#DoctorsForHumanity : Stopping Violence Against Doctors Is Our Moral Responsibility !

It took me a lot of thought, reading and analysis to be able to put down all that’s been happening with the doctors at large but I’ve tried my best & I hope it comes through. This is the truth, the reality & the prediction of the future, you must all be well-acquainted with. Let’s take it from the top. While being a doctor requires me to be on a special mission, a devotion; it also calls for involvement, respect and willingness to help all other people. But is that all? Is that how a doctor is perceived? 

A Doctor in India, is expected to: 

• be brilliant, 
• be willing to study for hours & years, 
• be willing to work in adverse conditions, including far-flung rural areas, 
• feel guilty about making money ALWAYS, because well it’s a noble profession 
• take responsibility for anything going wrong, literally ANYTHING 
• in fact they’re supposed to be GOD

If you think doctors are akin to gods, then I’m sorry to break it to you but, we most definitely are not ! We are as human as the patients we treat. We are not magicians or wizards either. 

Please stop living under the delusion of your doctor’s capability to fix any illness that you may bring to them. Please understand some very basic facts : 

• We are your fellow citizens, the government doesn’t give us any special privileges for rendering selfless service, slogging odd hours, working in pathetic work environments. 
• There are protocols that are followed by doctors irrespective of the patient’s background. 
• We have no personal interest in seeing our patients die, trust me, we look forward to filling up a discharge card, and not signing a death certificate.
• If there is indeed an element of negligence on the part of the doctor, the medical boards have specified very strict punishments. No doctor would knowingly commit gross negligence at the risk of losing his/her practising licence. 
• Besides, resorting to violence, cannot bring back your relative, even in a proven case of negligence. Sue the doctor, let the courts and the legal team handle the situation. If the doctor’s negligence does get proven, justice will be delivered.

‘No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, black mail or suit for damages.’

The above lines from a reputed Journal from the USA, written 135 years ago should be an eye-opener and also prophetic. 

Last few years, reports of violence against doctors, sometimes leading to grievous hurt or murder, are making headlines. Let me point out a few cases below : 

• August 2016 : B.J. Govt Medical College, Pune, Maharashtra – Dr. Abhijit Jawanjal and Dr. Sadiq Yunus beaten up.
• March 2017: Dhule Civil Hospital, Dhule, Maharashtra – Dr Rohan Mhamorkar was beaten up, and he lost vision in his left eye. Medical professionals in many hospitals across the country wore helmets to work for a couple of days after this incident, as a sign of protest.
• May 2018: Sion Hospital, Mumbai, Maharashtra – Dr Atish Parikh thrashed, Dr S. Dharmadhikari manhandled. Protests followed. Residents across Maharashtra wore black ribbons across their white aprons as a mark of their displeasure, working in an unsafe environment.
• June 2019: Two intern doctors at NRS Medical College, Kolkata, received near-fatal injuries at the hands of a 200 strong mob after a 75-year-old patient died in the medicine ward. 

There have been many more episodes, some reported, most of them unreported or hushed.

In the majority of the cases (60-70%), such violence took the form of either verbal abuse or aggressive gesture. More often than not, patients by themselves are not violence makers, but their relatives are. Let us not miss an important point here. It has always been the resident and intern doctors facing the vandalism of the mobs. A young 20-something-year-old student, lowest in the hierarchy of doctors in the given institute, who is only following the protocol set by his department, is the one getting thrashed in the middle of the night.

If you truly wish to get to the end of this, try finding out the HARSH REALITY of:

1. How a resident doctor works ?

2. What he eats ?

3. How RMO quarters are infested with pests & rodents?

4. How sometimes they are forced to do procedures without even gloves risking their lives with infections like HIV, Hepatitis B, etc ? 

5. What are the working hours ? 

6. How much is the harassment by administrators ? 

7. How are they forced to complete targets for camps, sterilisation procedures ? 

8. How much do they get paid ? 

9. What age they complete their degrees & become financially independent ? 

10. At what age do they get married? 

11. How much time they give to family & kids? 

12. What is their sleep pattern & condition ? 

13. How are they exploited by corporate Hospitals when they start practice? 

If the answers to these don’t give you goosebumps, my faith from humanity shall be shaken. Now, what makes you think that this young doctor is investing his time, energy and youth for such ungrateful patients who is seeking for opportunities to beat him up? Physical injuries are an occupational risk for those in the defence sector. When did they become a foreseeable risk among health care professionals? Those who are supposed to tend to wounds are themselves being rolled into operation theatres because their patients could not control as much as their temper?? How fair does that sound?

