How India treats its physicians: The patient is dead, let’s beat up the doctor. And go home
TNN | Aug 7, 2022, 07:26 IST
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These are real stories.
➤His colleague was under assault, he stepped in to protect her, and was assaulted with an iron rod. ➤A young professional tried his best to reverse the course of an impossible situation, didn’t succeed. He was slapped and then thoroughly roughed up.
➤A senior professional was humiliated, his colleagues were helpless spectators. He quit his job.
Anyone unfamiliar with India will never guess the profession that puts its practitioners at such risk and through such humiliation – but many in this country may get the correct answer. The victims, in each case, are medical professionals, doctors and, sometimes, nurses.
Assaulting doctors is a pan-Indian sport now. And enraged friends and relatives of patients are not the only ones in this game. Sometimes politicians and their retinue join in, sometimes senior government officials and police.
In other major countries, overwork and fatigue, dangers of contracting serious infections while providing care are the stress points of medical professionals. Only in India is workplace violence a job hazard for doctors.
It gets worse. There’s no guarantee an experienced, ageing doctor, even someone known to the patient’s kin, won’t be assaulted. There’s no guarantee a woman doctor won’t be assaulted. There’s no guarantee that a young doctor working in impossible circumstances won’t be assaulted.
But, and this is the nub of this terrible problem, there’s de facto full guar antee that no assaulter or humiliator will be punished.
‘Scared to treat serious cases’
Doctors everywhere are apprehensive and angry. Dr Unnikrishnan S, the doctor assaulted with the iron rod in Neendakar taluk hospital, Kollam, said what shook him most was that the assaulter had been his patient.
Terrible, unforeseen tragedies happen in hospitals. In PGI Chandigarh, junior resident Dr Harish tried frantically for 30 minutes to revive a woman who developed a severe allergic reaction to the dye injected for conducting a contrast CT scan.
Grieving next of kin can demand an inquiry. But in India, as happened in this case, violence is often the preferred response. The patient’s daughter slapped Dr Harish before roughing him up.
In Kolkata, doctors say the pandemic, as grim as it was for frontline health professionals, interrupted the endless cycle of violence and intimidation. “Until three years back, doctors here were scared to treat serious patients,’’ says Dr Diptendra Sarkar from Institute of Post-Graduate Medical Education & Research, Kolkata.
But doctors in Kochi didn’t even catch a break when the pandemic was raging. Forty cases of assaults against doctors treating Covid patients have been reported.
Pick a city or a town in India, trawl the local news, and chances are there will be a story of doctors getting beaten up.
On April 11, two resident doctors from Howrah District Hospital suffered shoulder dislocation and head injuries in a mob attack that followed a 56-yearold kidney patient’s death. On August 2, relatives of a road accident victim beat up a doctor of the Government Medical College, Aurangabad for allegedly not attending to patients, triggering a strike call by the resident doctors.
Of course, it’s not just angry relatives doctors have to contend with.
When netas, babus & cops join in
Powerful people in this country are no strangers to abusing power. So, as disturbing as it is, it’s perhaps not surprising that politicians, bureaucrats and police often do their bit to make doctors feel unsafe and/or humiliated. And sometimes, drive those who are trained to save lives to take their own lives.
Gynecologist Dr Archana Sharma from Dausa, Rajasthan, wrongly accused of murder when a patient died, committed suicide in March. Post a successful delivery, the mother of the child died of postpartum haemorrhage. Police booked Dr Sharma under IPC Section 302 following angry demonstrations led by politicians.
That was against laid down procedures. Last year, National Medical Commission (NMC) had issued guidelines requiring police to send medical negligence criminal complaints to the district medical council’s medical board. Before an arrest, experts must hear the case and the doctor’s defence must be heard.
But, as the Dausa tragedy showed, police does not comply, and the NMC seems powerless.
In her suicide note, Dr Sharma had written: “Don’t harass innocent doctors. ” That message should have had some effect on our politicians. But it didn’t.
Dr Raj Bahadur, vice-chancellor of Baba Farid University of Health Sciences in Punjab’s Faridkot district, was forced by Punjab health minister Chetan Singh Jouramajra to lie down on a damaged mattress in front of staff and patients. He resigned a few hours later.
Delhi-based Dr Rohan Krish nan, founding member of Feder ation of All India Medical Association (Faima), doesn’t mince words: “Politicians are so arrogant they forget the dignity, service and dedication of doctors’’.
This arrogance is obviously infectious. In Tamil Nadu, a medical officer was transferred out of Kanyakumari because the district collector reportedly didn’t like his body language. The transfer followed a five-hour review meeting held in May during which the collector, M Arvind, hauled up Dr Allan Major, in-charge of the Rashtriya Bal Swasthya Karyakram, for allegedly browsing on his phone.
“There should be an inquiry and the doctors should be given a chance to explain. Suspension and transfers can’t be done without due process,” says Tamil Nadu Government Doctors Association president, Dr K Senthil.
A doctor in Mohali’s medical college highlights a hazard doctors all over India have to cope with: people often drop names of local politicians and threaten doctors with reprisals if they don’t see the patient “on a priority”.
