Incidents of assault against doctors in India have increased in the last few years. Majority of the doctors feel insecure at their workplace and that sometimes reflects on the quality of patient care. This article discusses the probable reasons for the increase in assault and what measures should be taken to avoid it, emphasizing on the role of communication. Assault against medical professionals in India due to various issues like delay in attending patients, cost and quality of treatment, negligence of doctors is tremendously increasing. According to an estimation given by Indian Medical Association, about 75% of doctors have faced at least some kind of violence during their practice. This issue is worse in government hospitals as they distinctly lack security measures and protocols. Assault on doctors, current scenario in India: Over the past few decades, India has witnessed major economic growth. At the same time, there has been increased commercialization of healthcare facilities. Due to this, most of the doctors are choosing corporate settings in urban areas. This has resulted in unequal distribution of the number of doctors between the rural and urban areas. Government hospitals in India follow the welfare model as most of the patients in these hospitals are from the lower socio-economic background. Such hospitals are often swamped with patients and hence the quality of care can easily get compromised. On an average, a doctor in government hospital OPD attends about 200-300 patients per day. According to a recent report, a doctor in India spends about two minutes per patient and this may impart a perception of negligence to the patient, leaving him partially satisfied. Trust in the doctor-patient relationship has decreased over the last few decades. In earlier times, the medical profession was being considered as a noble profession with the predominant objective of serving the mankind. Due to increased and easier access to digital media, patients are more exposed to cases of medical negligence and malpractices. This has caused increased distrust among patients towards doctors. Most of the government hospitals lack adequate security system. Furthermore, the common public has almost completely lost their faith in the judicial system and hence in instances of medical negligence or other legal issues, they prefer to seek immediate revenge by using physical means rather than filing a case in the court. Expected measures to avoid violence against doctors: Apart from doctors, the roles of hospital authorities, government, media and the community are equally important in avoiding violence against doctors. Hospital authorities: Adequate security personnel should be made available. Any visitor or attendant should not be allowed to enter without checking for proper identification and entry in the register. Visitors should not carry any kind of weapon in the hospital premises. Safety of doctors should be ensured by creating an emergency protocol and an evacuation plan to avoid the major act of violence. Government and police: Doctors should work with the government authorities to set security measures for themselves. A strict provision should be made in the law and any act of assault against doctors should be considered as a non-bailable offense. Media: The media plays an important role in conveying latest happenings in the healthcare sector to the public. Defaming physicians without any evidence should be avoided and convicting doctors should be left for the courts. Also, they should cover positive news about healthcare sector equally effectively. Community: Everybody’s expectations from healthcare providers have increased over years but people should understand the limitations of a doctor and medical science. They should believe in the judicial system and choose the proper way to lodge a complaint or a case instead of opting for physical assault against doctors. Importance of communications skills: Patients often expect empathy and assurance from doctors that they will recover soon. Indian medical schools are excellent in giving medical training to their students, however, they seriously lack in teaching them empathy. Most fresh and young doctors are not often empathetic enough towards the patients and attendants, which leads to a sense of neglect in patients. This may trigger the violent assaults easily. It is inevitable for doctors to explain the patient’s prognosis to the attendants in a lucid manner. Almost 50% of the cases of violent incidents occur in the ICU and about 70% are caused by patient’s relatives. Any miscommunication from the doctors regarding patient’s prognosis may cause patient’s relatives to have too high or unrealistic expectations for patient’s recovery and that may trigger violence if his condition doesn’t get better. Doctors should also explain the importance of certain diagnostic tests if they are costly. As most patients lack health insurance, they think of these tests as a financial disaster. Also, sometimes they feel these are unnecessary and this results in displacement of anger towards the doctor. The most important point that all doctors should remember is, they should be polite to patients, irrespective of how many patients they attend every day. After waiting for hours to see the doctor, ineffective or rude behavior from a doctor can easily make patients and their attendants to feel angry and agitated. Doctors also should not overreact while breaking bad news and always be polite and empathetic in such situations. Positive communication certainly helps in building faith among patients. Rotation of residents in private and public hospitals: India is a vast country and patients come from all backgrounds and socio-economical strata. It is hence important for all doctors to get an exposure to all kind of patients. In this regard, medical fellows and trainees should rotate between public and private sectors. The approach of dealing with patients in these two settings is completely different and this diverse exposure will improve their communication skills. In public sector, the number of patients attended by a doctor is huge and this gives them hands-on training in handling various situations. After experiencing the environment in both types of hospitals, doctors can choose the middle path which will help them in avoiding incidents of assault. Although the current scenario seems gloomy, it is not impossible to deal with this issue. The problem is multi-factorial and hence appropriate measures from all sides will help to tackle it. References: Mishra. Violence against doctors: the class wars. Indian Heart J. 2015. 67:289-292. A. Pai. Violence against doctors on the increase in India. Natl Med J India, 2015. 28:214-215. Paurush Ambesh. Violence against doctors in the Indian subcontinent: A rising bane. Indian Heart J. 2016. 68:749-75
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