Mannat Kaur Bhatia
Final year Mbbs
Government Medical College, Patiala
The World Health Organisation defines violence as “ the intentional use of physical force or power, threatened or actual, against oneself, against another person or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation” (1) It includes threats, verbal abuse and the use of weapons like scalpels and scissors to physically attack the doctors and nurses. Every doctor, especially every family physician knows patients in his or her practice who have experienced violence- survivors of child abuse, sexual assault, or intimate partner violence etc. But how well is violence against these doctors themselves understood? Is it not important to reflect on how this profession—always held in respect in our society—has come under the siege, threatening the sanity of the people who were previously bestowed upon a divine status?
Before I approach this further, there is a need to understand the psychopathology of this brutality, in the recent scenario, especially in India. All around us we see several identity groups assaulting people whose views they do not agree with. We have seen writers, filmmakers and journalists being killed for their views. In a similar pattern of thought, this ferity against health care professionals is the despondent violence of the victim who has had a loss of faith in public health institutions and has anger against the perceived marginalisation, using violence as a displacement of this general frustration, on to the doctors. There are many reasons for this distress, the most important being a sense of neglect and dissatisfaction to the patient. Any average medical officer posted in a government hospital sees close to 350 patients per day, which could compromise the quality of care. Secondly, media sensationalised stories of organ theft, medical negligence and malpractice have led to an increased distress in the public, of the health sector. Due to all this, violence from patients families has become nothing more than a desperate demonstration of power that has led to a work environment, where the young resident doctor, working at the frontline of an overburdened, poorly funded and understaffed public health system, gets beaten up with a minimum reward for his toil.
Unfortunately, this is not just an Indian phenomenon. US Today in its op-ed piece quoted from a 2010 survey of the Emergency Nurses Association, that more than half of the ER personnel were victims of physical violence, including being spit on, shoved or kicked,
and one in four reported being assaulted more than 20 times over the past 3 years (2). This brings us to a stark reality again – that to what extent is violence acceptable and tolerable?
An immediate step is to understand accountability, not only from doctors but also from patients, government institutions, civil servants and all other sections of society. What this means is that the general public must truly believe that the institutions of the state which have been nominally created to serve them are actually doing so. In return, doctors should propagate a good understanding of the patient prognosis to their families and communicate openly to the patient that in spite of recent advances in medical technology, there are some interventions and cures that have not yet been achieved. It needs to be emphasised that doctors can’t perform miracles, but can only modify the disease process.
Most importantly, to make hospitals a safe environment for the doctors and nurses, there needs to be strengthening of laws making any kind of violence a non-bailable offence. The government should aid in placing these stringent laws at every health institution along with measures such as checking for weapons at entry, providing visitor badges at entry and not allowing too many attendants with the patient.
The recent pattern wherein humiliated doctors go on strike demanding security resulting in the ministers mouthing words of sympathy initially, but a few days into the strike, threats are again issued to the doctors to get back to work. This will continue to be without any effective solution to the problem since violence in itself, is not just a security issue. The management of violence needs to catch up with the daily reality facing the healthcare sector, to ensure that doctor-nurse safety is valued alongside patient safety. The physicians and other health workers should by no means accept this violence as part of their job, instead should try and reduce this divide between the medical community and civil society.
- World Health Organisation. Violence. 2011; http://www.who.int/topics/violence/en/ Accessed March 3, 2011
2.USA Today op-ed: Violence Against Doctors and Nurses Due Health Care Dysfunction.