Dr Amogh Nandkarni
Physician, help yourself: thus help your patient too. Let this be his best help: that he may behold with his eyes the man who heals himself.
RohanMhamumkar, a senior resident doctor at Government Medical College, Dhule, recounted the horrifying incident that sprung from referring a complicated case to neurosurgery hospital. “The incident was petrifying. I have got a skull fracture, and I lost my vision in the left eye.”
In another case at the state-run JJ Hospital, two resident doctors were assaulted by relatives of a deceased patient, resulting in facial injuries and large damages to hospital property.
Multiple similar instances all over the country demonstrate what policymakers have long suspected, that the incidents are not pre-planned by situational outbursts of anger against a failing healthcare system, marred by apathy and corruption. A look at various contributory factors would highlight this point:
1) India just spends 1.4% on its GDP, pathetically short of the expected 6%, even lagging behind its major defence and technology rival, China, at 3.1%.
2) With a physician ratio of 1 per 1800, a statistic widely contended because of the fact that doctors who often retire, die or emigrate end up being counted in the healthcare system, India has a tough task ahead of creating a robust healthcare environment.
3) A recent study by the Indian Medical Association pegged the numbers of violence against healthcare personnel at 75%, either in the form of verbal or physical abuse.
4) In a state of apathy from the government and widespread demonization, doctors all over India have taken up innovative means of self-protection, either resorting to union strikes reminiscent of India’s socialist era, as seen in the case of Maharashtra association of resident doctors. Or, taking defence into their own hands, as seen as Taekwondo training courses being taken by doctors at All India Institute of Medical Sciences, Delhi.
5) Nobel Laureate Amartya Sen, as an exercise, studied around 5000 articles in 2012, published by India’s major editorials, only to find healthcare reportage was pegged at 1%, not even a number representative of either GDP or public expectations.
6) A BMJ study documented the time spent with the patient by Indias primary healthcare consultants as a measly 2 minutes, way behind first world countries who averagely gross upto 20 minutes in patient interaction. The phenomenon of practicing medicine in an ivory tower has distanced and dehumanized the doctors, if public perception is to be believed.
While legal recourse has been sought, with Nineteen states of India have some kind of Medicare Service Persons and Medicare Service Institutions (Prevention of violence or damage or loss of property) Acts passed and notified in the past 10 years, the enforcement is far from nation-wide.
Further, the Medicos Legal Action Group stated the lack of filing an FIR by the local police, hush agreements reached between doctors and patients, and the lack of a single penalty case under the law as an indication of its failure.
Innovative measures suggested include the initiation of a Central Law under the Indian Penal Code and stricter and more enforceable jail terms against those who perpetrate violence. In the tangle of the judicial system, a report of violence by a healthcare personnel may be met by a report of criminal negligence filed by the attendants of the patient. Further, the need for greater doctor-patient communication in the world where interactions have become increasingly meagre may go a long way in giving the modern healthcare professional the image makeover that is so needed in these times.