Doctors Saving Citizens Lives – Now Fear for their Lives?

Doctors Saving Citizens Lives-Now Fear for their Lives?

Indian Medical Association (IMA)- Mangaluru and all the allied medical and paramedical fraternity will hold a protest this morning (Monday) May 22 to condemn the assault and abduction of a senior surgeon/Assistant Professor Dr Abhijith Shetty and a senior lady nursing staff Ms Florence by a mob at Yenepoya Medical and Dental College, Deralakatte recently. The surgeon was allegedly dragged by a mob of nearly 40 people, assaulted and kidnapped in the early hours of May 16, following the death of a 65-year-old patient from Kinya who had been admitted to the hospital for cellulitis and other health complications. The doctor was rescued by his colleagues with the help of the police near the Ullal bridge, and three persons were arrested. In support of the doctor, the medical fraternity in the city and surrounding places led by the IMA has therefore called for a bandh today. The protest march will be carried out from Jyothi circle to the DC’s office and a memorandum will be submitted to the DC. It will also involve closure of all elective services in all hospitals in the district. Emergency services including casualty, emergency OT (operation theatre) and casualty/ICU will continue uninterrupted.

“While assaults on doctors have happened in the past, the problem has only increased in gravity, despite assurance by the authorities and higher-ups. It has tarnished the name of the city and the entire region, which is otherwise a very popular destination for both medical education and health care.”- Dr K R Kamath- President, IMA,Mangaluru

“This is the first time I have come across such an incident in my 31 years of professional career. Mangaluru is known to be one of the safest place in the country but these types of anti-social elements are creating difficulties to our profession. We will not be able to do our work fearlessly. We need to educate people that we are not God and we cannot ensure success in our treatment each and every time. The health condition of a patient could keep on changing, but that does not mean the doctors have not treated them with all care.”- Dr Anantha Rao Prasad, member IMA, Mangaluru

Mangaluru: I am propelled to write this piece here not just because it spells a harsh future for the medical profession in India, and for that matter here in Mangaluru, but also because its saddens me that many of my friends who are in the medical profession feel that their job is kind of risky these days, because of some of the issues over which the incidents took place were either systemic or inevitable — and not remotely the fault of the hapless doctors. Many of my relatives are doctors, even my niece a doctor who worked as HOD of Radiology Dept at Fr Muller Hospital, presently joined her husband in Las Vegas-USA. All these doctors should be respected as “Saviours” and not as “Martyrs/Tormentors”, which has been happening recently.

Speaking about a doctor (Dr Kishore-name changed), whom I have known for many years and have seen his dedication and commitment towards his job and his patients, I can tell that he has always been a proponent of hope and beacon of inspiration. His tenacity has made him endure the rigorous academic cycle, competition as well as the deplorable conditions of sleeping in wards, skipping meals and several hours of being on call — all this he has done with unparalleled zeal. I have sensed his trauma as he saw his patients die every odd day, when they were brought in serious conditions due to accidents etc – he tries his best to save them, but not all the time. Citizens should realize that doctors are not God and they cannot ensure success in their treatment each and every time.

Over the years, I have noticed that this doctor has compromised on many things — festivals, marriages, anniversaries, what have you. I distinctly remember him joking that he should have opted for a Lawyer or Engineer’s profession for better financial prospects, to which he had a dignified reply: “I work for I care.” Today, for the first time, I see him question his decision to opt for medicine — not because he’s vulnerable or weak, but because he isn’t allowed to demand her right to safety. Remember when the doctors in Maharashtra held a protest against the assault on their colleagues, the division bench of the Bombay High Court had made a senseless statement, slamming the “no-show agitation” launched by resident doctors across Maharashtra, saying “If you (doctors) do not want to work, then resign. You are not factory workers who resort to such protests. Shame on you. How can doctors behave in such a manner?” With due respect, the verdict and comparison are imperious and leave any doctor desolate.

