Doctors under siege

Workplace violence against health-care workers can only be checked in the backdrop of improved infrastructure

There have been numerous media reports of instances of violence against doctors and health-care institutions across India. In most cases, the proximate cause is the death of a patient. All reports suggest that most of these patients could not have been saved with the infrastructure available in the institution, yet their deaths have been seen as a case of neglect by medical personnel. Doctors have responded to these attacks with anger and anguish, by striking work, demanding more security and even taking to social media with messages about how the profession is seen as an easy target.

Growing violence

Violence against doctors is not new. The World Health Organisation published guidelines on handling workplace violence in 2002. However, the incidence and intensity of violence against medical professionals in India is on the rise.

It is important to reflect on how the medical profession — always held in respect in our society — has come to such a sorry pass where health-care workers need protection from the very people they are meant to take care of. It appears that these attacks are symptomatic of a larger malaise, manifested in a general increase in violence as a method of demonstrating power, loss of faith in institutions, anger against perceived marginalisation, and lack of understanding of science and society. The state has failed to stand firm on the rule of law. Civil society has been complicit. Each group in our fractured society becomes vocal only when its interests are affected. Thus doctors, pillars of the establishment, have failed to ensure the security of the established society by standing up against violence as a method of settling differences.

The present health-care system in India has inequity built in. Patients can see it. The demand by medical professionals for better pay is seen as selfish. It has to be coupled with demands for patient care such as better access, better facilities, and more personnel so that individual attention can be given. At present, most doctors are not advocates for patients. They play along with governments unwilling to spend on health care and accept the prevalent view that providing public sector health care is a favour and not a right. Doctors are seen as a part of the power structure. When they are attacked, public support and empathy is lacking.

A divide

Also, tremendous technological advances in medicine are not available to the majority in India. Increasing privatisation, corporatisation and commercialisation of medical care have ensured that many procedures cannot be accessed by the general public. Examples of the privileged having access to extremely expensive care in the private sector, though many of these interventions are usually futile, propagates the idea that modern medicine can salvage even the most critically ill provided enough money is spent.

There is also a failure to establish and propagate a good understanding of modern science in India. Such understanding would encompass the knowledge that although medicine in the modern world has greatly improved the chances of survival in many serious conditions, there are also many situations in which no intervention will succeed. Otherwise, there remains a suspicion that all was not done to save the patient and that much more would have been done had the patient paid more for an expensive hospital and doctor. The frustration against their own position in society is vented by attacking the doctor and the facility.

A way out

What can be done? An immediate step is to ensure exemplary action against violence as a means of settling issues. More long-term measures require vastly improved health infrastructure, fewer patients per doctor in line with international norms so that care can not only be given but seen to be given.

Doctors should participate in spreading understanding of science and society. At present, the public often does not understand the deeper structural problems underlying the apparent failures of the doctors. Medical practitioners should help highlight these.

Peoples’ committees in hospitals will be a welcome step. There must be a constant audit of the working hours of medical personnel and the fatigued doctor should not be left in the front line to deal with an emotionally charged public. Social workers in crucial departments such as accident and emergency wards to handle anxious crowds will certainly reduce the stress of already overburdened postgraduates and house surgeons.

Civil society and the medical community must together to demand better health care for our population. We cannot falter now.

George Thomas is an orthopaedic surgeon at St. Isabel’s Hospital, Chennai and J. Amalorpavanathan is former Director, Department of Vascular Surgery, Madras Medical College, Chennai

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