Making the Surgeons Safe in India.

Sir,

To be a surgeon by profession carries many advantages such as high income and better social status, and the surgery is considered rewarding and challenging. However, there are risks and dangers inherent in this career. Being a surgeon is a stressful business as the surgeons experience higher stress than the general population. Even though the surgeons make all efforts to communicate with the patients, they often become frustrated because sometimes the patients do not understand the risks of surgical procedures. Despite explaining the likely outcomes of the procedure and getting an informed consent, expectations for “sure shot results” are the norm, and the surgeons often have to face the distaste of family members, if something goes wrong with patients. National newspapers continuously report about the doctors getting manhandled and threatened, even to the extent of being killed by the patient's relatives.1

The violence against health-care professional is a global problem, and not restricted to India.1 It has been reported in several countries such as the UK, Australia, Germany, China, Pakistan, Turkey, and Nepal.123 Incidents of violence against doctors in India have seen a recent increase.1 According to an estimate by the Indian Medical Association, >75% of doctors have seen violence at work.4 In the last few decades, the doctor–patient relationship is not at its best, and the trust between them has been broken to the extent of violence. The vague stories of unnecessary laboratory tests and invasive procedures are often levelled against the health-care professionals and charging them for commercialization of medical profession.5 It has caused patients’ distrust to grow against the doctors and the hospitals. The ever-hungry media adds fuel to damaging this delicate relationship by rapidly jumping to conclusions and publishing incredible stories of malpractice and medical negligence. Lately, it has been noticed that the media has been trying to demonize the health sector professionals and hospitals through their “revelations” and “breaking news.” Hence, it becomes important and relevant to make regular communications with the media people through our professional bodies and associations. We believe it would help in educating them and apprise them about the challenges faced by the health-care professionals and institutions, in providing the medical care to the patients.

Most doctors in India, especially in government hospitals, are extremely busy and flooded by patients, and hence it is inevitable that the quality of care may sometimes get compromised as the doctors attend a significant number of patients, in a small window of time. It imparts a perception of neglect and unsatisfaction to the patient and their family. Delay in attending to their patient or poor communication can quickly drive them over an edge. Apart from these factors, high expectations of complete and quick improvement from the patient and their relatives are major contributing factors for increasing assaults.6 It seems that dual forces of less government spending on public health (about 1% of GDP) and the rising costs in private hospitals may be responsible for an increase in assaults on doctors in India. Due to lack of adequate resources and long queues, the middle and upper economic class return for their health-care needs to private hospitals. It is, therefore, raising expectations (sometimes unrealistic) about the standard of care.

The security of doctors at work is a significant challenge in the most government hospitals in India, due to lack of adequate security personnel, especially at odd hours of the night and on holidays. The Government of India has not yet been able to formulate a definitive protocol for tackling these violent incidences, and hence the perpetrators often go scot-free. The lay public also has lost faith in the police and judicial system and feels that only the rich would get justice. Thus, in cases of an unfortunate eventuality, the medical attendants may resort to taking an immediate revenge, as a knee-jerk reaction, and often use the physical means rather than taking a legal course of action. There exist no laws for the protection and safety of the medical community.1 It is incredible to note that until recently in most states of India, there was no law to protect the doctors on duty from the physical violence by the patient and their attendants. On the contrary, there has been a non-bailable offense to assault other public servants on duty. The public takes an undue advantage of these facts and does not hesitate in resorting to violence against the doctor on duty. These people get further encouraged to repeat such incidences in future, as they usually go unpunished.

We feel that the need of the hour is to save this noble profession in India by formulating strict legal provisions to ensure the safety of health worker, and these laws must be displayed prominently in the hospital premises so that the perpetrators are forced to think several times before committing this heinous act. Deployment of a sufficient number of police officers and security guards is necessary for every hospital. Violence against the doctors on duty must also be considered as a severe offense in law and must be subjected to severe consequences. The media must also be quite sensitive in reporting about the doctors and health-care facilities, as demonizing health-care professionals without adequate evidence and verifications lead to the negative image of this noble profession. The public must be made to realize that the hospitals are sanctums of healing and recuperation and any violence against the health workers could jeopardize the management of sick patients and hamper their recovery to health.1 It is paramount that each hospital must ensure the safety of their doctors and should create an emergency protocol to deal with a significant act of violence.

In the medical curriculum, the students are not briefed and educated about “how to deal with the patients, relatives, and media” appropriately. It seems of paramount importance now for the doctors to learn to deal with the violent patients and their relatives, and this must be included in the medical curriculum as a short subject.2 Improvement in the communication skills of the doctors with patient and family would go a long way in improving our relationship with them and reducing their aggression toward the doctors. In a Chinese study of the doctors, increased violence by the patients has been a major contributing factor for the low morale of the doctors.3