The White Coat – A Crown of Thorns?

Dr Ekansh Debuka,

KGMC Lucknow

The colour white is inherently positive and is symbolic of goodness, purity and cleanliness. As such, the white coat became the pre-eminent symbol of physicians all over the world since the early 19^th century. Besides enabling a doctor to be easily recognizable, it instilled calm in everyone and inspired unerring confidence.

For most aspiring doctors the “white coat” is a thing of dreams, it’s what ambitions are made of. To be qualified to dawn one is to be chosen to be a part of a small niche of gifted individuals in whom have been invested the power to heal and cure. But it’s a cape of thorns and brings a burden of responsibility to uphold the sanctity of this revered profession.

Like all things, changing times can lead to the erosion of the best of values and ethics. The doctor-patient relationship has deteriorated drastically and is at an all-time low resulting in some ugly and distasteful exchanges that have often turned violent. The margin for error for healthcare professionals is almost zilch and with the patients and their loved ones harried and already on the edge, even a small misstep from either party is enough to start an altercation. Couple that with the fact that the healthcare community doesn’t pose a united front at any level and the white coat, which once commanded respect and evoked an unflinching trust, a coat which was once a symbol of the sanctity of doctors, now, paradoxically, makes them soft targets. Sample this, according to a study by the Indian Medical Association, three out of every four doctors have faced violence at work. (1)

This is the indirect result of the meagre government spending on health care in our country which stands at a dismal 63$, lesser than even Srilanka and Bhutan as per WHO health stats 2018. (2) India spends only 3.95 of its GDP on the health sector of which the public spending is just at 1.15. Consequently, the private sector is burdened with handling much of the health care, especially the small and the medium private establishments. They provide the bulk of the services, are isolated and disorganized and very vulnerable to violence. An indication of the chasm between the private versus the public sector in India is the fact that Private healthcare costs four times more and yet the majority are still treated there.

On the contrary, there are those who strongly believe that the white coat instead offers protection to the wearer. Especially, the administrators and the policymakers, who are incidentally not the ones facing the brunt of it all, insist that steps are being taken to curb the violence. The doctors though have long argued that while it is a non-bailable offence to assault any uniformed public servant, no such provision is in place for them. This leads to the fearless attitude of miscreants which rapidly evolves into a mob mentality for they know there are shall be no consequences.

There is still, without doubt, a lot of respect for the caregivers with people in all walks of life making special considerations for them. A lot of this is intangible but is still acutely felt and cherished and is probably what our health care system thrives on. Unfortunately, it is a grave mistake to hope that this might by itself uphold the industry while plunderers run amok.

Steps must be taken and fast by both the government and the caregivers themselves. The media must stop demonizing doctors, must report responsibly and be accountable for what they present for it is they who form the public opinion. The government must re-enforce the industry with a strong legislature, better funding, stringent laws and valid concessions wherever applicable. The doctors must ensure they communicate better and counsel effectively so that the expectations are realistic. Proper documentation, getting insured, restricted entry and adequate security along with setting protocols are some pointers all healthcare providers must establish and inculcate. An interesting indicator to identify possible violent behaviour is the STAMP system which lays out certain red flags namely Staring and eye contact, Tone, Anxiety, Mumbling and Pacing. (3) This should put the doctors on high alert and deal with the situation and individuals accordingly. Above all, it is imperative that all these things start and progress hand in hand else we haven’t seen the lowest ebb of this yet.

Care for thy caregiver for he deserves better and so do you.

References:

1. Dey S. Over 75% of doctors have faced violence at work, study finds. Times of India4 May 2015.
2. http://www.newindianexpress.com/nation/2018/may/18/india-spends-just-usd-63-per-capita-per-year-on-health-who-report-1816416.html
3. STAMP system can help professionals to identify potentially violent individuals. Eurek Alert! The global source for science news. Washington, DC: Black Lack Publishing; 20 June 2007. Available at eurekalert.org/pub_releases/2007-06/ bpl-ssc062007.php(accessed on 2 Jun 2017).