Mobocratic Vigilantism against Doctors: A real threat to the future of medical profession |

*Ramesh Aggarwal

*Professor, Department of Medicine, LHMC

The Post independence era till the advent of the 21 st century had witnessed high esteem and regard for the medical profession in India with doctors admired and even revered as noble messengers of God by the society.

However, over the last two decades, this regard and admiration has nosedived to a level where patients and their relatives have started resorting to physical violence and vandalization when their experience is not up to the desired expectations.

With the advent of modern medicine, advanced diagnostics and therapeutics, the cost of health care has increased substantially on a global level. Majority of Indian population is unaffordable for private care and visit government set ups for emergency and routine services. They bring chronically ill patients with unrealistic expectations of instant diagnosis and relief in this resource deficient government set ups. Not surprisingly, front line doctors and residents become scapegoats for the deficiencies as they are always in the eyes of the patients and have to struggle with the blame and the violent consequences. The media also shows a tendency to highlight victim stories and glorify the perpetrators to generate viewership. This has led to development of a wide trust deficit between the medical fraternity and the common man.

On the other side, patients who visit private healthcare believe that because they are ready to spend money, they should have guaranteed results. Majority of these patients are not ready to accept the limitations of medical science and any failure on the part of the doctor to save the life of the patient is considered unforgivable. Also, the lack of trust instigates patients to doubt every action of the doctor from prescribing drugs, suggesting investigations, or deciding hospital stay for full recovery.

This generalization of the medical profession that all doctors have a single minded focus to over-charge and squeeze the maximum out of each patient is uncalled for and undesirable. No profession is pure white and how it can be, when it is made of imperfect humans.

This profession still has majority of physicians whose primary concern is their patient’s welfare. The society and policy makers should understand that Health care is not consumerism and that the Customer is King approach cannot be applied here.

If we try to understand the reasons of this increasing trend of violence against doctors, majority of the attacks occur due heat of the moment, where emotions of relatives cloud their moral judgement due to loss of a loved one. Additionally, surveys have documented that long waiting periods, non-availability of crucial investigations, inordinate delay in referrals, unhygienic and crowded conditions with lack of basic facilities are some of the important causes of resentful behavior of relatives.

A very important aspect of the patient doctor relationship is right communication. It is not uncommon to observe, that young doctors display lesser sensitivity to emotions of the patient and relatives. Emotional Quotient or emotional-intelligence develops with experience and only a few are born with it. Lack of EQ is also partially due to stress and exhaustion of long duty hours, studying for exams, personal issues, etc.

When doctors keep these communication gaps and do not show empathy in high-emotional-stress situations, the media influenced and biased relatives mistake it for arrogance and get triggered easily towards physical assaults and violence.

We as one of the most educated professionals should jointly come together to address the causes to curb this rising menace. We need to work and train more on problem solving skills, cultivate the art of active listening, improve communication abilities of the front-line doctors, so that they become more empathetic while breaking bad news, taking consent and discussing treatment choices. The ever evolving curricula for medical graduates is now incorporating these soft skills for all young doctors which would lead to graduates being well trained in bed side manners, conversation skills and counselling techniques.

Emphasis should be laid on improving the grievance redressal system so that patients and their relatives can be put at ease, and their concerns can be addressed. All hospitals should develop a standard operating procedure (SOP) for violence e.g. Code Purple which is used worldwide and conduct mock drills to ensure all staff members know their roles in the event of violence. Displaying posters in prominent locations that convey the message that violence in a hospital is a criminal offense may help in discouraging unpleasant events. A crash course on basics of self-defense should be in place for all the hospital staff members especially the front line health care providers.

On the state and national level, increase budgeting in healthcare is the need of the hour. Our country’s health budget is meager as compared to that of West with the expectation of same quality of care. More health budget spending would translate to better facilities and increased doctor–patient ratio, leading to a decrease in violence related to infrastructure and manpower challenges.

In 2022, the ‘Prevention of Violence Against Healthcare Professionals and Clinical Establishments Bill, 2022’ was introduced in the Lok Sabha. The Central Protection Act for Doctors was the proposed legislation aimed to define violent acts against healthcare professionals and lay down punishment for such acts. It is high time that a strong central Protection Law be made to limit the violence. Legal provisions should also be in place to deter relatives from alleging negligence in cases of sudden death of a patient unless evidence is present. Deployment of adequate security personnel in government hospitals is needed to ensure a safe workplace for doctors.

The Greek philosopher Aristotle wrote: “Anybody can become angry; that is easy. But to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way—that is not within everybody’s power and is not easy.” There is an urgent need for social behavioral shift towards non acceptance of violence in hospitals. This misdirected vigilantism against doctors is discouraging young graduates from working in emergency care. There is a looming threat that if this apathy and violence continue unabated, then it would be hard to find a doctor when you need one the most.