Violence against medical personnel has increased over the past three years, despite a wave of state laws passed in 2008/2009 that explicitly prohibit such attacks on doctors, nurses, paramedics and hospital property- categorizing such attacks as non-bailable offenses and mandating prison terms of one to 10 years, depending on the state. As a deterrent, such laws have clearly failed. The consequences appear grave. Doctors are now less likely to take risks, since the death of a patient might provoke mayhem. If a patient comes in a serious condition and a doctor spends all night in the ICU with the patient, if he dies, the patients kith and kin will be after doctor’s blood. The violence has also led to growing fissures within health systems, with younger doctors resentful of becoming punching bags without adequate protection from their supervisors and institutions. Strikes may provide an outlet for outrage, but they also lead to neglect of countless other patients.

Meanwhile, boundaries are blurring between India’s violent political culture and the blue-curtained hospital space. According to medical superintendents and social workers, numerous politicians like to throw their weight around crowded emergency rooms in a bid to pump up the vote bank in their constituencies. Their designated patient must get immediate attention, or else. “Don’t you know who I AM?” seems a common prelude to bullying and shattered windows, courtesy of his or her entourage. Then there are some hardcore activists groups that always want to create trouble.

The ignorance of police personnel should be penalized. Even if they do know the law, they give importance and sympathy to the patients’ relatives, which in my opinion, should be curbed. According to one senior doctor speaking to Team Mangalorean said that one crucial task is to train doctors to communicate more effectively with patients and their family members. Medical colleges should stop waiting for the stodgy Medical Council of India to introduce changes in the medical curriculum and instead take the initiative to train doctors to become more accommodating in answering questions and more empathetic in their manner.

If you look at the district or some of the other hospitals, a resident doctor is not only the first point of contact with patients but also the one handling the maximum workload. It’s a complete failure of the judicial machinery as it chose to indict a profession on the whole when it is incumbent upon it to offer real-time measures for the crisis. Rebuke doctors for the “mass leave” if you must, but ensure the grievances are heard, that security is provided and that residents are not overworked and underpaid. Doctors need this confidence and compassion if they are to deal with grave cases, not live in the constant fear of being lynched by a mob.

On the other hand, there are certain media which has played a major role in demonizing doctors with the purpose of peddling news. Journalism has become increasingly combative and, as a result, indicting doctors sans proof has been normalized. This brand of journalism sells a negative image of the medical community. Since it might be callous to pin the blame on the patient or the attendants, some media outlets find it convenient to scapegoat the physician, causing the public to start a witch hunt, no less. Such fear mongering has sown seeds of deep suspicion in the minds of the people. For instance, among few media outlets, there has been a predilection to suggest that due to the striking resident doctors, emergency cases are being compromised, which is factually wrong as the only reason senior doctors have not joined the protests is to ensure emergencies are covered.

Anybody who cares to scrutinize the multitude of episodes of violence would establish that the greatest proportion of such assaults happen with resident doctors or doctors who are still in the process of honing their skills. This is perfectly understandable because in big tertiary centres such as district hospitals, a resident doctor is not only the first point of contact with patients but also the one handling the maximum workload. They put in hours, even days at a time and, in the process, presumed to be tolerant and compliant enough to earn a satisfactory evaluation from their seniors. Shouldn’t the resident doctor, based on the precedent put forward by the judicial verdict, legally decline to work more than what human rights law allows the world over?

A study by the Indian Medical Association (IMA) has revealed that more than 75 per cent doctors have experienced violence at work. According to the Act, violence against doctors, medical staff and medical establishments is a non-bailable offence, attracting imprisonment of up to three years and a fine of up to Rs 50,000. Also, the offender would have to pay twice the amount of damage or loss caused to property as compensation. Unfortunately, with no awareness created about around it, the Act seems to be followed only on paper. In the meantime, our lovely police is largely unaware of its existence. The handling of such assault is so depraved that despite several doctors suffering attacks in recently, not a single conviction was made.