And why has the violence increased beyond repair? There are several reasons for this : 

• We need a scapegoat for what is ultimately a poor healthcare system in our country. 
• We don’t have adequate resources for a good healthcare system. 
• We want to run hospitals, do effective tests, treatments, surgeries and medicines, but we don’t have the money needed to get quality in all these aspects
• We don’t value the excellence of doctors yet expect them to become a saviour of the world. 
• We expect doctors to take all the downside, get paid a lot less than people of similar intelligence do in other fields and threaten them too. 
• We call it unfair & morally guilt them and ask them why they became a doctor in the first place. 

It’s almost like abusing or hitting a doctor when the patient dies is a norm. Agitations and protests and doctors’ strikes immediately follow. But nothing major happens after that. After about a week of gradually weaning discussions and debates, the issue dies down, the Hippocratic Oath kicks in and residents and interns and all other protesting doctors get back to work, only to be assaulted again.

But if we truly want to end violence against doctors, we need to go deeper into the root cause of the problem & actively work towards changing the attitudes.There’s an increasing population of aggressive patients & their impatient and intolerant behaviour is a common trend. 

You’ll be shocked to know that the Indian Medical Association has reported, “ 75% of doctors face verbal or physical abuse inside hospital premises”. 

A cycle of violent strikes and negative media coverage has tarnished the image of the medical community in India, how? 

• Many people now view doctors with a feeling of troubled dependence.
• On the one hand, the general population is bombarded by unsupervised advertisements suggesting easy, one-shot cures, and oversimplified medicine. On the other hand, there are constant news reports (often inaccurate and judgmental) of medical negligence that continue to shake people’s faith in doctors.
• The many stories of medical achievement tend not to be reported as frequently as the few reports of negligence. 
• Patients from poorer backgrounds tend to accept whatever facility a public sector hospital can provide. The very rich seek care only in expensive private sector hospitals. Yet the middle class (which has increased significantly in number with the economic liberalisation of the country) is left in limbo. They cannot afford private sector hospitals for prolonged treatment because of the cost and yet they are highly discontent in the public sector hospitals, where the volume of patients is huge and facilities are limited.
• In a land where swamis and soothsayers make more television appearances than doctors, society needs a strong medical role model.
• The media needs someone who can educate rather than sensationalise and give the medical profession an “image makeover.” 

Understand !! No doctor enters a hospital with the intention of harming a patient, nothing can be learnt without making mistakes, and no outcome can be optimised in the face of limited facilities without co-operation and safety for themselves in mind. It is time that society understands this, and it is our job to explain it to them : 

• We need to work on self-analysis to diffuse mob behaviour; team building; systemisation; and reducing physician stress, burnout, and psychological pressure from treatment mistakes and failures. 
• Practically, the total number of classes currently given to developing soft skills in the Indian medical curriculum is negligible. 
• The present attitude of medical educators can be likened to an “old school” swimming instructor who throws na?ve doctors into the water thinking that they will learn to float by themselves. The result is a ticking time bomb in every hospital in the country. 

It’s comes as no surprise to me that there’s hence a change in MBBS Curriculum after 21 Years. 

From August 2019, medical undergrads will have a new course to enhance doctors’ responsiveness to the needs of patients and their families. For those in school wanting to study medicine later on life, merely being a proficient doctor won’t be enough. They will have to acquire critical communication skills. At least, that’s what the latest MBBS curriculum slated to be rolled out from the 2019-20 academic session seeks to inculcate in the context of emerging diseases and scientific advances. Revised after 21 long years, the new undergraduate curriculum was finalised by the Medical Council of India. Titled “Competency-based UG Curriculum for the Indian Medical Graduate,” it essentially marks a significant shift from the classroom-rote learning of the 1997-born programme to one which stresses on medical ethics, better doctor-patient relationship and outcome-based learning. The new MBBS curriculum has a course called Attitude, Ethics and Communication (AETCOM) which will run across years. Students will be assessed for how they communicate with patients; how they counsel people for organ donations or other challenging procedures; how sensitively do they offer care and obtain consent. All these things will count along with competencies and skills. 

But is that enough? Will this solve the havoc we’re inviting our way? Absolutely not !! Please understand. You need the smartest and best people to be doctors. A woefully poor healthcare system also means Indian doctors are under tremendous pressure.

The country needs more doctors. India will need 2.07 million more doctors by 2030, to achieve a modest doctor-to-population ratio of 1:1,000, according to a study published in the Indian Journal of Public Health, in September.

The study titled Aggregate Availability of Doctors in India: 2014-2030, conducted by the economics and business policy faculty at the FORE School of Management, used Medical Council of India’s (MCI) historical data from 1960-2015 on registration stock of doctors obtained from Indian medical registers.

The research has also highlighted that given these findings, and the prospects of the numbers increasing over the next 15-year period, it looks like an impossible task to achieve even a modest doctor-population ratio of 1:1000 by 2030, by when the population is estimated to reach 1.476 billion. 

