Aggression and violence against doctors: How to address this frightening new epidemic?

Sadly, in today's world, doctors do not hold the same place of respect as they did 15 to 20 years back and there is a steadily declining mutual trust and erosion of the doctor–patient relationship. There is an increasing trend of aggression and violence against the doctors/healthcare professionals in India and it has become a frightening new epidemic. Almost every week, there is an incidence of violence against a doctor or hospital. As responsible members of the medical fraternity, it is our duty to strengthen the doctor–patient relationship and follow measures to prevent or minimize violence against doctors. Small- and medium-healthcare establishments, female specialists (obstetrics and gynecology), and resident doctors working in public hospitals/medical colleges/teaching hospitals are the most vulnerable. All the members of medical fraternity and health professionals working in a hospital need to prepare themselves because they also can be one of the sufferers of violence against doctors.

It is high time that this trend of aggression and violence is reversed and the doctors and healthcare providers are provided with the protection they need. The government must take measures to provide hospitals and other healthcare facilities a safer environment for all by better allocation of the GDP in health care. This would enable the doctors to work with full dedication and devotion without fearing for their lives. Sensational news by media houses about a patient dying because of the alleged negligence of doctors only serves against the interest of the patient.[1] More and more doctors are now refusing to tackle serious cases fearing for their lives. As a result, more precious lives are being lost.

As nicely summarized in the editorial, the government, societies, and doctors themselves can drastically decrease the violence against healthcare providers in India by utilizing and implementing several measures.[2] It is essential to remain alert, communicate at every step during the treatment, and watch for signs of aggression and violence by the doctors for both the patients and their loved ones during an emergency.[3] During sickness and medical emergency, the patient and their loved ones are also emotionally distressed. Numerous factors affect the patient as well as their friends and family. Try to listen to their problem without interruption and avoid a long waiting time.

Apart from the government addressing this problem by appropriate law, hospital facilities should also take-up effective measures to prevent these cases, for instance, restricting entry in the emergency rooms and other areas of the hospital. The major step is to prevent any mob mentality violence.[4] Restricting entry can help in this case. Hospitals should not allow a large number of visitors in the patient's room. A limited number of visitor entry passes should be given to all patients and stricter security must be implemented to ensure only the individuals with passes can enter. Moreover, guards should be on duty at sensitive areas of the healthcare facilities like casualty, operation theaters (OTs), and intensive care units (ICUs).

Another crucial step for prevention of violence involves healthcare providers taking informed and valid consent from the patients and/or their family members after a detailed explanation about the prognosis, treatment outcome, the need for repeat surgery, and cost of the treatment. In spite of low levels of health literacy and emergency cases, consent must be a priority.[5] The detailed consent must be in the language and dialect of the patients, preferably with witnesses before any step is taken. The patients and their family members must be aware of the situation and the recommended treatment. A consent form must be created providing detailed information about all the pros and cons of the treatments, alternatives, and consequences, and the same must be explained to the patient and the family. Acceptance or refusal of treatment by the patient or their family member should also be clearly stated in the form along with their signature.[6]

Moreover, the hospital/healthcare providers must maintain proper documentation of the patients, which starts from the patient coming in for treatment until they are discharged. While this might not prevent violence, it can still be highly useful in case of an unexpected incidence of violence and/or filing of a lawsuit. In such cases, the police typically confiscate the documents. The cases in which each step of the procedure is clearly documented along with the consent forms, the healthcare providers would be favored.[7] Aside from this, all healthcare facilities should be aware of the increasing incidences of violence against doctors and be alert for any signs of violence. Healthcare providers must learn to assess all situations for the potential of violence and be vigilant.

Aggression and violence against doctors can be minimized by following the acronym- P.S.M.

Protection team against violence: Every hospital must formulate a “protection team” and educate its doctors and staff members what to do in case of aggression and violence against medical professionals. Senior doctors must reach the spot to minimize any escalating situation.

Poster display: Posters conveying the message that vandalism and violence in a hospital or clinic is a criminal offense must be displayed at prominent places in the hospital. The poster must be written in easy language so maximum patients and their loved ones can easily understand it [Fig. 1].

Figure 1

Sample of a poster by the Indian Medical Association, Kota Branch displayed in the hospital to prevent violence against doctors

Prevent or restrict the entry of public: At no stage, should hordes of visitors be allowed at the patient's bedside. Entry should be strictly using passes and this must be implemented through good security, preferably by ex-army personnel. Security guards and good quality CCTV cameras must be placed outside and inside the hospital at sensitive areas like the ICU, OTs, and casualty.

Strengthen the doctor–patient relationship: Much needs to be done to improve the doctor–patient relationship using communication. This must begin by the doctor informing the patient and their family about what is going on. Always inform about the cost of the treatment, prognosis, need for repeat surgery, and regular follow-up, and others. The patient can take the help of “Dr. Google” for finding the details about the treatment.

Spend more GDP on healthcare establishments: The government must spend more GDP on healthcare establishments to provide better care at public hospitals.

Mock drill: Mock drills need to be conducted and each staff member should be clear about their role if the situation of impending or actual violence does arise. All hospital and clinical establishments should develop a standard operating procedure (SOP) for violence and also develop a “protection team.” The protection team should be fully trained on how to handle the situation. A distinct siren may also be installed in the hospital to alert everyone in case violence occurs in the hospital campus, and members of the protection team should form a human chain around the doctor/healthcare professional under threat. The healthcare personnel involved in the chain need to remain calm and avoid any altercation that may escalate the situation. The practice of this mock drill by the protection team should be done monthly in every hospital/medical establishment.

Medical teaching: Medical students must be taught about aggression and violence against doctors and it should become a part of the medical curriculum.

Medical unity: Medical community needs to be united to handle the crisis of violence against doctors, especially by forming a WhatsApp group (Rush to Stop Violence against Practitioner: RSVP). A united medical fraternity can also build pressure on the government to bring in and implement tough law to protect medical professionals. The legislative measures taken to curtail violence against doctors have repeatedly failed to address the issue despite being notified in almost 19 states in the country in the past decade. To curb the events of violence against doctors, it is imperative to increase the spending on health care and modifications needs to be brought in the Indian Penal Code (IPC) to integrate a tougher penalty against the criminal act.

Media sensitization: Doctors need to sensitize the media to avoid publishing sensational news. For a balanced view upon an incident, doctors must ensure that their version of the event is also published.

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