Disowning responsibility amounts to nothing short of laxity of duty. Perceiving the ever-sensitive atmosphere in any health care vicinity, the action plan to foil episodes of violence should have been conceived long ago.Yet, every new incident brings little in the form of action other than verbal condemnation, futile protests and candlelight marches. Faith in the doctor–patient relationship has taken a beating recently. Every time such horrific assaults take place, we see the political powers turn into mute spectators, waiting for flames to subside.

What keeps us from addressing the issue? Have we reached the rock bottom of appeasement politics? A multi-faceted problem. The origin of the issue is multi-faceted. With the rise of commercial hospitals, the mentality of parents to let their children choose medicine has changed from a charitable to a lucrative one. This change has drastically influenced people’s perception of doctors. Earlier even when there used to be one medical officer for an entire village or a small district, people’s trust in the doctor remained high. The doctor was regarded as part of the local community and integral to the health and well-being of the social unit.

Decades ago, people went into the medical profession for the predominant vision of serving the ailing mankind, and thus were viewed as saints. But recently, with the privatization of healthcare, some doctors were blamed of being driven by greed and of embracing unethical practices. The ravenous media rapidly jumped to conclusions and published sensational stories of organ theft, medical negligence and malpractice. Reports about unnecessary tests and needless invasive procedures have caused patients’ distrust to grow. Government hospitals here follow the welfare model, as the majority of the population is poor and does not have health insurance. Such hospitals, offering subsidized medical care are flooded with patients and their attendants.

In addition to jeopardizing the safety of medical personnel, violence threatens patient safety and hampers their recovery to health. It is learnt that the average medical officer posted in the outpatient department sees close to 350 patients a day. It is reasonable to conjecture that the quality of health care is compromised while attending to such a huge number of patients in a short period. This may lend the impression of neglect to the patient and leave him/her only partially satisfied. After waiting in long queues for hours, some patients’ attendants find themselves at the brink of an emotional cliff.

Ineffective communication or delay in attending to a patient can easily drive them over the edge. Since most patients lack health insurance, at times, the diagnosis comes as a financial disaster and shocks them into emotional turmoil. This results in the displacement of anger toward the physician. Most government hospitals lack adequate security personnel. During the late hours, it is often the medical officer who plays the role of the doctor, as well as that of the security guard. There is no established protocol for tackling violence or assault incidents. Laws against doctor assault should be prominently displayed on the walls of the hospital.

Most of the police force is plagued by corruption and prone to bribery. Hence, relying on the police for safety is more often than not useless. The public struggles with a lack of faith in the judicial system and feels it is only the rich who obtain justice. Thus, in instances of patient deaths, people believe in exacting immediate revenge, seeking their “pound of flesh” using physical means rather than filing a case in courts. So what’s the cure? What can be done? Though the scenario seems gloomy, tackling the problem requires residents’ participation.

Doctors should work with the government in creating an effective strategy to prevent hospital violence. Security personnel should be posted at the entrance of every hospital and should not let anyone through without checking for identification. Weapons should be confiscated before allowing passage to anyone. All attendants must register at the front desk and be given a visitor badge to be worn at all times. No more than two attendants should be allowed with the patient. To ensure doctor safety, every hospital should create an emergency protocol and an evacuation plan in case of a major act of violence.

Violence in any form and, in any setting, is despicable.However, acts of violence in a hospital are the most extreme and should be dealt with an iron hand. Hospitals are sanctums of healing and recuperation. In addition to jeopardizing the safety of medical personnel, violence threatens patient safety and hampers their recovery to health. For the better of the society, doctors too — rather than giving the cold shoulder to the other aggrieved parties — should work in tandem with the government as well as the public, to tide over this crisis.

On a final note, I am sorry if I’ve hurt individual sentiments, I only want the issue to be resolved as soon as possible and for the likes of my doctor friends about their work that drives their passion. Long live the Doctors- the Life Saviors!

Note: Pictures for Illustration Only