When the bad news broke
The pleas for help suddenly became snarls
Tears dried up in eyes red with anger
Screams of anguish turned into roars of rage
The grief gushed out in the form of fury
And all hell broke loose
With revenge on their clouded minds
They began their menacing rampage
Destroying everything in their path to avenge their lost loved one
Shattering and smashing, ruining and ravaging
Finally the doctor lay still, bruised and battered
The pristine white coat was splattered with blood
Of the unfortunate one who adorned it.
Unfortunate, my friends, because there are some things we simply cannot control and yet we will be persecuted for outcomes beyond the reach of our Godlike abilities; attacked by the very people who came seeking our assistance, an emotional overreaction to the unbearable grief of losing a loved one. And for all the lives we bring back from the very brink of death, there always will be some who slipped away into the darkness.
Why is it that a doctor is expected to be altruistic, above temptation and akin to God, but he himself is not above suspicion, reproach and ridicule, and indeed, maligning and violence? For those who think these are isolated incidents and actually happen to very few doctors, a study by the Indian Medical Association states that over 75% of doctors in our country have faced some form of violence at their workplace. But why is this happening to the doctors, healers and lifesavers? There are quite a few causes which we must consider to fully understand these tragic outcomes.
Trust in the doctor-patient relationship has taken a beating (pun intended). The patient, once beholding his physician as the very embodiment of the Almighty, and taking his doctors words to be the gospel truth, has now lost faith in the capabilities of his saviour, wanting third and even fourth opinions before accepting the diagnosis. As the commercialization of health care increased, some doctors were accused of being driven by greed and adopting unethical
practices. Reports of unnecessary tests and needless invasive procedures just adding to the bill have caused patient distrust to grow and fester.
Patients are subjected to pathetic conditions- overcrowding, long waiting time to meet doctors, multiple visits to get investigations done as well as consult doctors, sharing a bed by two and sometimes three patients and poor hygiene and sanitation. Most patients lack health insurance- often the diagnosis comes as a financial disaster and shocks them into emotional turmoil. Frustration builds up with the innumerable problems of government hospitals like dysfunctional equipment, lack of necessary facilities and a shortage of staff and eventually boils over, resulting in the displacement of anger toward the physician. Given the poor budgetary allocation for health in India of only 1.3% of the GDP in the last 5 decades, the public healthcare system is on the verge of collapse. Violence against the health service provider is only a symptom of this crippling underlying malady.
The common public has a complete lack of faith in the law and order system as well as the judiciary. People now believe in exacting immediate revenge and take the law into their own hands, seeking their ‘pound of flesh’ using physical means rather than filing a case in court. Mob mentality frequently snowballs into a violent crisis in hospitals. No stringent laws exist for the protection and safety of the medical community. The public is well aware of this phenomenon and manhandles doctors without hesitation. Since such acts of violence regularly go unpunished, it emboldens the mob and encourages the occurrence of the next incident. There were 53 incidents of violence against doctors in 2 years Mumbai alone, with none of them resulting in a single arrest. Forget patients, even doctors cannot rely on the legal system to get justice! One will not forget the sorrowful story of Dr Kafeel Khan in UP, who spent 11 months in prison because he exposed the malpractices in the system and tried to make alternate arrangements of oxygen for his dying patients when the supplies in the government hospital he worked in had run out.
The media has played a major role in demonizing doctors with the sole objective of selling more sensational news. It is quite easy to scapegoat the physician and lead the public on a frenzied witch hunt. Such scandal-mongering has sowed seeds of distrust and scepticism deep in the minds of the people. Politics in India is dominated by sectarian groups with religious agendas. Some separatist party leaders feel no shame in publicly castigating physicians. In fact, a common method of gaining political mileage and securing the vote of the local community is marching into a hospital with the patient, and publicly manhandling the doctor.
This is not to say that the doctors are not at fault sometimes. In recent years we have seen physicians work in their own technical world, which results in a major disconnect between doctors and society. The public sees doctors as a group of people who are working in isolation and who are disinterested in them and their problems as patients. The importance of teaching empathy to budding doctors cannot be stressed enough. Proper and effective communication with the patient and the attendants is an art and should be taught to all young medical students.
We must remember the wise words of William Osler, “The good physician treats the disease; the great physician treats the patient who has the disease”. We have to bring back the concept of “family physicians,” who not only communicate well with families but also help and guide them when taking important medical decisions. In emergency and ICU settings, doctors should take time to clearly explain patient prognosis to relatives who may harbour unreasonable expectations. Counsellors for emotional support should be available at all times.
Mobocracy cannot be allowed to raise its ugly head. Laws should be enacted to safeguard the security of doctors and nurses and all healthcare workers. Assaulting medical personnel on duty should be made a cognizable offence, with serious legal consequences like prison time and a hefty fine, and these should be prominently displayed on the walls. Security personnel should be posted at the entrance of every hospital and should not let anyone through without checking for appropriate identification. Weapons should be confiscated before entry. All relatives must register at the front desk and be given a visitor badge to be worn at all times. No more than two relatives should be allowed to see the patient at any time. To ensure doctor safety, every hospital should create an emergency protocol and an evacuation plan in case of a major act of violence.
Violence in any form and in any setting is reprehensible. However, acts of violence in a hospital are the most extreme and should be dealt with an iron hand. Hospitals are sanctums of healing and recuperation. In addition to jeopardizing the safety of medical personnel, violence threatens patient safety and hampers their recovery to health.
Isn’t it ironic that after honouring Mahatma Gandhi as the “Father of our Nation”, today we blatantly disregard his most basic principles of Ahimsa-the practice of non-violence? We must not let these ugly incidents mar the medical community. We must work with the government and the public to tide over this urgent and crucial problem. Only if we are united and make it clear that we will not take this lying down, but stand up for our basic rights of safety and security, will there be a change in the laws as well as the people? We will not be cowed down by such tactics and continue to diligently fulfil our duties towards our patients who desperately need our timely aid and expertise. And we will stand strong together in the face of adversity, always hoping for a better future. Jai Hind!