'Doctors continue to bear the brunt of social aggression'

With India possessing a mere 9.09 percent of the World Health Organisation (WHO) recommended doctor density per 1000 people, frayed tempers and impatience have been manifesting themselves in various forms of aggression and violence against doctors.

Even as the nation celebrates the World Doctor's Day on July 1, incidents of aggression continue to mount and undermine this noble profession.

Violence seems to have increased in Indian society in general, if one follows the incidents of mob lynching following rumours propagated on social media outlets such as WhatsApp or Facebook.

Psychologists contend that this could be part of a larger trend in society, of not holding back and of giving vent to innate prejudices, bigotry, patriarchy or chauvinism inherent in conservative societies.

Or it could stem from a deep-rooted feeling of rebellion against oppression, injustice, unfairness, frustration and discontentment with the existing systems of governance.

A 2015 survey by the Indian Medical Association concludes that at least three fourth of all doctors have faced some form of violence at work. In March, 2017, more than 2000 junior doctors from 17 government run hospitals in Mumbai went on a 4-day strike protesting a spate of violence against doctors.

Violence can take the form of verbal abuse, threats and intimidation, sexual harassment, physical attacks, attacks with a blunt or sharp weapon, theft and damage to property. Female doctors are more vulnerable to such forms of aggression as are people from minority communities.

"Patient dissatisfaction is the commonest reason cited by perpetrators of such violence and agitated friends and relatives accompanying the patient are the chief actors involved. Trauma or emergency wards, Intensive Care Units and Recuperating wards after surgery were the most frequent stages where such violence was enacted," said Dr. AK Khokhar, Dean Training of International Institute Of Health Management Research, Delhi.

"Recent reports sensationalizing negative stories from hospitals where patient deaths were caused due to negligence often reinforce existing prejudices and add fuel to the fire of frustration faced by people already highly charged with emotion upon imposition of care for a loved one. Doctors need safe environments to think clearly and intelligently in order to perform at their best in a life threatening patient care situation," added Dr. Khokhar.

Dr. SD Gupta, chairman, IIHMR University, Jaipur said, "What hospitals and healthcare personnel need is a protocol to manage situations before they come to a head. Patients need to be educated about their rights and obligations. There needs to be clear and consistent communication with friends and relatives responsible for and who stand to be affected by a patient's medical condition, about the risks and limitations of medical therapies being administered.

"Expectations need to not only be established beforehand, they need to be accepted by the stakeholders. That is where a healthcare manager trained in conflict resolution and negotiating skills can make a difference. Doctors, managers and hospital staff need to be trained in pre-empting and preventing violence by mobs in hospitals."

Healthcare is pivotal to societal well being because of its crucial role in mitigating factors that affect the fulfillment of a happier more productive life. Basic medical services that enable a dignified standard of living are an indelible part of Article 25 of the UN's Universal Declaration of Human Rights.

The highest standard of mental and physical health as well as an environment free from epidemic, endemic, occupational and other diseases is guaranteed by the International Covenant on Economic, Social and Cultural Rights via Article 12, to which India is a committed signatory. As agents of this vital human function, doctors need to be protected from violence in all its manifestations to enable them to work with dignity, dedication and contribute to making the world a happier more constructive place.

"This is quite unfortunate and seems to be due to miscommunication and absence of understanding. Doctors are the primary bearers of news about a patient's health and any lack of emotion in conveying that news can be misinterpreted by charged friends and relatives of patients," said Sanjeev Gupta, MD, Kusum Group of Companies.

"But it has to be borne in mind that doctors, especially in public hospitals, are constrained by various factors such as absence of free beds, administrative restrictions and triage considerations. Therefore they may have to make tough decisions at times. There probably needs to be some training for both doctors and patients to treat each other. Such violence affects the unbiased judgment of the healthcare expert and consequently the quality of care and medicines that can be recommended," he concluded.