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No Room For Complacency

No Room For Complacency

India is said to have the largest public health care system in the world. As per current population estimate of 1.35 billion, a doctor population ratio at 1:867 (Ayurveda, Unani, Homeopathy and allopathic doctors considered together) is rather inadequate. Nonetheless, it is rather appalling to see medical  practitioners, who have opted for a challenging profession in order to serve the public,  sporting head bandages and wearing helmets.

Yes,  workplace violence seems to be on the rise and its intensity is a growing worry. In most cases, the proximate cause is the death of a patient. Studies suggest that while some patients brought in at a critical state have less chances of survival, others could not have been saved with the inadequate infrastructure available at the health care institution. Yet their deaths have been seen as a case of neglect by medical professionals.

So, who is responsible for the safety of doctors? Since public health is a State subject, the primary responsibility of providing accessible, affordable and quality healthcare to the public at large lies with the State Governments. It also means that medical professionals should be able to discharge their duties in a safe environment, free from workplace violence.

This June 11, widespread anger following a 75-year-old patient’s death at Kolkata’s State-run Nil Ratan Sarkar Medical College and Hospital triggered a series of avoidable incidents. A mob of 150 people not only created mayhem but also attacked two junior doctors so brutally that one of them was injured, rather grievously, with a skull fracture. Consequently, junior doctors in government medical colleges and hospitals throughout West Bengal launched a “cease work” agitation leaving tens of thousands of patients to literally fend for themselves. The agitation spread across the nation, disrupting medical services as doctors went on a token strike. There were clarion calls for stricter laws and increased security for doctors. Finally, the strike in West Bengal was called off following intervention by the Chief Minister.

Barely three months later, on 2 September, 73-year-old Dr Deben Dutta was cruelly attacked by the workmen of Teok Tea Garden in Assam. The workmen were angry because Dr Dutta wasn’t in the hospital when a 33-year old patient was brought in. As the patient died even before the doctor could begin his treatment, in retaliation, the doctor was lynched to death.

The above two instances would suffice. According to Indian Medical Association, 75% of the doctors across the country have faced some kind of violence at work. Broadly, three out of four doctors reportedly are subjected to verbal or physical abuse.

But will the situation improve? Hopefully, yes. The Union Health Ministry’s move to enact a new law to make acts of violence against healthcare professionals a cognizable and a non-bailable offence is a welcome step. The Ministry has already solicited objections and suggestions from public with regard to the draft Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill, 2019 which is displayed on its website before finalisation of the new law is aimed at ending the sickening saga of violence against doctors in India.

The new legislation also seeks to provide compensation for injury to healthcare service personnel - namely nurse, midwife, doctors, medical students, ambulance drivers and helpers or for causing damage or loss to property of a clinical establishment - namely a hospital, a clinic, a dispensary, a sanatorium, an ambulance or even a mobile unit.

A hefty fine of between Rs 50,000 to Rs 5 lakh and imprisonment of between six months to three years would be slapped on anyone committing violent acts or abetting violence against healthcare service personnel. If convicted for causing grievous hurt, then the accused can be imprisoned for a period between three years to ten years and with a fine between Rs 2 lakh to Rs 10 lakh.

In addition to the punishment, the convicted person would also have to pay an amount, twice the amount of fair market value of damaged property or loss caused, as determined by the court.

Importantly, all is not well as far as the health of our people is concerned. But it is rather worrisome that at 1.4% of GDP, our spending on healthcare is abysmally low. Notably most government hospitals are overburdened, understaffed and ill-equipped. NITI Aayog’s latest State Health Index portrays Kerala as the healthiest State while Uttar Pradesh is the unhealthiest. Even as Rajasthan over the years has improved its health status, the situation in Madhya Pradesh, Odisha, Uttarakhand and Bihar reportedly have not improved at all. So the inadequacies and the apathy of the public healthcare and its infrastructure have to be improved drastically. The problems of overcrowding in hospitals and the need to increase the number of emergency beds have to be attended on a war footing. The communication skills of resident doctors that often become the trigger of violence according to an AIIMS study has to be improved.

So, can doctors complement their healing skills with soft skills and build a trust with better communication?

As the basis of a good relationship between doctors and patients lies in mutual respect and understanding, at the community level, the set of moral principles that guide medical professionals in their dealings with the common man has to be transparent. A feeling of loyal camaraderie is essential, not only for the sake of the profession, but also for the welfare of patients.  Disproportionate influences of pharmaceutical companies, for example, could present doctors with financial incentives to prescribe particular brands of drugs and medication rather than others, thus biasing their  decision making. But strict regulations as in place in some countries can minimise unduly influences of pharma concerns. There can be no room for any complacency.

(Published on 09th September 2019, Volume XXXI, Issue 37)