession ceased to be ‘noble’. This further led to profession’s commercialisation leading to mushrooming of Corporate Health Sector, Inducements, and deteriorating ethics/Interpersonal relations. Fuel to the fire was added by lack of Drug Policy, Bureaucratico-political influences /activism /over activism, low pay/perk of government doctors and Lack of Media Support (Negative Journalism). Greed has been thrusted and violence is the outcome. The medical journal Lancet observed few years back, “We must protect patients but we must also find better ways to protect professional. If we do not, medical progress will cease, particularly in controversial and distressing area”. Let us all not compel doctors to completely distance themselves from the ‘Hippocratic Oath’. Stop both violence & labelling doctors as greedy, if existence of God cannot be erased substitution of a doctor cannot be found till mankind survives on the earth.
(The author is Senior Surgeon,
Social Activist, Columnist &
Hony Secretray JAKASI)
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