Why can’t we Solve Violence against Doctors?

The attack on doctors is the outcome of a severe crisis in the Indian Healthcare System. With simmering resentment among both patients, healthcare providers are finding it hard to obtain actionable targets.

In January last year, *Swamy received a chilling call from his mother. She told him that she was diagnosed with a malignant tumour in her stomach. It was a terrifying time for the entire family. However, what made the experience even more difficult for Swamy and his family was the lack of empathy of specialists in their city.“The oncologist at one of the major hospitals was not even willing to listen to my mother. He spoke to her exactly for three minutes and asked her to talk to his assistant. It was such an infuriating moment for me. Hearing about this incident, my family doctor suggested going to a teaching hospital, where his batchmate was working. It is sad that today you need the recommendation to get the attention of a doctor” explains Swamy.

Many Indian patients are not as patient as Swamy. According to a study by the Indian Medical Association, over 75% of doctors have faced violence at work. Dr Arun Gadre, says that the lack of standard operating procedures and lack of transparency regarding pricing often leads to tension between doctors and patients. “I had a bitter experience at a top hospital in Pune. The surgeon was my friend and told me that the implant for surgery on the leg of my daughter would cost me Rs 50,000. However, the final bill was Rs 1,04000. This is the sad reality of our healthcare system,” adds Gadre, who practised in a drought-prone area of Maharashtra for more than two decades.

He also notes that it is crucial to create a panel with doctors as well as patients, to deal with patients complaints. “With schemes like Ayushman Bharat, it is important to have more checks and balances otherwise it will lead to more issues between the doctors and patients,” adds the gynaecologist.

Unnecessary Tests, Procedures and Operations

However, this will not be easy. In just a decade, the number of women who opted for a Caesarian section (C-section) more than doubled across India, especially in the cities, according to a study published last year by Mumbai-based International Institute of Population Sciences (IIPS). Why? “Many doctors are worried about complications and don’t want to take the risk,” says a Cochin-based Gynaecologist.

Dr *Hari, a general physician seconds her opinion.“I have become a  doctor to cure people. Many doctors earn more money with these commissions from laboratories than their fees. I usually ask the lab to give the discount to  patients, as I don’t accept cuts.”

In his speech a few years ago, even Prime Minister Narendra Modi also mentioned about doctors' foreign trips to attend pharmaceutical company-sponsored conferences. "You probably know that doctors' conferences are held sometimes in Singapore, sometimes in Dubai. They don't go there because people are ill there; they go because the pharmaceutical companies need them to," he said.

Doctor’s Blues

However, just because one egg is rotten, should we throw the entire basket? Dr Roshan Radhakrishnan, an anesthesiologist, notes that policymakers have to accept that the trust between the public and doctors is at its lowest today; a malunited fracture that needs to be fixed but will take years, possibly decades, to regain its strength. “But we must work to heal the fracture now even if we, the present day doctors, do not ourselves receive its benefits. And that involves evaluation, introspection and forcing a change in multiple systems,” he explains.

Meagre Health Budget

Another area, which needs help is healthcare financing. When the government itself invests less than 2 % GDP on public healthcare, the financial burden for a country prone today to both transmittable and sedentary lifestyle based illness falls on the pocket of the individual, who has to turn to the more expensive private sector.

Further, having to part with an exponentially large sum of money and yet watching someone you love pass away instantly makes the doctor you meet the face of your health problems. Anything less than an absolute cure is now considered failure and fleecing of the patient, even if the risks have been explained in advance by the physician.

“I don't advocate the 'present day doctors are evil and money minded' theory that social media debates immediately offer as justification to violence. A random Google search on these cases of abuse would show that invariably, it occurs following the death of a patient bought with multiple comorbidities. The victim here is often the casualty medical officer, the emergency doctor and the intensivist. These are not fields that charge money from the patient directly or withhold critical treatment if they don't get paid under the table,” Radhakrishnan explains.

“Yes, money minded and unscrupulous doctors exist for sure, but they deserve to be punished by laws that exist. Instead here, the innocent end up getting assaulted for the crimes of the guilty,” he adds.

Long Road Ahead

Dr Santanu Chattopadhyay, Group Medical Director CK Birla Hospitals seconds his opinion .“If the outcome is right, patients are happy; however, if the outcome is wrong, they think there is medical negligence. Medicine does not always give the same results as other branches of science like mathematics where 2+2= 4. It is like driving a car, and no one can guarantee that accidents will never happen. It is often not the fault of the doctor as the outcome is not in his/her hand. At NationWide, the most crucial step to prevent violence is communication. Transparent communication plays a significant role in setting up realistic patient expectations. We record conversations between patients and doctors as a piece of evidence. Better communication and documentation are essential to prevent such incidents. The government should educate patients about the fact that an adverse outcome is not always a case of medical negligence. Secondly, the government should increase investment in public healthcare. Further, there should be dialogues between doctors and patients, so that patients understand the difference between medical error and negligence,” he concludes.

To sum up, Indian healthcare must make hard choices. One thing is sure currently, authorities don’t do justice either to patients nor doctors. Harjit Singh Bhatti, former president of Resident Doctors Association of All India Institute of Medical Sciences, New Delhi points out that delayed surgeries or lack of infrastructure are not the doctor's fault. “The government should provide better healthcare facilities at village level and district level to provide primary healthcare. There are district hospitals without even gloves, so a doctor cannot even examine a patient. So, they refer patients to hospitals like Safdarjung, RML or AIIMS. At AIIMS, the footfall is almost 15,000 at OPD.  At AIIMS, doctors have started taking self-defence classes like Karate. The government should create campaigns that any attack on doctors is a punishable and non-bailable offence. They should also place CCTV cameras, emergency alarm systems and deploy security guards as well as quick response teams in key areas,” concludes Bhatti.