Risks of Saving Lives

  • cover - august issueWritten by Vinod Kumar
  • Doctors in our country are at rising risk in the workplaces due to the angst of distressed relatives. Many reports concern medical professionals being roughed up, even killed, by patients’ disgruntled relatives. There are a numerous cases of violence against healthcare professionals leading to death of some doctors as well as nurses by patient’s relatives. This situation seems to be similar in most of the countries in this region including China, Bangladesh and Pakistan.

According to a recent study by the Indian Medical Association (IMA), over 75 percent of doctors in India have faced some form of violence at work. An another study published in medical journal The Lancet said that delay in attending to a patient, request of advance payments, or withholding a deceased body until settlement of final billing are a few of the reasons why angry relatives tend to lose their temper and attack doctors.In view of growing violence many doctors feel that medicine has become a ‘dangerous’ profession, and they should be provided ‘security’. A report suggests that almost 70% of doctors won’t want their own children to go into the medical profession.
Increasing commercialization and corruption coupled with unethical practices by some medical professionals, lack of communication between doctor and the patient, poor image of medical profession, lack of faith in judicial system and the police and insufficient security for doctors have lead to increased violence against the healthcare professionals which has highlighted the importance of patients satisfaction and patient safety.
A number of news reports also throw light on the fact that violence in healthcare sector has been increasing at an alarming level throughout the country. Doctors become an easy target for the blame game by sensational media reports. Since a wide gap exists between the patient’s expectations and the reality, patients who feel they have not been looked after properly then take the matters in their own hands. These incidents have certainly decreased the self esteem of the doctors. “Health Spectrum” has speaked to many doctors and health activists. According to them, it is high time that authorities in our country should wake up and initiate some effective measures. Some of these could be as under:
1. Strict accreditation of medical and dental schools ordering closure of all those institutions with poor quality and standards. Those institutions which fail to get accreditation should be given some time to improve and make up the deficiencies failing which they should be closed down.
2. The number of enrollments in each medical and dental school should be based on the number, quality of teachers and other teaching facilities.
3. Doctors should never assure 100% cure and avoid negligence.
4. Each patient should be adequately examined, investigated and treated.
5. Negligence should not be accepted under any circumstances.
6. Over confidence and too much cautiousness in patient care should also be avoided.
7. A realistic appraisal of the prevailing situation and communication to the patient and their attendants, relatives should be ensured.
8. Patients should be involved in decision making regarding their treatment giving them adequate information about the possible complications.
9. Periodic updating of the condition of the patient to the attendants is necessary. Healthcare professionals in general and junior doctors in particular must develop proper communication skills and empathy.
10. Every healthcare facility must have a liaison office to deal with the media and respond to their queries. No media personnel the electronic media in particular should be allowed to enter the healthcare facilities without permission and they should be briefed by the liaison officer or the hospital spokesman. Media in particular has to show responsibility while reporting health issues and those covering health must have some core knowledge of health issues.
11. All healthcare facilities must have a proper boundary wall with adequate security system in place with monitored entry of public. Security guards should be posted inside the hospital particular in most sensitive areas like Emergency, Intensive Care Units, and Operation Theaters.
12. There is a need to improve the Doctor-Patient relationship. Under no circumstances the previous hospital or the referring doctor should be criticized.
13. Avoid using words like you have come late.
14. In desperate situations, the patient must be given the choice of calling another doctor for second opinion if they so desire.
15. Professional specialty organizations should play their role and come up with a mechanism of self monitoring of their members to ensure ethical medical practice.
16. Relationship between the Physicians and the Pharmaceutical Trade and Industry needs to be looked into and Guidelines prepared by the National Bioethics Committee on the subject should be implemented which will go a long way in eliminating unethical practices.
In short there is an urgent need to make the healthcare facilities a safe environment for the healthcare professionals to work only then they can be expected to work with devotion and dedication. Breaking News on the Television Channels regarding death of patients due to doctor’s negligence has only served to work against the patient’s own
interest as now the healthcare professionals are very reluctant to handle serious cases, hence many precious lives which could have been saved are being lost.

