Dr Geeta Sundar

According to the World Health Organization, violence is the intentional use of physical force or power, threatened or actual, against a person, or against a group or community that either result in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. [1]

Violence can be divided into four groups: by intent crime, from consumer to worker, worker from another worker and interpersonal relations. Violence, thus, could be verbal or behavioural affecting the healthcare workers physically or physiologically. [1]

Studies published across the world have reported high incidences of violence against medical professionals. Most of them claim that nurses in the psychiatry department and dementia units were subject to almost a constant level of physical abuse, whilst the emergency care physicians are the doctors facing the major brunt of this burden. And since reporting of the act is voluntary, only 20-30% of the victimized take the next step. [1, 2, 6]

Studies conducted in various countries are as follows: [1, 3, 5]

  • In the US, 78% of ER doctors were subjected to violence in 2011 alone.
  • Switzerland reported that more than 50% of its staff had faced violence.
  • Japan reported that 10% of their health workers reported sexual abuse in 2011.
  • Birmingham reported that more than 60% of GP’s experienced abuse or violence at the hands of there in a year.
  • In Germany, 50% of their physicians were subject to aggressive behaviour out of which 10% faced serious criminal consequences.
  • In Israel, 70% of doctors and 90% of the working staff of the ER reported violent acts.
  • In India, a study reported 87% of incidents were verbal.
  • Indian Medical Association states that over 75% of doctors have faced violence at work.

But this is just the tip of the iceberg. Borders don’t divide violence into developing or developed nations. Violence stems from an inherent part of our lives in this era and is almost as prevalent as the air we breathe. The WHO, in the light of the matter at hand, has initiated a global campaign for violence prevention. The National Crime Victimization Survey, US, showed health care workers have a 20% higher chance of being the victim of workplace violence than other workers. According to the Occupational Safety and Health Administration (OSHA), approximately 75% workplace assaults reported annually occurred in health care and social service settings and workers in health care settings are four times more likely to be victimized than workers in private industry. [1, 2]

When the above-mentioned reports of violence-plagued Birmingham, the NHS replied with its own “Zero Tolerance” guidelines. Their zero tolerance attitude, been in place since 1999, started prosecution of offenders since 2003 and has also set up a CFSMS – Counter Fraud and Security Management Service. The NHS SMS Legal Protection Unit helps trusts with Guidance on patient confidentiality and the Data Protection Act, Advice on issues such as withholding of treatment, legal advice on the most appropriate sanctions and redress available for specific cases and advice in cases of physical and non-physical assaults. [3, 4]

Similarly, the United States, under the Joint Commission has addressed these issues to provide legal support for its healthcare workers. As published in the Sentinel Alert Event in 2018, for improvement of tracking efforts, OSHA launched the Injury Tracking Application, a secure website where covered employers must submit their workplace injury and illness information, including acute injuries and illnesses, days away from work, restricted work activity, or job transfer. Also, to safeguard their health workers’ interests, as per the General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act of 1970, employers are required to provide a place of employment that is “free from recognized hazards that are causing or are likely to cause death or serious harm”.[2, 7]

In addition to this, to create awareness and educate the healthcare staff on the risk factors, the possible outcomes and the steps necessary to deal with such acts of violence, OSHA, Department of Health and Human Services (DHHS), NIOSH, Department of Labour published many recommendations and information bulletins for training their staff on violence prevention and actions. [8]

In contrast to all these western nations dealing with their workplace violence in a systematic way, encouraging reporting and advising on the ways to ebb the menace, India still stays a wide breadth behind. Neither has she taken the required norms to protect her healthcare staff, but she also hasn’t raised any potential judicial corrections. The laws are in place, but none too strong or complete or evident to help the injured healthcare workers. [9]

There are multitude of reasons for workplace violence – incomplete and influenced media coverage on doctors, meagre health budgets, illiteracy of most patients, small and medium private nursing homes, lack of support from the law, expensive healthcare with no insurance, the intense number of patients, lack of communication and follow-ups, absent security personnel, lack of adequate mental health care and the mob mentality of people – some spectacularly evident in India than the other nations. But, without starting a momentum, without encouraging a uniform adequate behaviour of the society, without lending an ear, without sheltering compensation for the victimized, without executing the necessary steps to secure and preserve the future generations of healthcare professional, Indian health workers can only bat with peaceful rallies and demonstrations, absenteeism from work and discourage their children from entering this field of noble glamour underlined to disrupt like a grenade.[11, 10, 3, 5]




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