India's health system is facing several crises but the magnitude of the problem regarding the violence of health care professionals, particularly doctors, is far greater. Doctors in thousands across India went on strike to protest the recent spate of violence against them. Growing number of assault incidents and attacks 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 percent of doctors in India have faced some form of violence at work.
Disputes and Causes
Disturbed doctor - patient relationship, patient dissatisfaction—is one of the main causes with agitated friends and relatives accompanying patients the usual perpetrators. The disputes are observed mostly in cases like accident and emergency, intensive care unit, general medicine wards and post-surgical wards. They form the most common settings for violence against doctors.
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 his doctor. The doctors need to understand this crucial aspect of the relationship and address patients accordingly.
In recent studies two main factors have been identified which were said to contribute in 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, shortcomings in legal system and the absence of any other effective way of addressing the patient’s grievances.
It has also been observed that patients and their attendants no longer remain silent regarding any kind of medical malpractice or medical negligence on 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 poor quality. As a result, the incidence of medical errors has increased, the length of hospital stays is prolonged, and medical expenses are increased meanwhile, patients’ legal consciousness is also rising - causing medical disputes leading to even violent acts.
It is important to decrease medical disputes to protect the legal interests of both doctors and patients by reinforcing hospital security and protecting 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. 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 Authorities
Hospital authorities (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.
Reforms in Medical Education
Though it will not be easy for the government to infuse new life into the medical education system as such, so, the priority 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 the 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.
To conclude as a practicing doctor I would request the doctors on strike and India's entire medical fraternity to leverage this crisis as an opportunity to come together with the patients to demand greater nation-wide political commitment to address the underlying social determinants of violence against doctors. At the same time patients should repose the trust and cooperate with the doctors who are the only legal experts in medical sciences.