India’s health system is facing a lot of crisis and the magnitude of the problem especially the violence with the health care professionals, particularly doctors, is perhaps far greater. Doctors in thousands across the country went on strike to protest a recent spate of violence against them. At least many separate incidents of assault on doctors, especially at government hospitals, are reported on weekly basis. As per a recent survey by the Indian Medical Association, as many as 75% of doctors in India have faced some form of violence at work.
WHY ASSAULT (CAUSES)
Disturbed doctor – patient relationship, patient dissatisfaction—is the proximate cause, agitated friends and relatives accompanying patients are the usual perpetrators and accident and emergency, intensive care unit, general medicine wards and post-surgical wards are the most common settings for such violence.
I would say when the doctor’s self-perception and the patient’s expectation don’t match, discontent arises. This mismatch between projection, expectation, and reality can be seen as reasons by the patients to be angry or violent. Moreover, a patient might have several images of a doctor without knowing the technicalities that are involved in the health care sector. I think doctors need to understand this crucial aspect of the relationship and address their patient accordingly while as those attending patients must also see that amount of work load, lack of facilities and other technical pressures that are always hovering over the doctors. And above all, people need to understand that there are certain medical conditions where no intervention can work and as a result, a doctor can’t help beyond a point.
As per recent studies, the two main factors identified which were contributing to the increasing incidences of violence- one was increased awareness among the patients of their rights besides their legal consciousness while the other was poor quality of medical services. Other factors that are attributed to rising incidence of violence include catastrophic out-of-pocket expenditures on health, lack of trust in doctors and hospitals, commercialization of the medical services system, poor government investment in the healthcare system, negative media reports about hospitals and doctors, inadequacy of legal systems and the absence of any other effective way of addressing the patient’s grievances.
It is now observed that patients and their relatives no longer remain silent regarding any kind of medical malpractice or medical negligence unfortunately on the part of some doctors or other paramedical staff. They want to identify why unexpected results happened and wish to receive adequate explanations besides demanding compensation from hospitals. This has given rise to increasing disputes between the patients and healthcare professionals and healthcare facilities.
Another important factor is the problems in the medical infrastructure system resulting in decreased quality. As a result, the incidence of medical errors has increased, the length of hospital stays is prolonged and medical expenses are increased as well. Meanwhile, patients’ legal consciousness is also rising – causing medical disputes leading to even violent acts.
WHAT IS THE NEED?
It is important to decrease medical disputes to protect the legal interests of both doctors and patients by reinforcing hospital security and ensuring the safety and dignity of medical staff as well as settling medical disputes under the law. To reduce medical disputes, the key measure is to gradually improve the quality of medical services and prevent avoidable disputes. If we generally talk of India’s Health Spending, it is only 1.5 % of GDP as compared to 18 % of GDP in US. Therefore there is need of exponential increment and budgeting towards Health Expenditure in India. Though there are many actions which can be taken by the government, hospitals, and medical schools, but the most critical is to encourage hospital directors to enhance and improve the quality of medical services.
ROLE OF HOSPITAL DIRECTORS:
Hospital directors can manage their hospitals well if they are given powers to appoint and make necessary audit of the staff based on their performance. They should be able to review the staff performance and give input in development of services and planning. The directors act as the most important persons in hospital development.
Therefore, we believe that designing an effective incentive and constraint mechanism to monitor hospital directors would strengthen hospitals’ quality management, train professionals, and improve clinical services. As a result, patient safety would be improved resulting in reduction in medical disputes and acts of violence. How do we encourage the hospital directors to improve the quality of medical services needs to be looked into. It is critical to implement effective and reliable performance assessment tools to evaluate the performance of hospital directors.
NECESSARY REFORMS IN MEDICAL EDUCATION SYSTEM:
Though it will not be easy for the government to increase the number of students in the medical education system as such, the priority, however, should be to conduct a series of strict accreditations for medical schools and enhance their level of standards. To ensure that accreditation is objective and impartial, it is necessary to set up scientific accreditation standards and invite legal and highly qualified experts to evaluate the performance of all these medical schools. Those institutions which are denied accreditation after inspection should be closed after giving them some time to improve and make up the deficiencies pointed out by the inspection team. The number of enrollments in the medical schools should be based on the number, quality of teachers and other teaching facilities.
In conclusion, I, being a doctor myself, would request the striking doctors—and India’s entire medical fraternity—to leverage this crisis as an opportunity to come together with their patients to demand greater nationwide political commitment to address the underlying social determinants of violence against doctors. At the same time, I would also advise patients to build trust, cooperate and emulate with the doctors who are the only legal experts in medical sciences.
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