Why doctors are having to run for their lives in India

Dr Manish Kumar, a resident doctor at Jaipur-based Sawai Mansingh Hospital, narrates a traumatic experience he underwent while on duty:“It was supposed to be just another Sunday, typically chaotic and tiring for medical practitioners. I was posted in the male ward that treats patients forwarded from the emergency. I had been working continuously from Thursday night till Saturday evening and had returned to the post for another marathon shift after a short break.Generally, we expect 40-45 patients over 2-9 pm on Sundays with only two resident doctors to treat them, apart from nursing and support staff. At around 6.30 or 7 pm, we came across a new admission — a 70-year-old, referred from a hospital in Uttar Pradesh. The patient was in shock, his blood pressure was extremely low and he was suffering from every ailment I could think of — cancer, severe pneumonia, a failed kidney and infection in the entire body. Making matters worse, at least five of the patient’s relatives — three men and two women — also entered the ward and started giving us instructions on how we should begin the treatment.As I was wondering why the security guards didn't stop them, a twenty-something cocky lad threw the patient's file at me and asked me to start dialysis. I explained that the elderly man was not in condition to undergo such a procedure.But they were in no mood to take no for an answer.We put the patient on the bed and asked the male family members to get some medicine. At that time, the patient’s entire system suddenly collapsed and he fainted. I performed the cardiopulmonary resuscitation (CPR) procedure on him for about 30 minutes but could not save his life. medium90797690“Aap ne maar diya [You killed him],” the family accused me. I tried to console them, explaining that given the patient’s condition it was already too late, only to be met by a flurry of expletives. To avoid further confrontation, we all huddled inside the nursing cabin to complete the formalities to handover the body. But this caused the family’s rage to spiral. One of the relatives came inside the cabin and threatened to kill me. I was trying to pacify him when he started roughing me up; the rest of the family members joined in thrashing me. A colleague came to my rescue and we locked ourselves in another room. The family then ransacked the entire ward before police arrived. I was in shock. The trauma was such that I could not go to work for the next four-five days. Even after four years, when I see more than two attendants with a patient, shivers run down my spine.”Dr Kumar’s case is hardly new or unique. More than 75% of doctors have faced some form of violence, a 2015 study by the Indian Medical Association (IMA) revealed. medium90797792Things have gotten so bad that in some states like Bihar and Rajasthan, doctors, especially in the private sector, have started hiring private security agencies and bouncers for their safety. What doctors wantRajasthan-based gynaecologist Archana Sharma's recent suicide, following harassment from a deceased patient’s family and after an FIR was filed against her, has not only sparked protests by the medical fraternity across the country, but also prompted the Indian Medical Association (IMA) Dwarka to file a PIL in the Supreme Court seeking directions for issuance of guidelines for protection of doctors.“We are planning to submit an application stating what actions should be taken at the time a medical emergency occurs. For instance, what should the police do, including not allowing anyone to bring a body in front of or inside the hospital to protest because that affects the treatment of other patients as well,” says Dr Ashok Sharda, state president, IMA Rajasthan. medium90797811What does the law say?There are already some state laws in place to protect doctors from workplace violence, but implementation has been a challenge. Consider the Prevention of Violence Against Medicare Persons and Institutions Acts, which have been notified in 25 states and Union territories in the past decade. “These state laws have an inherent flaw. The law provides for imprisonment of three years for attackers. But the Supreme Court later said that for a law to be a non-bailable offence, you need to have a section which has a minimum imprisonment of seven years,” says Dr Ravi Wankhedkar, treasurer WMA and former IMA president.According to him, the medical body wants all states to modify their respective laws to increase the imprisonment to more than seven years. medium90797839The only pan-India law currently protecting doctors is unfortunately limited to the pandemic or similar situations. In September 2020, the Rajya Sabha passed the Epidemic Diseases (Amendment) Bill, 2020, that specifies that no person can commit or abet violence against a healthcare service personnel, or cause damage/loss to any property during an epidemic. Culprits are punishable with imprisonment of anywhere from three months to seven years and with a fine of up to Rs 5 lakh in case of grievous harm. The PIL in the apex court seeks a universal central law of this Act. “The Act was passed during an epidemic only because the government needs us. We have requested the government to make this law endemic,” says IMA’s Dr Sharda.“Lastly, we want no murder charges to be registered against a doctor in such cases; culpable homicide should be applied on the basis of a proper report of the expert committee,” he adds. medium90799265Better bedside manners is keyHowever, giving the medical fraternity a safe environment will need more than just legal muscle. Healthcare workers will need to do their part by learning empathy along with their medical training and polish up their communication skills, especially when it comes to breaking bad news.“You need to understand the psyche of the patient who is already in physical, mental and financial pain. If we don't talk properly to patients, relatives get annoyed. Unfortunately, there is a breed of local politician, who for their own political purposes take advantage of the situation and the local police always has a very good rapport with them,” explains WMA’s Dr Wankhedkar, adding that the doctors, on the other hand, “tend to live in their ivory towers”.“Statistics from a recent Indian study of 151 doctors, evaluating workplace violence, suggested that only six of them had received some formal training in effective communication,” reads a 2018 research paper titled “Violence against doctors: A wake-up call”. Five of the doctors, incidentally, were from the psychiatry department where it is a part of the curriculum. medium90797868Centre needs to step upDoctors also point to the “misplaced priorities” of the government, like not improving public health infrastructure. “Whatever meagre amount is allotted to health goes to tertiary care centres and not towards strengthening the primary healthcare,” says Dr Wankhedkar.The way forward hinges on improving India’s doctor-patient ratio, failing which the public healthcare system is on the verge of collapse. “No one really knows how many doctors are actually practising in India,” says radiologist Bhavin Jankharia in a TOI blog post. He estimates the doctor:patient ratio at 0.74:1000. The World Health Organisation recommends a minimum ratio of 1:1000. Violence against healthcare workers is only a symptom of this crippling malady.Sources: IMA, Indian Journal of Medical Research, The National Medical Journal of India, Journal of Health Research and Reviews medium90797628How fake doctors are killing and maiming people in India medium90797653