The Citizens of India,
The Authorities of India,
Subject: Violence Against Doctors – A NATIONAL ISSUE NOT A STATE CONCERN
We understand you are a very busy man/woman and have a lot on your plate. However, it is a sincere request from the Doctors of India that you personally read the complete email and hear our case. I know it is long but nothing in it is purposeless, so please bear with us.
The Dhule case of brutality against a resident on call has shaken me to the core.
I am appealing to you as an individual, as a doctor and as a human being to help us. In this letter I want to draw your attention to the incidence of such events and the gravity of the situation. I would like to explain the possible causes for such events and suggest some measures that may help provide a safer environment for doctors to work in.
The Dhule incident is gruesome but not the first of its kind.
As a response, many of us filed greivances with the PMO. However the office has treated the matter as a state issue and not a national one.
Reforms in one state or temporary measures have not helped the plight of doctors in the past and are unlikely to help in the future.
The plight of DOCTORS of INDIA will only improve with NATIONWIDE REFORMS.
I remember that in response to the dalits being assaulted in Telangana in August 2016, the Prime Minister had claimed, “Shoot me, if you have to, but do not target dalits”. So why is the central government turning a deaf ear to the assault on doctors?
Moreover the statement of the Chief Justice of Maharashtra High court has lifted our faith for any reforms. Justice Sikri, in wake of attack on 3 trial court judges in New Delhi had said that he has taken a strict view of the incident on Judicial officers. “I and my colleague judges have taken a very serious view of these incidents. A judicial officer requires a fearless and independent mind to do justice and any apprehension in his/her mind about his/her safety would certainly hamper his/her capabilities to judge fearlessly and impartially,” he said. However, on the issue of assault on doctors, the judges took a completely different stand.
The doctors have faced immense difficulty gaining support from the government or the justice system, very little support from the public and the media. They do not have the resources, the time or the power to make a difference themselves. Hence we are appealing to you, citizen of India, to help us awaken the nation to this cause. The strike of the doctors was just the smoke rising from a long burning fire. The fire of assault on doctors. A fire that is recurrent and every time more ferocious. The smoke rises and ultimately suffocates the common man while it burns the doctors. If the root cause of this fire is not understood and taken care of, it may rise again, sometime in the future , somewhere else, and affect doctors and the common man again as is evident from the past.
An ongoing study of the Indian Medical Association, IMA, revealed that over 75% of doctors have faced violence at workplace. 70% of these attacks are due to excess escorts accompanying the patients. Attacks on Doctors and Indian Hospitals have been continuously rising; exponentially so in the last 5 years. The attacks have not only increased in frequency, but also in violence.
Assaults have been noted in ALL STATES from Himachal Pradesh to Tamil Nadu, not just MAHARASHTRA.
In September 2013, a lady doctor on call at the Lok Nayak Hospital in Delhi was physically assaulted and apparently threatened with rape by a patient’s kin. Her only crime was attending to the sicker out of the two patients that had come in at
the same time; at which the other patient’s relatives had taken offence.
In early 2015, a doctor was assaulted in Allahabad and the infrastructure in the ICU damaged by the relatives of an eighty-year-old patient who came in a critical state in multi-organ failure and died in the hospital.
Just last year, a 3-year-old child was brought in dengue shock syndrome to KEM Hospital, Mumbai. As there were no vacant ICU beds in the hospital, he was admitted to the ward after a written and informed high-risk consent form was signed by his parents. Critically ill, the child suddenly died despite all appropriate measures. Therefore, his father and uncle with two other people took it upon themselves to beat up three resident doctors with iron stools, rods and wooden sticks snatched from two female security guards.
On December 22, some people forced the doctor at Una hospital, Himachal Pradesh, to see a patient in the car but when he asked them to bring the patient inside, they misbehaved despite the fact that the patient was brought dead. After four hours, those people forced the doctor to apologise to the dead body and misbehaved with him. The stress from the incident and pressure from the people continued and on January 18, the doctor suffered a heart attack and died.
Now, we have the incident in Dhule. Since there were no neurosurgery services at the hospital as needed by the patient, the resident on call referred him to a hospital where they were available. At this, the resident doctor was so brutally beaten that he lost an eye.
Even while the protests went on, 11 doctors were assaulted in the span of 10 days in Maharashtra alone.
The list is endless.
As doctors, we signed up for all the hard work, thousands of hours of study and practice, countless sleepless nights, innumerable personal sacrifices and service to mankind – but we did not sign up for physical and verbal abuse.
