Violence against doctors: A social malaise in India

Violence against doctors is a widespread and complex social malaise that has received the short end of the stick by the public and the successive governments in India. A few days back an Orthopaedics resident in Dhule got beaten up by a merciless mob for referring a head injury case to a tertiary hospital where a neurosurgeon was available. The poor resident is blinded in one eye due to the attack. Horrifying things like this keep happening every few months and yet doctors are supposed to move on as if nothing happened.

Nearly 75% of doctors in India according to a study by the Indian Medical Association (IMA) have reported to have faced some for form of violence at work. (At risk while saving lives: 75% Indian doctors face violence at work, reveals study). No region in India seems to be immune from it but some like Maharashtra, West Bengal and Northern part of India have proven to be the most brutal against doctors.

Why do people attack doctors in India?

• Poor healthcare systems where the level of care diminishes as people live further away from the city. The public hospitals even in the cities are woefully inadequate with people having to depend on private entities to take care of their health and paying out of pocket since most people in India are not insured. This makes them angry at the system and beating doctors are the only outlet for this frustration.
• Unrealistic expectations among the public believing that by spending lots of money they can ensure that people will not die. Conversely, angry that people die despite having spent so much on their treatment. The penchant of the very religious populace correlating medicine with magic makes it a tough proposition to convince them otherwise.
• The trust deficit between the medical community and their patients has been a recent ailment. The general public is under the impression that hospitals and doctors are plotting to make money out of them, so they don’t trust their decisions and their advice.
• The rise of vigilante justice among the general public in India because they feel the justice system is too slow in India. Nothing like few punches to those that anger them to settle their nerves. You see a lot more violence in general today on the roads, public spaces and even in schools.
• There is also a tribe of professional trouble-makers who incite mobs and extort money from vulnerable hospitals in the form of protection money. This is pretty common in the north of India especially around states surrounding Delhi. There have been some instances even in the south.
• The almost nil repercussions of assaulting doctors. It is not even a non-bailable offense yet. The governments is still twiddling their thumbs and sitting on it until there’s a self interest in going forward. Sometimes politicians themselves are happy to indulge in some doctor beating- BJP Karwar MP Ananthkumar Hegde thrashes doctors inside hospital. Why are policemen not attacked as often as doctors are in India even though policemen are actually in a dangerous field of work?
• Media vilification of doctors. A few years ago an entertainment program by a popular movie star had provided a one sided view of the medical profession in India for the public to chew on. This is often cited as evidence of corruption in healthcare- though it was later found that most of the index cases were frauds trying to gain fame through the program. This virtual assault goes on unabated everyday through TV, movies and print media. This poisons the minds of people, prejudicing them even before they enter the doctor’s clinic. Surely there is corruption in healthcare in India like in everything else in India-but painting everyone in the same brush seems to justify beating doctors for it.

How do we prevent this unrelenting violence against doctors?

Like most things in life, the answer to this question is not going to be a magic bullet which will miraculously solve this problem. Few measures I can suggest is:

1. Strict central legislation making it a non-bailable offense to threaten or perpetuate violence against doctors and hospitals. In Maharastra apparently, there is The Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2010. Despite this, the doctor in Dhule got beaten. Hardly anyone has been convicted under this act. So we need a central law and gazetted notification to all law enforcement authorities.
2. Fast track courts to punish the guilty offenders as soon as possible without regard to the political connections or other affiliations. Offenders should compensate for damages and pay heavy compensation for injuries caused to the doctors. People should received rigorous jail terms for this.
3. The governments should compensate hospitals for medical service given in emergencies especially road traffic accidents. Patients’ attendees in an emergency should not be worried about monetary considerations on getting treatment in emergencies.
4. Fix a rotten healthcare system. This is by far the most difficult thing to achieve and unless the governments focus on this aspect, we are not going to solve this problem in the near future. Hospitals in rural areas should be able to manage less serious cases so that the burden on tertiary centers is reduced and the really needy patients get better care.
5. Basic health care should be available in remote areas with improved infrastructure, good supply of medicines and consumables. Rural service should be incentivized.
6. Have a referral system based on triage rather than indiscriminate referrals seen from several government hospitals and medical colleges. This clogs up the tertiary care centers and leads to more anger in the public.
7. Relevant training of doctors and para medical staff in handling patients in complex situations like in disease, death and emergencies. Dealing with anxiety, fear and doubts of the patients can be challenging but something is not really taught in our overworked medical system. No matter how much we train people to deal with such situations, it is nearly impossible to reason with an irate mob.
8. Restrict entry of patient families and friends from emergency area and to ask police to ensure that it is strictly enforced.
9. Ensure protection of the emergency by having police patrol the area regularly and prevent mobs from assembling around the hospital.
10. Public education drives and advertisements in popular media acknowledging this important problem as well as portraying that doctors are professionals (and NOT GODS) who try their best but they cannot perform miracles. Politicians and media should refrain from giving out irresponsible messages to serve their own interests.

On a lighter note until the situation improves, many private hospitals have resorted to hiring bouncers to man the emergencies and I don’t really blame them given the situation.

Delhi hospital hires bouncers to deter attacks from patients and relatives

Unless the bouncers or the doctors are armed with guns I doubt a few muscular men will have any effect on the huge mobs baying for blood.

Originally published at www.quora.com.