Is it a surprise that our best doctors are running abroad, or even worse, not even becoming doctors in the first place at all? If you speak to an aspiring doctor’s parents they’d tell you how they feel like they’re about to send their child into a rather dangerous battlefield. They fear this because some mindless drunk idiot will storm into the hospital with a 100 other similarly inebriated junkies, and beat the life out of the bundle of aspirations and dreams. It will only be a miracle if the young doctor survives the physical injuries.

Also the masterstroke here is that a mob won’t be charged with any crime. The perpetrators will all walk out free while the young doctor may start looking at alternate career options. Such incidents will continue unless the public gets sensitised to the fact that doctors are human too. They try their best to deliver the best possible treatment to all patients. Lives are lost despite best efforts. Hitting them draws the same kind of blood as the kind that flows in the patients’ veins. If they don’t make it through, death doesn’t differentiate between patients and doctors. 

This is not a subject that gets discussed in an average Indian household. That is why it needs to get discussed, it is time it got discussed. The general opinion about a doctor is that of a marketing strategist, who prescribes expensive treatments that don’t work and orders fancy investigations that are beyond affordability. This is far from reality. 

Google has led patients and relatives to believe that they know more than their doctor, who has invested at least a decade of his/her life in going meticulously through an enormous amount of medical literature. People come with unreasonable expectations, failing to meet which is leading to physical violence. This situation needs to change. Don’t forget that it may be your sons, daughters, brothers, sisters, or friends who aspire to be a part of this noble profession. And to provide them with at least a safe work environment, where they can be sure of their own survival before they start saving other’s lives is our moral responsibility. 

The general deterioration of the morality ethics of intellectual class in India and rise of pseudo intellectuals is according to me the issue of concern. 

What needs to be done next? 

• Responsibility on hospitals : Hospitals can do much to reduce the violence. In government hospitals, this can be done as a part of general reform for the hospital services in the form of:

1. improvement of services in a global fashion; 
2. employment of adequate number of doctors and other steps to ease the rush of patients and long waiting hours; 
3. use of computer and internet technology; 
4. hospital security should be strengthened and it needs to be properly interlocked with nearby police station; 
5. no arms/ammunition by patient or their relatives should be allowed inside the hospital; 
6. there should be transparency on rates of different investigations, rents and other expenses in the hospital; and 
7. there should be a proper complaint redressal system in the hospital.

• Responsibility of the patients : The patient family and society at large should take the responsibility to prevent this violence. Disputes between patients and hospitals or doctors are not to be sorted through violence, but in a civilized society, there are avenues of dispute redressal which should be used. There should be an understanding that vandalism and violence in a hospital or clinic is a criminal offense and any civilized society should have low tolerance for such heinous acts.
• Responsibility on leaders : Hardly social leaders are seen to condemn such violence today, and surprisingly sometimes they try to justify the situation.
• Responsibility of the media : Both print and electronic media should not to sensationalize the news. Medicine is not a black and white subject and so also its management. Diagnosis of a patient is essentially hypothetico-deductive process, and with new evidence through investigations and knowledge, the diagnosis of some of the cases continues to be refined. However, whatever the diagnosis be, the management of patient generally includes such uncertainties into account and treatment continues.
• Responsibility of the government and political parties : In India, the cause of violence against doctors is multi-layered. Spending around 1 per cent of the GDP by the government in a population which increased five times since independence is not enough. Modern medicine is progressing by leaps and bounds, but most of the medical colleges and hospitals in the country could not keep place with the progress (Table). The government needs to put the effort to see how the overcrowding in the hospitals can be prevented. No nation can build hospitals for 1300 million patients, but it is possible to build hospital for 1300 million citizens who are largely healthy. To keep 1300 million people healthy in a country like India is a humongous task. Nutrition, immunization, health education, pollution control, personal hygiene, access to clean water, unadulterated milk, unadulterated food, facilities for exercise, playground, etc. are the basic requirements. The government should concentrate its activities on preventive medicine. The government should punish unlawful behaviour of anybody who harms the doctor and vandalizes the hospital.

Although violence against doctors and other health workers is not uncommon, the incidence in India seems to be increasing. As there are certain responsibilities of doctors and other healthcare workers, similarly, responsibilities also have to be borne by patients and their relatives, political parties, hospital authorities, law maintaining machinery, media and government to see that health care improves and violence against doctors is strongly dealt with. 

"The greatest danger to the future is apathy"

I know the journey is long & the road is really bumpy but if we the people of fraternity, the medical professionals don’t take a stand for ourselves then we can’t expect anybody else to do so too. We need to UNITE & fight for ourselves & our future. Because if we continue like this, the day won’t be far (10~15 years) when India will face a dearth of good doctors.  

Let’s unite & spread awareness, one patient at a time, one day at a time. Let’s start a conversation, let’s become #DoctorsForHumanity in its most authentic essence.