Underfed and under-rested, the doctors continue to work in sleep deprivation for days on end, often in places where there are not even common public facilities. Despite this, they endeavour to give the best possible care to every patient at every odd hour, in every season and irrespective of the caste, creed, colour or financial status of patients. And yet doctors become human punch bags for the patient relatives, mostly due to no fault of their own.
The victims of such assaults are mostly the resident doctors who are young and are still starting to deal with such delicate situations. In the emergency room, a doctor has to assess the medical condition of the patient, assess the resources available, formulate a plan for the treatment – all keeping in mind the hospital facilities and the patient’s financial status. Along with that, there are medico-legal records to be made and other formalities to be dealt with. In addition to this, the doctor has to anticipate the emotional reaction of the panicked patient escorts and try to deal with the same.
All this has to be done within a few minutes, with the abysmal personal condition of the doctor himself and without any room for error and maintaining good manners and a warm countenance throughout. It is too much to be expected from a person.
The doctors are given no special training to handle such circumstances. They have never been taught mob psychology or the fine art of counselling. There are no counsellors available at hand. They have nothing to rely on except their short experience.
Most of the attacks happen during the evening and night hours. This is so because the hospital staff and personnel are less and the senior doctors are often unavailable to counsel patients in an efficacious manner.
The inability of the patients to understand the functioning of the emergency room and the expectation of immediate and guaranteed cure is also responsible for fuelling such incidents.
Many relatives come to the hospital with the hope of immediate treatment for the patient. However, they fail to understand that sometimes the facilities or the super speciality required by the patient are not available at the hospital. A doctor cannot provide treatment of a speciality he is not qualified to handle. In such a case the doctor does whatever is possible to help the patient and refers the patient to a centre where the facilities required by the patient are available.
Sometimes the patient load is so much that all the ICU beds in the hospital are occupied. In such a case, the patient cannot be admitted. This is not because doctors do not want more workload. It is because no more critical machines and appliances needed by the patient are available in the hospital. The number of ICU beds is linked to the critical care apparatus available. Let us say a patient is admitted when ICU beds are not available. Later, he develops breathing difficulty. However, the hospital has only as many machines to assist breathing as the umber of ICU beds. Nothing can be done for the patient then. In order to avoid such a situation, if there are no more ICU beds, the patient is not admitted. It is advised that he be shifted to a hospital where he can receive the required treatment. It is advised in the interest of the patient.
The emergency room works on the protocol of triage and not on first come – first serve basis. This means that the most serious case that has the maximum hope of survival after using the hospital services is attended to first. So, let us say two people in the emergency room have the same severity of injuries. One has 90% chances of survival if operated soon. However due to other factors such as age and long-term diseases, etc. the other patient has only 10% chances of survival. If only one OT is available, then the person with more hope for survival will be attended to first. Otherwise, we may lose both patients. However, if 2 OTs are available, both will be attended to immediately. The less serious cases will be seen later.
Please bear in mind that these are international protocols set in place for doctors to follow. These protocols were made to help the maximum number of patients with the available resources. Doctors CAN NOT and DO NOT choose which patient to attend first.
However, it is very difficult to explain such things to the relatives of the patient. Due to their emotional condition, the relatives also find it difficult to understand such complicated things. It also uses up time which the doctor would rather spend treating the patient. Treatment of the patient is the first priority of the doctor. Once the patient is stabilised, or the maximum possible treatment given to the patient; the relatives are informed. However, this takes time. Meanwhile, the patient’s relatives get angry and frustrated.
The emergency room or ER is run by doctors in general medicine and general surgery or orthopaedics. Very few hospitals have specialised Emergency medicine or trauma surgery specialities meant to exclusively handle emergency cases. Doctors from super specialities on call are not in the ER. They are in their respective departments in the hospital. They are summoned according to the requirement of patients after their initial assessment. They report within a few seconds to a few minutes and perform their assessment. After this, they order absolutely necessary investigations to determine what treatment to give. Only then, they inform the general doctor of their plan. Until then, the general doctor has no authority to discuss management plan of another speciality with the relatives. It should be noted that the treatment of the patient is not delayed. The treatment is started at once and the assessment goes on side by side. However, all of this takes time to be put together to be told to the relatives.
The emotional turmoil of the laymen makes it very difficult for them to understand much, if anything, about the illness, the reason for referral or delay in information being given to them. All they know is that bringing a patient to the hospital automatically means a miraculous cure. They are already frustrated at the situation, so they unleash all pent up wrath on the helpless doctor in front of them without a second thought.
