75 per cent doctors face threat of violence

Seventy-five per cent of the doctors face threat of violence in some form or the other according to a survey carried out by International Institute of Health Management Research (IIHMR) and the Indian Medical Association (IMA) with more than 1,000 doctors in India.

The survey found that 75 per cent of them faced verbal abuse which was the most common form of violence, 51 per cent of them complained of threats and 12 per cent of physical assault. The doctors who faced physical violence stated in the survey that they felt angry, frustrated and fearful. They also felt fatigued and suffered from low self-esteem. The survey has been published in the National Medical Journal of India.

The survey found that most of the attacks on doctors are during peak hospital hours, during emergency medical interventions or post surgery. The survey found that there was lack of co-ordination between the hospital administration at the time of hospital admission, delay in attending to the patient, demanding of advance payment, withholding a deceased body pending final settlement of hospital bill and unethical practices by doctors of being too hard on the patient’s relative which lead to provoking them to resort to violence.

The situation at hospital levels is becoming risky as physicians however conscientious or careful can’t tell what day or hour can the patient or his relative resort to malicious accusation, blackmail or file a suit for damages.

The survey found that patient’s lack of understanding of technical matters, unreasonably high expectations, high cost of healthcare were some of the reasons that the patient and their relatives resorted to violence against doctors.

Dr Sanjiv Kumar, director of IIHR said, “There are 156 laws that are applicable to hospitals in India but it is not the remedy to bridge the trust gap between medical professionals and public. Doctors need to introspect on their conduct where sensitivity is one of the most important factors in dealing with emergency cases and those who are being treated in intensive care units. The relatives have to be dealt with care and the hospital unit must not demand money at every stage.”

Prof. A K Agarwal who was a part of the survey explained, “There is a strong need to understand the behavioural issues that govern relatives. This requires appropriate management by the complete hospital administration. The doctor-patient communication must be clear and transparent. There must not be tall claims made and critical issues must be properly explained. There must be one person from the patient’s relatives who must communicate with the doctor. Too many relatives make things difficult for doctors.”

Following guidelines can help to manage and prevent the violence against doctors. The Indian Medical Regulations, 2002 that sets down the actions to be taken for prevention and regulation of violence against medical professionals should be in practice in the day to day working:

1)         Proper record keeping of every patient.

2)         Patient grievance should be redressed with utmost care. A separate committee can be formed for the same.

3)         Transparency regarding the hospital, staff and the treatment should be followed.

4)         Proper co-ordination with the local and state medical associations.

5)         False commitments should be avoided at any stage of the treatment.

6)         Immediate police complaints should be made at the time of violence with evidences.

7)         Information should be displayed in the hospital that any violence or similar activity in the hospital premises is a punishable offence.

Inputs by Dr Sumesh Kumar, assistant professor a member of the survey.