Death, serious illness, accident situations which create complete emotional turmoil are witnessed only at one place and that is a hospital. It is natural to feel frustrated, helpless shocked, dumb stuck and sad when one loses a near and dear relative or a friend. Unexpected and unanticipated incidences make the emotional trauma more profound. Even an iota of doubt about adequacy / correctness of treatment can further trigger the emotional upsurge. This may lead to unruly behavior leading to violence at hospitals. We are finding these problems recurring more frequently in last few years in Indian hospitals. A wide coverage is given by the media when violence occurs and even wider coverage is given when doctors go on strike. But there is one more category of victims of such assaults. They are patients who are under the care of that doctor who was assaulted. It is not uncommon that life saving gadgets and oxygen lines have been broken and vandalized. The patients have suffered or even lost life while being shifted. It is precisely for this reason that in almost all the countries “zero tolerance policy” is adopted regarding violence is hospitals. It is the same policy that is applicable at the airports. However it is only in India that zero tolerance policy is applicable for other industries such as aviation but not to healthcare. Of late series of violent incidences were reported in the government hospitals. High workload, improper living conditions, stress and inadequate rest are factors which make an human being more prone to irritability, erroneous behavior and poor response. But doctors are not expected to be human beings ( they are given the status of God) so they are expected to be patient, calm and smiling irrespective of the surrounding situation. Inadequate facilities in government hospitals and escalating costs in private sector are perfect stimuli for patients and relatives to engage into hospital violence. In the recent case at Dhule( Maharashtra), the doctor was beaten so badly that he will lose his eye sight. A young man who was allegedly under the influence of alcohol was brought with a head injury to the hospital. The doctor on duty informed the relatives that the hospital does not have CT scan machine and a neurosurgeon. The doctor suggested that the patient will have to be shifted to another hospital. Thus saying the truth caused him to lose his eye. What can a doctor do if facilities are not available in the hospital? The truth is that the government is still not serious about providing a good “accident and emergency service” to society. We still do not have good ambulances and trained manpower to man them. Internationally this job is done by paramedics and not by the doctors. We are still discussing about issues such as “Can paramedic give an injection? Is it legal?” We have still not been able to give a legal recognition to the paramedic cadre. The apathy is so much that recently the Government of Maharashtra created single council to deal with paramedics and physiotherapists! On one hand the Supreme Court as well as the government have pronounced rights of patients to get emergency services all the time. That is great! As a citizen I also feel that if I meet with an accident or have a medical emergency I must get the medical help. But we are we realistic? The Supreme court in its judgement states that it is a responsibility of every doctor to provide “Quick assessment, stabilization and transfer “ in medical emergency. Sounds great and simple too. So let us analyse this simple situation. Imagine that a woman in strong labor pains is brought to an ophthalmologist’s clinic in emergency. The doctor is busy with a cataract surgery. Now what does the doctor do? How does the doctor “stabilize” her? After working in the field of gynecology for twenty years I know that woman heavily in labor will get stabilized only after she delivers! And how does one transfer her? Does the doctor accompany the woman leaving his/her ongoing cataract surgery? Who pays for the transport? Many state governments have started ambulance services for transport. However they are far from being called efficient. Many are willing to transport only if the patient wants to go the government hospital. Besides that our law still does not recognize the “Samaritan principle” and provides immunity to a person who provides emergency care. Unless the problems of stake holders are not accepted, understood and addressed, real solutions cannot be found out. Simple solution is to identify and earmark those hospitals who run 24X7 casualty services and expect emergency services from them. The lack of communication skills is another reason that is commonly cited. Agreed….But have they been formally taught in medical schools? It is the health ministry that decides the curriculum not the practicing doctors. There is almost complete unanimity on the falling faith and trust quotient on doctors. The society is worried about the declining ethical standards of the medical profession. Has the society at large kept up with the ethical standards? Is it that doctors fall from heaven? Is it not that the doctors also come from the same society which has declining standards? When private medical colleges were allowed to open shops and collect huge capitation fees so that parents could make their wards a doctor, the decay had begun. Insufficient health services by government has pushed the society to avail private healthcare. Complex regulatory mechanisms is pushing it towards corporate which run health care services for profit. Now if we decide to disregard all these root causes but only talk about violence and strikes in isolation then it is hippocracy. Yes, expectations from health care services are rising. Dying has not remained a norm and restoration of health is not a miracle any more. Sometimes patients do feel that the treatment has gone wrong. They may suspect negligence or deficiency. But do we have adequate and strong redressal mechanism in healthcare? Patients and relatives go to the police. Usually medical negligence is never a criminal offence. Naturally they feel betrayed. The Consumer courts is the right place to go. There is a backlog of around 5 years in most of the consumer courts. In general using any government machinery has become an ordeal for the citizens. Today even if a minor accident occurs on the road the vehicle owners prefer to quarrel caring a dam about the traffic jam that is caused. Holding unconnected people for a ransom has become a norm. It is the same mentality that works when hospitals are vandalized. In fact we have to understand that we can’t have doctors working under severe pressure and fear. Professionals who take split second decisions on issues of life and death can’t function under pressure of consequences of their decisions. It is already leading to defensive practice and that is unhealthy for the society at large. The WHO decided to propagate the “patient safety ideology” in the world upon realising the complexity of the issue. The word patient safety is misunderstood by doctors themselves. According to the WHO patient safety deals with safety of patients and care givers. In India no one…healthcare providers, law makers, policy makers and politicians wants to understand this holistic concept. It is high time that government actually shows some real action on the ground in this regard. Else it is going to be the repeat telecast of the same story again and again. Doctors will strike, patients will suffer, media will blow it, courts will call the strike illegal, politicians will score points but the real loser will be the doctor patient relationship of faith, trust and empathy. Share your views.  
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