The fact that many such culprits never face much penalty, further empowers the public to vent their frustration on doctors. They end up brutally beating the young doctor on call, often mutilating him or her for life and many times completely damaging their career, too.
While raising the wisdom of the society and making them more capable of dealing with their emotions in a mature manner is too much to ask for, short and intermediate term measures can be taken for a smooth functioning of the healthcare system.
Some such measures that we feel will help improve the safety and security of doctors are listed below.
- Making violence against doctors a cognizable, non-bailable offence nation-wide with strict penalties to the culprits.
- Increasing security in the hospitals, especially in the emergency rooms for the protection of the doctors. It should not be done as a temporary measure but implemented as the requirement for the functioning of the emergency room. The security should be doubled at night and given the power to detain violent escorts until police can arrive at the scene. posting more Male nurses in ER for the night shift shall also be helpful.
- InstallingCCTV cameras in the hospital, especially in the ER for proof of assault to convict the culprits.
- Allowing at the most two relatives at a time into the emergency room and wards. If anything is required, hospital personnel are available at all times for the patient.
- To enhance effective communication, the medical education should involve courses regarding mob psychology and grief counseling so that young residents at the start of their careers know how to handle such delicate matters.
- (Grief) counsellors should be appointed 24 hours in the Emergency room to handle emotionally charged relatives of the patient and keep them informed of the progress of the patient.
- A separate room with only fixtures and security should be made available to break bad news to the relatives.
- We would also like if the relatives can be explained the following in the ambulance itself en-route to the hospital. This can be done by the ward boy, paramedic etc. accompanying the driver.
- Beds may not be available and hence the patient may need to be referred after giving whatever treatment is possible.
- Superspeciality or services needed by the patient may not be available and hence he may be referred after giving whatever treatment is possible.
- The possible treatment of the patient will start immediately but complete assessment may take time. The doctor will first take care of the patient and once he is stabilised and complete assessment done, he will inform you. Until then, please be patient.
- If there are more serious patients than this one, they may be attended to first. Patients are attended to in order of severity as per the guidelines of the emergency room. So please be patient.
- In no circumstance whatsoever, is anyone allowed to harass or injure doctors.
In addition to this, reaching out to the society to bring about a change in their opinion of doctors is critical as a long-term reform. Some people carry a warped image of doctors in their mind which in turn is used by the perpetrators of such violence as justification for their actions. In the mind of some people, the image of doctors is that of heartless demons who run a business for personal gain and live lavish and comfortable lives at the cost of others – a picture so far from reality it is almost fictitious. I agree, there may be some corrupt doctors. However, there are a few corrupt people in all professions. This does not mean that every person in every profession is corrupt. It is wrong to patronise any profession as corrupt as it is not true. Action should be taken against the corrupt people in all walks of life via proper channels. Nothing gives the right to a person to start beating up another human being for any cause.
There is a huge gap between Doctors and the patients, the doctors and the Government, and the Doctors and the Media. Painting doctors black and somehow making them look responsible for everything going wrong with a patient distracts people from asking the real questions from the people actually responsible. The pent up anger is misdirected towards the doctors. Hence, the above-mentioned gap and the hatred for doctors increases and adds fuel to the long burning fire.
A pure and pious profession is viewed by some people in a light so ugly and atrocious, it is nauseating. This distorted viewpoint takes away the faith of the society in doctors. A faith that is the lifeblood without which healthcare cannot function.
Unless this demon is bridled, the gap between doctors and the world bridged and the real facts made understood, there is bleak hope of improvement in the condition of doctors in this nation.
Media can play a pivotal role in portraying the true condition of doctors and redeeming our image in the eyes of the society. There are numerous advertisements issued in public interest, raising public awareness regarding crime against women, domestic violence, drunken driving, smoking etc. The government has an advertisement asking doctors to provide free services on the 9th of every month, which a lot of doctors are willing to do.
- We would highly appreciate if there were an advertisement issued in public interest making people aware of violence against doctors and pleading them not to perpetrate it.
Doctors Have Been and Are on Your Side, Patients
Medicine is a hard and trying road. One needs strength of character to go through this furnace. A person who has never walked this path will find it difficult to understand the pain and the glory of it. Let it be known that a doctor would never want to see his patient suffer. The sound of the cardiac monitor beeping after a successful resuscitation is the sweetest music to the ears of the doctor. It is proof that half his life that was spent in books, all the late night parties he missed, all the functions he failed to attend, all his education loans, all his workaholism has finally not failed him.