• Nearly 50% of violence reported form ICUs or after a patient has undergone surgery, says ongoing IMA study
• Kin & attendants of patients behind 68 % of such cases
• Visiting and peak hours most prone to violence, besides the tense moments during transfer of critical patients to hospital
• Experts say figures would be higher as most doctors don’t report such incidents

Doctor’s Views

Raju VaishyaViolent society is detrimental to the practice of humane medicine

  • Dr. Raju Vaishya

It May Be Asking Too Much Of Doctors To Be So Active, Given The Present State Of Affairs. We Can Begin Small, By Promoting Ethical And Honest Voices From Our Profession. We Can Also Increase Our Credibility By Condemning Colleagues Who Collude With Criminal Politicians.
A violent society is detrimental to the practice of humane medicine; it negates all the ‘achievements’ of modern medicine. The medical profession must do more than just condemn such violence; it must reflect on the ethics of its own practice. For doctors, this means not perpetrating violence through their practice, through the medical system or through collusion with the perpetrators of violence. It also means practising an active social ethics, being at the forefront of preventing violence and caring for all victims of violence, irrespective of their crimes and ideological affiliations.

Nearly 75% of doctors fear for their lives

Dr Prerna Motwani
Writer with Curofy

“I solemnly pledge myself to consecrate my life to service of Humanity.” This is the first declaration that we make as a doctor. The day we get our degrees and start practicing, a new life begins for us, a life that was pledged for humanity.
Doctors are considered as ambassadors of wellness and health, whom the society can look up to. It’s no wonder that more than 50% of our population wants their kids to grow up and become a physician. Yet, doctors are the most misunderstood underrepresented and overworked community in India.
A resident is supposed to work for 36 hours continuously, without making any error. Today, under every circumstance a doctor is expected to be efficient, congenial and ever smiling. Any break in this perfect behaviour is dealt with extreme backlash, usually in the form of violence.
Violence amongst doctors is not something new, it’s something that we read every now n then in the newspaper, condemn on social platform and then forget till the time another doctor gets beaten up.
Many blame this on the commercialisation of healthcare, which has led to a trust deficit between doctors and patient. But many of the incidents have happened even before the treatment was started. A resident ophthalmologist was beaten up in Jaipur till his hand was broken, all because he asked a patient to get in line for OPD. A dentist was beaten up in Pune because he wanted to step out for lunch after spending hours treating patients, and the patients waiting outside thought it was too much to ask for.
India as a country has grown largely intolerant towards doctors. Medicine is a noble profession, so how did we come to this point where violence against doctors has become an everyday occurrence?

1) Skewed patient: doctor ratio – According to a report there are only 0.7 doctors per 1000 people in India. This means that every doctor is overloaded with work, sometimes beyond human capacity. The sheer volume of patients that a single doctor has to treat is overwhelming and it’s no wonder human that a few mistakes occur. If you overload an individual with work beyond human capacity, mistakes are bound to occur.

2) Deplorable condition of government run hospitals – Thousands of doctors graduate every year in India, out of these only 10% get to do a post graduation. What about the 90% who didn’t? They either try to find jobs or set up their own private practice. In a country that has a skewed patient: doctor ratio, it’s an irony that there is a dearth of jobs for healthcare professionals. But unfortunately, government does not want to increase the number of vacancies in government hospital, and a few hospitals that do have vacancies are in deplorable conditions.
Patients who get treated in such institutions are obviously dissatisfied; they can’t express their anger on the government so they blame it on the person nearest to them, the doctors.

3) Commercialisation of healthcare ecosystem- It’s no secret that private hospitals have led to unethical medical practices. They exist to make profit and make no qualms about it. They justify their pricing by providing world class amenities to patients, but in the process a profession that was considered noble by everyone became a service to be provided. A doctor is still a healthcare professional who saves life, but a patient becomes a consumer who wants a perfect service. In such a scenario, if the doctor falters in anyway he/she has to face the wrath of the patients.
Nearly 75% of doctors feel that they are unsafe in this country and fear for their lives. As a healthcare professional, they should be able to invest their energy into saving lives of people, not their own.

