By Dr Kiran
Narayana Hrudayalaya Bangalore
Yes; we are debating, quite fiercely!
How to prevent people from attacking doctors? By legislation? By police action? By employing bouncers? Or by not allowing our children from getting into this profession?!
We are scientific people! We detest quacks who treat on symptomatic basis. We seek an etiology, establish a pathogenetic scale and intervene at appropriate level using best of our discretion. Its all when we treat the ailmets of others.
But, when it comes to tackling a serious question of our own safety, we never try to get into etiology; we are simply offering solutions at preventive level, damage control and rehabilitation!
The question that we need to ask and answer ourselves is, “Why are people attacking doctors?”
Didn’t people attack doctors in the past too? Yes; but the incidents were extremely rare. Most of the times such attackers were not because some patient died.
But now, the reason for attack is the death of a patient. That answers “people attacking”. Still, WHY and DOCTORS need answers!
WHY is a complex question to answer. Still worth a try.
Earlier when people moved around a hospital, they would see doctors at all important places. The chief of hospital, Medical Superintendent, CMO, Chief Physician, Chief surgeon etc were doctors. Most of the fees they paid were going to doctors. When a doctor wrote concession in bill, patient used to get it without much hassle. Doctors were most powerful part of the entire hospital system. Obviously for a patient, doctors were face of the system. The perception was fixed.
As of now, we are replacing hospitals with HEALTH-MALLS! Huge buildings, impressive interiors, expensive artefacts, eye-catching advertisements, discount coupons on health packages/lab tests, massive machineries, ultra-luxury wards, suites and what not!
These health-malls are managed by MBAs! Most of the decision makers are from business management background. They need not even know how a hospital looks like (let alone how it functions) before managing the complex system of healthcare delivery! They look at balance sheets, profit-loss charts, pie-diagrams instead of diagnosis, treatment charts and discharge summaries. They do “hiring and firing” instead of building a team of healers and counsellors.
But, unfortunately, for the patient, the doctors are still “face of the system”. They do not realize that doctors no longer get bulk of the amount in their bill. They do not know doctors are not allowed to decide the cost of their treatment or to write concession. They do not even know doctors do not decide brand of medicine that patient should get! In the name of cost cutting, most of the Health-Malls ask doctors to write the molecule and will get the most profitable brand available in the market, irrespective of its quality or credibility of company! How would a patient ever know these things? How can doctors talk about such issues with all patients? Its neither professionalism; nor practical.
The moment an MBA is running a health-care delivery system, it is no longer a service oriented firm; it is a business organization! The priorities of such organizations are different from a humanitarian institute. So, the rules change. Doctors realize this and keep quiet. However, patients do not know this yet. For them, doctors are earning a lot from exuberant bills they pay! They think doctors are greedy that the cost of health care has soared to sky! They feel they deserve value for money!
This “value-for-money” in health care is ill-defined! For MBA admin, it is profit margin compared to other industries! MBAs feel that the profit margin of Health-Mall is less than other Malls! So, customer is getting more value for money! Simple economics.
For the patients, it is end-point of their treatment. “Don’t worry about the expenses; I just want my patient cured” is a common sentence used by patient’s kin. That defines their “value for money”. This “consumer mindset” which has replaced “care/service mindset” makes huge difference in perception.
When “value for money” is not met, Health-Mall MBA admin is unhappy. As earning members of system, doctors take the brunt. They fire doctors, break treating teams, lure few morally weak members to take up unethical stands, get a new consultant who is capable of drawing more patients into the system, change the pay-package structures of doctors and so on. The entire equilibrium in system turns chaotic and makes every doctor jittery and insecure.
When “value for money” is not met, patient party gets violent. They destroy property of Health-Mall, attack doctors/nurses, gather a crowd and manhandle hospital staff, threaten consequences, take legal course, go to consumer courts, hire a shrewd lawyer who picks at every loophole in the system; or worse, they blackmail the system to extract huge sums of money. As “face of the system”, doctors are again at receiving end. The entire equilibrium in system again turns chaotic and makes every doctor jittery and insecure.
This explains “Why people attack”! But the question remains. “Why DOCTORS?”
We doctors have lot to blame and lot more to be pitied. We could do nothing when hospitals were replaced by Health-Malls. We could do nothing when power was taken away from us and given to MBAs. We could do nothing when money-hungry admins arm-twisted us to accept changed rules. Most of us were meek and weak to just nod our head to deteriorating standards of humanitarian consideration. Many of us just felt happy that we would earn more money and would be taken off the headache of managing “concession seeking” bunch. We had no idea of how future would turn against us!
Added to the woes were unscrupulous media and irrational policy-makers of Governance. Media has a huge role in demoralizing doctor profession. Even a 12th pass reporter or anchor gets judgemental without even making an attempt to understand reality. In fact, they don’t need reality; they just need “breaking-news”, sensationalism, material to fill their 24 hour sojourn. They are not bothered about long-term impact of their stupidity and irrationalism over the society.
Government on the other hand cannot be left behind. With most of the politicians having a meaty portion in Health-Malls, the policy makers make sure their investment is safeguarded but a scapegoat is ready for blaming for any mishap. Doctors are such inevitable scapegoats! We are neither empowered to resist nor given an opportunity to explain our plight. We are just at receiving end of scathe. The worst part of the entire picture is that even the judiciary understands none of these nuances.
So, with no support from internal system, no understanding from media, no sympathy from policy makers or judiciary, we doctors are overexposing ourselves to angst and fury of the patients’ kin. We have nothing to protect ourselves with. Our job makes us vulnerable.
This probably explains Why DOCTORS?
Overall, the scenario is complex. At one extreme is the vulnerability of hapless Doctors/Nurses; on the other end is the delirium and hysteria of patients’ attendants. Given the complex nature of economic dynamics running the health-care today, conflicts are inevitable. Civilized conflicts like legal option damage the doctors personally and financially. Uncivilized conflicts like manhandling, assaults, media induced infamy harm us physically, emotionally and psychologically.
The most painful aspect of entire equation is that the actual culprits are not even in the scene. Business managers who run the Health-Malls and Policy makers of health care are the actual causes of conflict of this complex nature. But, they are not made accountable; no one asks them any questions; long term impacts their decisions are not even brought to the book. No one bothers to get into the roots of the problem to find a long-term solution.
By making counter-attack groups, asking for laws against attacks, asking our kids not to join this profession, we just applying Iodex over the abdomen for Appendicitis!