Violence against doctors

Somethings on my mind about what’s happening now. It is not so simplistic like the BJP and TMC are making it out to be. Both are taking advantage of the situation.

The doctors protests in Kolkata must be handled with empathy and wisdom. This is not the time for TMC to scent conspiracies nor for BJP to attempt to communalise for political gain. This is a people’s issue and needs to be resolved without politics

Violence against doctors is on the rise all over the world. However, India has a unique problem. Meagre government spending on healthcare has resulted in poor infrastructure and human resource crunch in government hospitals. Hence, people are forced to seek private healthcare. Small and medium private healthcare establishments, which provide the bulk of healthcare services, are isolated, disorganized and vulnerable to violence. Violence against health service providers is only a manifestation of this malady. The Prevention of Violence Against Medicare Persons and Institutions Acts, which have been notified in 19 states in the past 10 years, have failed to address the issue. To prevent violence against doctors, government spending on healthcare must be increased and the Indian Penal Code should be changed to provide for a tougher penalty that could act as a deterrent to violence against doctors

India is not the only country facing violence against its medical practitioners; today this is a global phenomenon. In the USA, between 1980 and 1990, over 100 healthcare workers died as a result of violence. Another survey conducted in 170 university hospitals revealed that 57% of all emergency room employees had been threatened with a weapon over a 5-year period before the survey. A survey of 600 doctors in 2008 by the British Medical Association revealed that though one-third respondents had been a victim of verbal or physical attack in the past year, over half of them (52%) did not report the incident. Chinese doctors are often victims of violence. In June 2010, a doctor and a nurse were fatally stabbed in Shandong province by the son of a patient who died of liver cancer 13 years ago. A paediatrician in Fujian province was injured after leaping out of a fifth-floor window to escape angry relatives of a newborn baby under his care who had died. According to an editorial published in The Lancet, ‘Doctors in China are not unique in facing violence. However, for a third of doctors to have experienced conflict and thousands to have been injured, the scale, frequency and viciousness of attacks have shocked the world. Seventy per cent of physicians and 90% of support staff working in a hospital emergency room in Israel reported violent acts, mostly verbal abuse. Violence in Bangladesh has been reported to occur mostly in the hospital setting, but in the private healthcare setting as well. In a study of 675 physicians in training in nine tertiary institutes across Pakistan, 76% reported verbal or physical violence during the previous 2 months. Another study from Pakistan by Imran et al. reported that 74% of respondents in a public sector healthcare facility in Lahore were victims of violence during the preceding 12 months.

According to a study by the Indian Medical Association, over 75% of doctors have faced violence at work. A lady doctor in Tuticorin was killed by the husband of a pregnant woman who was admitted in a serious condition. She was referred to another hospital but died before she could be shifted. The husband entered the consultation chamber of the lady doctor with three accomplices and attacked her with a sword In 2014, in Mansa district of Punjab a doctor’s clinic was burnt following death of a boy who was referred to a tertiary hospital but died.

Innumerable incidents of violence against doctors are reported nearly on a daily basis across India, some resulting in grievous injuries. Even institutions such as the All India Institute of Medical Sciences, New Delhi, the premier medical institute of the country is not spared. Nineteen states of India have some kind of Medicare Service Persons and Medicare Service Institutions (Prevention of violence or damage or loss of property) Acts passed and notified in the past 10 years. Under the Right to Information (RTI) Act, the Medicos Legal Action Group Trust (MLAG) asked all senior superintendents of police in Punjab and Haryana, the two states where the Prevention of Violence against Doctors Act is in place for over 8 years, for the following information.

How many complaints by doctors or hospitals were registered under these Acts against patients or attendants?

How many of those accused of assault were punished under these Acts from 2010 to 2015.

According to the replies, most complaints were not registered as a first information report (FIR), a mandatory procedure to be followed by all police officials as per the judgment delivered by the Supreme Court of India in the case of Lalita Kumari versus the Government of Uttar Pradesh. In a few cases where the FIR was lodged based on the complaint, it was cancelled after a compromise was reached between the aggrieved parties and a cancellation report was filed with the local magistrate. Very few cases have reached courts after filling of a challan but no person accused of assault on a medicare establishment has yet been penalized under the Medicare Service Persons and Medicare Service Institutions (Prevention of violence or damage or loss of property) Acts of Punjab and Haryana from 2010 to 2015.

There are many causes for the increase in violence against medical personnel, but not restricted to a general increase in aggression in society as evidenced by incidents of road rage and other acts of violence witnessed in schools and colleges across India.

In India, doctors have traditionally been regarded highly by society. The present impression of private business-mindedness of some in the profession has led to a poor image of doctors. One of the factors that contribute to this poor image of doctors is the sensationalization of every news item, often ignoring information that would gloss over mundane details, exonerating a doctor in an incident of alleged medical negligence. As a hypothetical example, a television reporter shouting at the medical superintendent of a Delhi hospital reeling under a load of dengue patients as to why antimalarials were not given to a patient who died of dengue. This is done with an air of ‘knowledge’ that viewers would be convinced that not giving antimalarials to a patient of dengue in shock was medical negligence of the highest order.

Among other causes of violence against doctors in India are the pathetic conditions in which patients are treated in government hospitals. There is overcrowding, long waiting time to meet doctors, absence of a congenial environment, multiple visits to get investigations done as well as consult doctors, sharing a bed by two and sometimes three patients and poor hygiene and sanitation. There is frustration with systemic problems of government hospitals, from dysfunctional equipment to shortage of staff. Given the poor budgetary allocation for health in India, these problems are unlikely to change. Only 106 415 doctors are employed by the government in India, of the 938 861 doctors registered to provide healthcare to a population over 120 crore (1.2 billion).Of these, only 27 355 are posted at primary health centres (PHCs), which serve the rural population. With poor infrastructure and no increase in the number of posts for government doctors over the past many decades, despite an increasing population, the public healthcare system is on the verge of collapse. Violence against the health service provider is only a symptom of this crippling underlying malaise.

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