Dr. Monisha KapoorHospitals should have better communication with the patients

  • Dr. Monisha Kapoor.

There is no doubt that violence against doctor is increasing but cannot initially put the blame on the violator. Empathy is one thing that is missing now a day in medical profession because of lack of trained medical professionals and increasing work load leading to less time left for communication between doctors and patient that is the root cause of these violent episodes.
As a doctor, I myself have been a patient in one of the busiest hospital of Delhi, where I could not get to see the doctor who operated on me, before or after the surgery, being a surgeon myself I could understand there busy schedules and did not react as most of the majority who react to it, Probably as a doctor, I know everything is going to be fine, but non medicos get anxious very fast, when their close one has a medical aliment which they have no clue about, and the cold attitude from the hospital and staff make them go angry and leading to taking out there frustration on the doctor. It’s neither their fault nor the doctor’s. Its failure of communication and the warmth touch and assurance they need from medical side, which lots of hospitals fail to delivery. Hospitals should have special “patient _medical staff” purely dedicated to communicate with the patients and their attendant and apprise them of condition of the patient.

Dr. Monisha Kapoor.
J-18, Near SBI Bank, Saket
Mehrauli-Badarpur Road
New Delhi-110017
Phone: +91 11 40666307/08
Mobile: +91 9811439395

Over 75% of doctors have faced
violence at work, study finds

Violence against doctors varies from physical assault to threatening behaviour to mere verbal abuse.
NEW DELHI: Those who save lives are themselves at risk. More than 75% of doctors across the country have faced at least some form of violence, initial findings of an ongoing study by the Indian Medical Association (IMA) have revealed.
Doctors faced maximum violence when providing emergency services, with as many as 48.8% of such incidents reported from intensive care units (ICUs) or after a patient had undergone surgery, the study said. Relatives and attendants of patients were often found guilty of such actions. According to the findings, data of the past five years showed that escorts of patients committed 68.33% of the violence.
However, experts said the findings did not reflect the actual situation as not all cases were reported. The gravity of the problem is much more. “All cases of violence are not reported. Doctors often understand the situation of relatives who are in distress and do not report such cases. Mostly, those cases are reported where the doctor feels serious threat of life or has already faced so,” IMA secretary general Dr KK Aggarwal said.
Violence against doctors varies from physical assault to threatening behaviour to mere verbal abuse. While most incidents of violence were found to have occurred during visiting hours and peak hours, when doctors are busy and visitors are around, the study found that doctors and paramedical staff also had to face rage while transporting serious patients to hospital.
“The transport time is very crucial. This is also a kind of emergency service and relatives of patients are nervous and under stress. Any delay or even an unintended negligence results in huge rage and anger among the patient’s escorts,” the head of emergency services in a leading private hospital said.
While IMA is advocating a stringent law at the Centre to address the situation, doctors and healthcare experts say there is a strong need for counselling of relatives and escorts of patients.
Doctors need to keep patients and their relatives in the loop from the very beginning. “Patients should be told the truth, about the adverse effects and also given the choice of alternative treatment,” Dr Talat Halim, director, trauma and emergency at Fortis Hospital, said. He added that medical practitioners needed to show empathy with patients as well as their escorts, who are often in distress when in hospital.
Experts also pointed out the need to streamline processes in hospitals and at other healthcare delivery centres. For instance, a lot of violence-related cases happen when the patient passes away. While hospitals insist on clearing payments before handing over the body, distressed escorts often get into fights in such situations. Experts said such processes needed to be streamlined and handled by non-medical people.
The trend of violence against doctors is also on the rise in China. In 2006, around 5,500 medical workers were injured by patients or their relatives. However, in 2010, such cases increased to 17,000.
Source : Times of India, May 4, 2015

Vinod Kumar

Health Journalist & writer. Editor of monthly health magazine "Health Spectrum."

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