Doctors are not Gods, let them be human!

Dr R Kumar

JUNE 17 will go as a black day in the history, when patients across the country were denied medical treatment, as a mark of protest against an incident of violence against doctors at NRS hospital Kolkata. That was not the first case of assault on doctors, nor was it the last. The doctors’ strike was called off on hearing the old hackneyed phrase ‘doctors are Gods’, from Bengal CM. However, reports of fresh violence against doctors  soon started pouring in from several places. In the past also, incidence of assault were reported from Shimla, Delhi.  Mumbai, Kolkata, Surat, Hyderabad, Chandigarh, Ludhiana, etc. Gone are the days when doctors were revered by the community and patients felt secure under care of their doctors. Now there is a serious trust deficit. Doctors want to be saved from the patients’ ire and patients want to be protected against negligence and apathy of the doctors.The physician is no more an angel or noble but is emerging as a necessary evil. Violence breaks out often when doctors are unable to act Gods! Why can’t they be treated like other human professionals — to err is human.

How to reduce hospitals’ load?

India has the bane of large population and the corresponding facilities and manpower for medical treatments are not adequate. The doctors are over-worked and have to work round the clock against many odds — fatigue increases the chances of human errors. This, in turn, affects the safety of patients and consequent mayhem by the relatives and rowdy elements. The disgusting state of affairs at SKMC hospital, Bihar, where nearly 150 children died of encephalitis due to inadequacies of staffs, beds, sanitation, water, medicines, equipment; largely preventable condition, is a telling example of overloading a hospital and its consequences. VIP visits made it worse. Could doctors alone create necessary infrastructure to deal with increasing number of patients? However, they can easily become victims of assault or political blame game.

To reduce the load on hospitals, one has to delve into and address the core issues viz poverty and malnutrition, lack of education and poor health literacy, concentration of doctors in big cities, apathy towards healthcare allocations and callousness in seeking prevention and timely treatment by the community, lack of amenities and low compensation to doctors in rural areas, over-emphasis on the use of medicines sans ethics. There is a need to make a paradigm shift from patient-care to preventive health to reduce the incidence of sickness, and thus save the hospitals from getting choked with undue patient load. There is also need to develop home healthcare, since majority of patients can be treated better at home by harnessing the power of technology and tele-medicine, away from the vagaries of hospital-borne infections.

Better facilities needed 

Patients, or their relatives, may become violent for a multitude of reasons. They may be angry at being kept waiting, annoyed by the impoliteness of staff or upset about lack of equipment or poor infrastructure or a clinical error or fat hospital bill. Very often doctor will sense the signs of impending violence against doctors e.g. frequent interruption, intimidating gestures, or threatening in abusive language. They may start to throw objects around or walk out in haste and return with supporters. At this stage, helpless doctor needs urgent support of police. Can such protection be provided? Can law alone curtail violence; many laws have been in existence in various states! Role of social groups to resolve the issues cannot be over-emphasised. Society has to know that doctors are not Gods; they cannot be guarantors of cure from illness! 

If the working conditions of doctors are unsafe, and or bereft of basic amenities, equipment, medicines, supporting staff, recognition of hard work and basic courtesies, they cannot provide right medical treatment. Spontaneous anger against doctor in any case of unfavorable outcome is likely. However white coat comes with an obligation to absorb anger and abuse. Despite doctor’s dedication and politeness, in some cases it may lead to mob violence and litigation. This needs to be stopped completely, if patient-care is to be saved from total collapse.

Communication is the key

It is accepted that better communication and patient-centered approach improves the overall outcome of a therapy. A thoroughly informed patient and a shared decision-making have proven to lower violence against doctors and litigation. A lot of patience would be required to understand what the patient wants and differentiate it from what he actually needs.

A thoroughly informed patient should be aware of all healthcare options available for his condition and also the final outcome of each of them. In many cases, 

the patient may choose an option that may be different from what the treating clinician thinks is best for him. These 

situations need to be handled without restricting the patient’s autonomy. Doctor has to choose what pleases the patient and not merely what is best for him! Doctor is not a robot, but is not expected to stand on ego or lose temper in any case. Patients, too, have certain rights:

• To have adequate access to doctors, who patiently reply to their queries.
• To know the status, prognosis and line of management.
• Freedom to participate in decisions related to treatment. 
• Freedom to change doctors.
• Knowing whom to contact if doctor is unavailable.
• Having records handled confidentially.
• Knowing the cost of treatment and its break-up.
• Seen within a reasonable time of arrival with due courtesy.
• Taking a second opinion, if necessary.

Ways to check similar assaults 

Can violence against doctors lead to improvement in medical care? Why does it occur again and again? How can it be contained? Common sense suggests some simple measures:

• There’s need to reduce loads on govt hospitals.
• Better communication skills in the medical staff and improved infrastructure in clinical establishments. 
• Appropriate respect and security to doctors. 
• Realistic expectations and acceptance of the outcome of treatment.

Can this be achieved? Patience is the watchword for all stakeholders!