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   Table of Contents      
SHORT COMMUNICATION
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 89-92

Violence against Medical Fraternity: Time to Act


Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India

Date of Web Publication20-Aug-2019

Correspondence Address:
Pranav Ish
B1, Green Park Extension, New Delhi-110016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_49_19

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  Abstract 


Violence against doctors in India has increased in the last decade. The problem is worse in public hospitals, which lack appropriate security protocols. In order to tackle the issue, doctors need to accept the problem, understand the public and collaborate with the authorities to find a solution to prevent the untimely demise of this noble profession.

Keywords: Hospital security, safety, violence


How to cite this article:
Rathi V, Ish P. Violence against Medical Fraternity: Time to Act. MAMC J Med Sci 2019;5:89-92

How to cite this URL:
Rathi V, Ish P. Violence against Medical Fraternity: Time to Act. MAMC J Med Sci [serial online] 2019 [cited 2019 Sep 22];5:89-92. Available from: http://www.mamcjms.in/text.asp?2019/5/2/89/264787




  Introduction Top


Decades earlier, doctors in India were bestowed upon a divine status. Times have changed, the current situation is an alarming one. It speaks of rising incidents of violence against doctors with some ending in fatal outcomes.[1],[2] According to the Indian Medical Association, more than 75% of doctors have seen violence at work.[3] National media constantly report doctors being abused, bullied, manhandled, and even killed by the patient’s relatives.[4],[5] Mahatma Gandhi taught the concept of “Ahimsa”, meaning nonviolence.[6] However, over the years his legacy seems to have been lost.


  Etiologies Top


The problem is multifactorial [[Table 1]]. Over the past two decades, India has witnessed an economic boom. With the rise of corporate hospitals, the mentality of physicians has changed from a charitable to a lucrative one. Although not necessarily deleterious, this change has drastically influenced people’s perception of physicians.[7] With commercialization of health, more and more physicians have migrated toward corporate settings in urban centers.
Table 1 Multifactorial etiology of violence against doctors

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The family physician sees a hundred patients a day in a government hospital. It is logical to assume that quality of care gets sometimes compromised while attending to such a huge number of patients in a small window of time. This may impart a perception of neglect. After waiting in long lines for hours, some patient’s attendants are already at the brink of an emotional cliff. Ineffective communication or delay in attending to a patient can easily drive them over the edge.

Most government hospitals in India lack adequate security personnel. During night 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 a shooting incident. Most of the police force is plagued by corruption and is prone to bribery. Hence, relying on the police for safety is more often than not useless. The common public has completely lost faith in the judicial system and feels it is only the rich who obtain justice. Thus, in instances of patient death, people believe in exacting immediate revenge. While it is a nonbailable offense to assault a uniformed public servant like a bus driver or a policeman, there is no distinct penalty for hitting an on-duty physician in a white coat. The question of security to doctors was recently refused by the Supreme Court of India.

Since most patients lack health insurance, sometimes the diagnosis comes as a financial disaster and shocks them into emotional turmoil. This results in displacement of anger toward the physician. The highest number of violent incidents occurs in intensive care units and casualty and more than half are caused by relatives of patients.[3] Miscommunication by physicians cause attendants to have unrealistic or too high expectations for patient recovery. Hence, it is important to emphasize the patient’s prognosis to the attendants in a lucid manner.

Journalism has become increasingly competitive and blaming doctors has become commonplace. In addition to selling papers, this brand of yellow journalism sells a negative image of the medical community. Since it might be callous to pin the blame on the patient or the attendants, the ever hungry media rapidly jumps to conclusions and publishes sensational stories of organ theft, medical negligence, and malpractice.[8] Indian media outlets find it sensational to scapegoat the physician, thereby causing the public to embark on a frenzied witch hunt. Such scandal mongering has caused emergence of distrust in public. Politics in India is dominated by sectarian groups with religious or quasi-religious agendas. A method of gaining political mileage and securing the vote of the local community is marching in a government hospital with the patient and publicly manhandling the doctor.[9]

The problem of violence against doctors is not specific to India. The south Asian countries are all struggling with the same issue, although on various scales.[10],[11],[12],[13],[14],[15],[16] Studies performed in Turkey and Palestine have revealed a horrific situation prevailing in these countries as well.[17],[18],[19]

The problem is showing a devastating trend. A review article covering data from 2006 to 2017 found 100 cases of violence against doctors with 14 cases in 2017 [[Table 2]].[20] On the other hand, a quick search on the Internet reveals nine such incidents in the month of June 2019 only [[Table 3]]. Thus, the exponential increase will soon give rise to a point of no return where medical fraternity will have a downfall and eventually the untimely demise of this noble profession.
Table 2 Number of violence against doctors cases[20]