Surgeon-activist-writer Dr Sanjay Nagral points to Mumbai, where the country’s richest civic corporation, the BMC, operates five medical colleges. But senior staff is at the beck and call of local netas. “Deans get their staff to comply with the demands of corporators or local politicians,’’ says Dr Nagral, who has worked with civic hospitals for decades. It gets worse. Corporators and their entourages have been known to enter deans’ offices or even sterile ICUs.
While every assault and humiliation is indefensible, does the sheer frequency of these incidents point to some systemic triggers? Experts are divided.
Healthcare, Heal Thyself?
The root of the problem, many experts believe, is India’ shortage of doctors and healthcare infrastructure in comparison to the population’s needs.
True. As per health ministry data, India has 13,08,009 allopathic doctors and 5. 65 lakh Ayush doctors, translating into a doctor: patient ratio of 1:834, better than the WHO’s standard of 1:1000. But most doctors are concentrated in urban areas and in the private healthcare system.
Pune-based Dr Abhay Shukla from Sathi (Support for Advocacy and Training to Health Initiatives) and author of ‘Dissenting Diagnosis’, says the violence
is a “systemic” problem. “We are always looking for a scapegoat because the system is understaffed and woefully inadequate. ” Usually, lower-level staff, in many cases resident doctors, are targeted for their inability to communicate or carry out grief counselling for relatives, Dr Shukla says.
Failure to communicate with empathy is identified as a reason by others. Dr Nagral says many young doctors these days are particularly insensitive when it comes to consoling grieving kin.
Some doctors blame the “corporatisation” of healthcare. An experienced practitioner from Mumbai, who spoke on the condition of anonymity, says: “You first privatised medical colleges where students pay crores to become doctors, then you allowed public private partnerships in which the private parties dictate terms, and now corporatisation of hospitals is being promoted. ”
This doctor’s point is that expensive private medical care, provided by establishments where bottomlines are the first priority, and therefore delivered with little reachout to patients, can act as a trigger.
Some point to the choice faced by millions of low-income Indians — either overcrowded government hospitals, where quality of care is often poor, or very pricey private care. Expensive private treatment is not restricted to big hospitals in big cities either. Small nursing homes in non-metros can eat up a family’s life savings or push them into debt.
And even those nursing homes may not be around for long. “Nursing homes were the mainstay of healthcare delivery, but due to new legislation they may not survive. Owners now have to, among other things, use fire-proof doors only. The cost of such an upgrade will be passed on to patients, who will end up feeling further short-changed,’’ says Dr Lalit Kapoor, head of the Association of Medical Consultants, Mumbai.
Other experts point to the creaking system of adjudicating on medical negligence — there’s virtually no avenue for quick and fair hearing on complaints against grossly erring doctors. NCRB data shows 552 cases of medical negligence between 2018 and 2020. But healthcare experts say the actual number will be much higher.
Even cases that find their way to the legal system get caught up in the huge general backlog, and that applies to consumer courts as well. Matters aren’t helped by NMC amending rules to say doctors can appeal against an order but patients can’t. While all of this contributes to violence against doctors, the one thing that can have a deterrent and be fixed in the short term is also absent.
Why are assaulters never punished?
“When a doctor is beaten up, a case is often registered only after a protest,’’ says Dr Vijay Kapoor, secretary of Private Hospitals and Nursing Homes Society (PHNHS). Maharashtra was the first state to pass a legislation against assault on doctors in 2010, but 12 years on, convictions are still close to zero, he added.
Countrywide protests by doctors after the Dausa tragedy forced the Rajasthan police to change the FIR, but nothing much has changed in the state, Dr Kapoor says. “The main accused are now out on bail. A senior police official who was awaiting posting orders has got the posting,” he observes, adding that the Rajasthan Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008 is still in cold storage.
“Just one strict conviction will bring about change,’’ says Dr Lalit Kapoor.
If the cycle of violence never stops, India will pay an even higher cost.
Who wants to be a doctor?
Here’s what an Indian-American doctor, sickened by what’s happening to his fellow professionals in India, says: “If mob justice continues unabated, medicine will become even less popular, and fewer doctors will elect to help the sickest and most disenfranchised. Mobs will turn even more viciously against the few brave ones who remain in government-run hospitals”.
That’s from a blog by radiologist Saurabh Jha, Hospital of the University of Pennsylvania. Dr Jha writes he was secretly happy his niece in India decided against becoming a doctor. “Medicine is stressful enough without doctors being worried about their personal safety”.
What will happen if more and more bright, young Indians, tomorrow’s potential doctors, think the same way?
(Contributions by Malathy Iyer from Mumbai, Pushpa Narayan from Chennai, Somrita Ghosh in Delhi, Preetu Nair from Kochi, Shimona Kanwar from Chandigarh,Saibal Sen and Prithvijit Mitra from Kolkata & Syed Intishab Ali from Jaipur)
Dr Soumya Shrikanta Mohapatra
10 minutes ago
With all my honest years I have put up to become an orthopaedician, getting my education in premier institutes, today I am ashamed that I am a doctor in India. With every harassment by relatives to any doctor my blood boils. With so muc
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