Violence against doctors: How hospitals must plan to prevent crisis!

The recent episode of an attack on doctors in a Kolkata hospital and the subsequent strike by doctors across the country puts the spotlight back on the issue of violence against medical personnel. Attacks on doctors by kin of patients have made regular headlines across the country in recent years. A study conducted by the Indian Medical Association a few years back found that a whopping 75% of surveyed doctors had suffered some form of physical violence while on official duty. Pertinently, a majority of these assaults are reported from ICUs or Emergency Room where critically ill patients are admitted.

Violence against medical practitioners is not something unique to India. A German study published in 2015 found that almost 50% of surveyed doctors had confronted aggressive behavior, with 10% of them experiencing violent attacks. A survey conducted in China found that incidents of physical violence causing harm had increased from 48% in 2008 to 64% in 2012.

Instances of violence have considerably increased in recent years not just in overburdened public hospitals but also against private hospitals. At the root of this problem in India is the paucity of healthcare resources. Shortage of human resource, medical infrastructure and number of beds are real problems that must be addressed on the policy level. However, this disturbing trend is also symptomatic of the changing relationship between doctors and patients in India. Till a few decades back, doctors in India were looked upon with much trust and faith by people. Unfortunately today most common people look at medical practitioners with an element of suspicion and distrust.

Causes behind rise in patient violence

The trust deficit between doctors and patients is a real concern. With the proliferation of private clinics and the emergence of Corporate Hospitals, there is a growing perception that doctors are operating with the intention of fleecing. The mistrust phenomenon has also been fuelled by constant media scrutiny that highlights malpractices and corruption by medical practitioners. There is an interpersonal angle to the erosion of trust as well. In a country where the doctor patient ratio is far from satisfactory, doctors are always overwhelmed with patients. Heavily busy doctors often do not have enough time to invest in in-depth conversation with patients. Saddled with a meager healthcare budget, public hospitals present a dismal picture where overcrowding, long waiting time and the need for multiple visits for investigations and consultations frustrate patients on a daily basis. Lack of sufficient security and protection for doctors also embolden mob violence which itself has seen a disturbing growth in recent years.

 Role of hospitals

This brings us to the all important question of what hospitals can do to minimize such incidents. With doctors busy with clinical work, there is need to have adequate number of managers to provide administrative and managerial support so as to allow doctors perform their duties without fear or distraction. The officials responsible for administrating a hospital must not only have managerial skills but also adequate soft skills, a compassionate approach and understanding of social and behavioral issues.

Here are a few necessary elements of a sound hospital management:

Consent and communication at regular intervals

Often, doctors do not adequately communicate with attendants, who later complain about being kept in the dark. At no point should the relatives be misinformed or given unreasonable expectations of recovery when the patient is critical. It is highly important that in case of critical patients, treating doctors meet families every day, even more than once if required and clearly explain to them the prognosis. Having a regular and honest communication ensures that patients are under no false expectations.

Informed consent is another significant step in preventing violence. While attendants are always made to sign documents before a medical procedure, doctors or hospital managements hardly explain the contents of the documents to medically illiterate families. Not to forget the need to have proper documentation of patients’ course of treatment so as to be secure in case a matter goes to police or court. The Golden Rule of consent taking is “The person (doctor) who holds the knife holds the pen”, in short, the consent should be taken only by the doctors after a detailed explaining in the language understood by the patient / patient family.

Compassionate treatment of kin

It is essential for hospital managers to inculcate the spirit of compassion and care among all staff members. For doctors and medical staff witnessing serious illnesses and mortality, it is an everyday affair. However, for families who lose a member, it is nothing less than an earth-shaking event. It is important therefore to be considerate to them, make processes smooth and quick and eliminate unnecessary hassle. Care must be taken that attendants of critically ill patients are not pestered too frequently to pay bills. Doctors and staff members must try to console grief stricken families and counselors for emotional support should also be made available. Compassionate treatment can go a long way in pre-empting any kind of unrest.

Be prepared

While all efforts must be taken to pre-empt violence, it is also important to be prepared to deal with a violent situation, much like you are prepared to handle emergencies such as a fire or earthquake. One of the most important steps to prevent violence inside a hospital premise is to restrict entry of attendants through passes. Security guards must be placed not just on the hospital gates but also at sensitive areas such as ICUs and emergency units. Staff members at such locations must also be trained to stay alert to signs of any possible unrest. A standard operating procedure must be developed and each staff member should be aware of the do’s and don’ts of such situations. If signs of aggression are noticed, senior management must immediately reach the spot, intervene and speak to attendants to prevent the incident from escalating.

Rebuild trust

For the medical community at large, it is important to make efforts to rebuild the lost trust between doctors and patients. They must also make efforts to not just treat patients physically but also assuage their concerns, remove their doubts and help reduce stress. The corporate houses that are investing in the field of medicine must also pay attention to create affordable healthcare facilities.

About Author: Dr Dharminder Nagar is the Managing Director of Paras Healthcare. He has the unique advantage of being a doctor, hospital administrator and entrepreneur all in one. Dr Nagar was awarded the Entrepreneur of the Year (2015) Award at the India Health & Wellness Summit 2015 and Dynamic Healthcare Entrepreneur of the Year 2015 by Six Sigma Healthcare Awards at the World Entrepreneur Summit.