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Table 3 Cases of violence against doctors in June 2019

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  Solutions Top


Although the current scenario seems gloomy, tackling the problem requires physician 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 appropriate identification. Laws against doctor assault should be displayed prominently. To ensure safety of doctors, every hospital should create an emergency protocol and an evacuation plan in case of a major act of violence. The importance of teaching empathy to budding doctors cannot be stressed enough. Proper and effective communication with the patient and the attendants is an art and should be taught to all young doctors. The role of politicians, media, public, and patients cannot be undermined [[Table 4]].
Table 4 Solutions for curbing the menace of violence against doctors

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In emergency and ICU settings, doctors should take time to clearly explain patient prognosis to attendants who may harbor unreasonable expectations. Counselors for emotional support and translators can help. Law should be enacted to safeguard the safety of doctors and nurses. Assaulting medical personnel on duty should be made a cognizable offense, with serious consequences. The media is the window of society and unnecessarily blaming physicians should be avoided.

Violence in any form and in any setting is nothing less than an act of terrorism. For the good of the Indian society, actions are needed fast, else the future of this noble profession is at risk.

Financial support and sponsorship

Nil.

Conflicts of interests

There are no conflicts of interests.



 
  References Top

1.
Nagral S. Doctors and violence. Indian J Med Ethics 2001;9:107.  Back to cited text no. 1
    
2.
Pai SA. Violence against doctors on the increase in India. Natl Med J India 2015;28:214–15.  Back to cited text no. 2
    
3.
Dey S. Over 75% of doctors have faced violence at work, study finds. Times of India 4 May 2015.  Back to cited text no. 3
    
4.
Anand T, Grover S, Kumar R, Kumar M, Ingle GK. Workplace violence against resident doctors in a tertiary care hospital in Delhi. Natl Med J India 2016;29:344-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Arun B. A doctor’s murder. Indian J Med Ethics 2001;39.  Back to cited text no. 5
    
6.
Gandhi M. The Essential Gandhi: An Anthology of His Writings on His Life, Work, and Ideas. Random House Digital, Inc; 2002.  Back to cited text no. 6
    
7.
Ambesh P. Violence against doctors in the Indian subcontinent: a rising bane. Indian Heart J 2016;68:749-50.  Back to cited text no. 7
    
8.
Mishra S. Violence against doctors: the class wars. Indian Heart J 2015;67:289-92.  Back to cited text no. 8
    
9.
Ghosh K. Violence against doctors: a wake-up call. Indian J Med Res 2018;148:130-33.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Chinese doctors are under threat. Lancet 2010;376:657.  Back to cited text no. 10
    
11.
Shi J, Wang S, Zhou P, Shi L, Zhang Y, Bai F et al. The frequency of patient-initiated violence and its psychological impact on physicians in China: a cross-sectional study. PLoS One 2015;10:e0128394.  Back to cited text no. 11
    
12.
Wu D, Wang Y, Lam KF, Hesketh T. Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open 2014;4:e 006431.  Back to cited text no. 12
    
13.
Jiao M, Ning N, Li Y, Gao L, Cui Y, Sun H et al. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open 2015;5:e006719.  Back to cited text no. 13
    
14.
Mirza NM, Amjad AI, Bhatti AB, tuz Zahra Mirza F, Shaikh KS, Kiani J et al. Violence and abuse faced by junior physicians in the emergency department from patients and their caretakers: a nationwide study from Pakistan. J Emerg Med 2012;42:727-33.  Back to cited text no. 14
    
15.
Khawaja A, Irfan H. Violence against doctors in government hospitals and the role of media. J Pak Med Assoc 2011;61:1163-64.  Back to cited text no. 15
    
16.
Magar A. Violence against doctors in Nepal. J Nepal Med Assoc 2013;52:I-II.  Back to cited text no. 16
    
17.
Kitaneh M, Hamdan M. Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study. BMC Health Serv Res 2012;12:469.  Back to cited text no. 17
    
18.
Kaya S, Bilgin Demir İ, Karsavuran S, Űrek D, İlgűn G. Violence against doctors and nurses in hospitals in Turkey. J Forensic Nurs 2016;12:26-34.  Back to cited text no. 18
    
19.
Baykan Z, Öktem İS, Çetinkaya F, Naçar M. Physician exposure to violence: a study performed in Turkey. Int J Occup Saf Ergon 2015;21:291-7.  Back to cited text no. 19
    
20.
Ranjan R, Meenakshi XX, Singh M, Pal R, Das JK, Gupta S. Epidemiology of violence against medical practitioners in a developing country (2006–2017). J Health Res Rev 2018;5:153-60.  Back to cited text no. 20
  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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