The disturbing trend of increasing violence against doctors is a result of not only an overburdened hospital but speaks volumes about the declining relationship between doctors and patients. The medical fraternity has an important role to play in healing bonds
The recent episode of attack on doctors in a Kolkata hospital and the subsequent strike by them put the spotlight back on the issue of violence against medical personnel. Attacks on doctors by kin of patients have made regular headlines in recent years. A study conducted by the Indian Medical Association found that a whopping 75 per cent of the surveyed doctors had suffered some form of physical violence while on official duty. Pertinently, most of these assaults were reported from ICUs or emergency rooms where critically ill patients are admitted.
Further, a German study published in 2015 found that almost 50 per cent of the surveyed doctors had confronted aggressive behaviour, with 10 per cent of them experiencing violent attacks. A survey conducted in China found that incidents of physical violence causing harm increased from 48 per cent in 2008 to 64 per cent in 2012.
Instances of violence have considerably increased in recent years, not just in over-burdened public hospitals but also in private hospitals. At the root of this problem is the paucity of healthcare resources in our country. Shortage of human resource, stretched medical infrastructure and lesser number of beds are real problems that need to be addressed at the policy level. This disturbing trend is also symptomatic of the changing relationship between doctors and patients. Until a few decades ago, doctors were looked upon with much trust and faith by the people. Unfortunately, today, most people look at medical practitioners with suspicion and distrust.
Causes behind rise in patient violence: With the proliferation of private clinics and the emergence of corporate hospitals, there is a growing perception that doctors are operating with the intention of fleecing. The mistrust has also been fuelled by constant media scrutiny that highlights malpractices and corruption by medical practitioners. There is an interpersonal angle to the erosion of trust as well. In a country where the doctor patient ratio is far from satisfactory, doctors are always overwhelmed with patients. Heavily busy as they are, often doctors do not have enough time to invest in in-depth conversation with the patients. Saddled with a meagre healthcare budget, public hospitals present a dismal picture where overcrowding, long waiting time and the need for multiple visits for investigations and consultations frustrate patients on a daily basis. Lack of sufficient security and protection for doctors also embolden mob violence, which itself has seen a disturbing growth in recent years.
Role of hospitals: With doctors busy with clinical work, there is a need to have adequate number of managers to provide administrative and managerial support so as to allow doctors to perform their duties without fear or distraction. The officials responsible for administrating a hospital must not only have managerial skills but also adequate soft skills, a compassionate approach and understanding of social and behavioral issues. Here are a few necessary elements of a sound hospital management:
Consent and communication at regular intervals: Often, doctors do not adequately communicate with the attendants, who complain about being kept in the dark later on. At no point should the relatives be misinformed or given unreasonable expectations of recovery when the patient is critical. It is highly important that in case of critical patients, treating doctors meet families every day, even more than once if required and clearly explain to them the prognosis. Having a regular and honest communication ensures that patients are under no false expectations.
Informed consent is another significant step in preventing violence. While attendants are always made to sign documents before a medical procedure, doctors or the hospital management hardly explain the contents of the documents to medically illiterate families. Not to forget the need to have proper documentation of the patients’ course of treatment so as to be secure in case a matter goes to police or court. The golden rule of consent-taking is: “The person (doctor) who holds the knife holds the pen”. In short, consent should be taken only by doctors after a detailed explaining in the language understood by the patient/family.
Compassionate treatment of the kin: It is essential for hospital managers to inculcate the spirit of compassion and care among all staff members. For doctors and medical staff witnessing serious illnesses and mortality, it is an everyday affair. However, for families who lose a member, it is nothing less than an earth-shaking event. It is important, therefore, to be considerate to them, smoothen processes and eliminate unnecessary hassle. Care must be taken that attendants of critically ill patients are not pestered too frequently to pay bills. Doctors and staff members must try to console grief stricken families and counsellors for emotional support should also be made available. Compassionate treatment can go a long way in pre-empting any kind of unrest.
Be prepared: While all efforts must be taken to pre-empt violence, it is also important to be prepared to deal with a violent situation, much like one is prepared to handle emergencies such as a fire or earthquake. One of the most important steps to prevent violence inside a hospital premise is to restrict the entry of attendants through passes. Security guards must be placed not just on the hospital gates but also at sensitive areas such as ICUs and emergency units. Staff members at such locations must also be trained to stay alert to signs of any possible unrest. A standard operating procedure must be developed and each staff member should be aware of the dos and dont’s of such situations. If signs of aggression are noticed, senior management must immediately reach the spot, intervene and speak to attendants to prevent the incident from escalating.
Rebuild trust: For the medical community at large, it is important to make efforts to rebuild the lost trust between doctors and patients. They must also make efforts to not just treat the patients physically but also assuage their concerns and help reduce stress.
(The writer is MD of a leading healthcare company)