Would a warrior be proud to lose a battle? Would a scholar be proud to lose his Knowledge? Could a farmer who has worked his fields for the whole year stand the destruction of his crop? Could an artist stand the soiling of his masterpiece? A doctor is all these and much more while treating a patient.
Doctors have a rigorous schedule everyday. Despite that schedule, a number of doctors continue to fight for patient’s everyday. We fight for better facilities, more ICU’s, more insurance, etc. etc. etc. There are doctors who work to raise funds for the treatment of and treat burn victims, acid attack victims, kids with autism and breast cancer patients in addition to their everyday duties. There are doctors who give away money from their pockets to help poor patients. Now, a famous celebrity with crores of rupees, giving away a couple of lakhs for a cause hits the headlines. However, a doctor raising money twice or thrice his own salary only for the benefit of the patient, or giving away half his salary for a patient, does not hit the headlines – in part because doctors believe in ‘do good and cast it into river.’
This is the main reason you do not hear much about doctors. Our entire lives are spent entombed within the walls of the hospital constantly fighting life and death. It is only when the fire erupts that the public suffocates and doctors make the headlines.
After putting in everything into the treatment of every patient that comes to him or her, the doctor does not deserve brutal beatings and mutilation for life. The doctor does not want to leave his or her home every morning wondering if he or she will be alive to return to it at the end of a 36-hour workday.
If a doctor lives in the constant fear of his or her life, how could he or she possibly provide the best possible care to the public? How can their morale support such rigorous and trying demands on their profession if they are deprived of basic human rights? Why would he agree to provide free services and endure postings in even the most neglected areas of the country if he knows anyone can mutilate him for life without facing any consequences? Why would anyone choose to take this profession at all? In such a case, the situation of health services during the strike may very well be the situation of health services all over the country in the future. In hurting a doctor, you are depriving yourself of the healthcare and services provided by him – services that no other profession can come and fulfill.
The people who are convinced that a doctor can control the resources and services at a hospital or he or she would willfully harm his patients has not understood the challenges faced by a doctor in daily life. The people who believe that their heinous crime of beating up doctors is in any way justified have never understood the profession at all. When interviewed later, their simple answer is – We were so struck by grief and emotion, our minds did not know what our hands did.
Grief makes people blind. Doctors know this, and don’t expect people to hold together at such times. Oftentimes they even help the relatives to cope with it. For grief is the right of every human being who has loved, and without love, there is no humanity. However, grief does not give anyone the right to vent out their frustration on and physically injure others – least of all on one of the few professions that save lives.
The voice of doctors for their protection has hardly ever been heard, especially via channels other than strikes. If it is heard, people often forget it after a few days. We shudder to think what future lays ahead for this profession if doctors continue to be beaten up so brutally. We cannot wait for a heinous incident like Nirbhaya to happen before the nation awakens to the plight of doctors.
Violence against Doctors is a very serious matter. It is as widespread and serious as crime against women, corruption or pollution. It is not the matter of a STATE OR A REGION, BUT A NATIONWIDE ISSUE and requires the immediate attention of the CENTRAL government. We do not ask for much – only safety and security. These, we believe, are the basic rights of every human being. The Judiciary, politicians, TV actors, cricketers and even prisoners and the accused have the right to security. SO why are doctors being deprived of this right despite repetitive and life-threatening assaults on them? The doctors of India have faith in you and believe you will not neglect our plea for basic necessities such as safety and security in the workplace. Please help us ensure the security of doctors so that they can work without fear and continue to provide their best services from the core of their hearts to every single patient.
As a common man, we hope you hear this plea from the fraternity of doctors and understand the gravity of the situation. We hope you understand our point of view and cooperate with us and uphold your duties as citizens of India and honour our rights as citizens of India – just like we do for you. A mutual trust has to be re-established and doctors have always been ready to meet you more than halfway. So please, stop and think for a second before you start the assault, is the doctor in front of you really responsible for what is happening? Please ask why and how before you start throwing blows. And even if you do conclude that the doctor is responsible, ask yourself, are you entitled to take law into your own hands? Aren’t there proper and civilised channels to address the issue?
Panic is not the excuse for violence.
Pain is not a reason to inflict it on others.
Tears from eyes of one do not give them the right to hurt the hand that heals.
The death of a relative does not give someone the right to draw blood from the person trying to save lives.
It is time the nation decides whether it wants to fight diseases or its doctors.
Doctors of INDIA.
To get an inside view on the life and workings of a hospital, Please read “An Average Day in a Resident’s Life” soon to be uploaded on our blog.