Why Doctors and Patients Need to Work Together
The problem, most simply put, is about access to accountable, affordable healthcare for every citizen.
(On National Doctors Day, FIT is republishing this story to remind our viewers of the contribution doctors make to enrich our lives and to thank them for their service)
In March 2017, a vicious and brutal attack on a young doctor at a public hospital in Maharashtra had the precipitating cause for a strike by young doctors seeking more security at the workplace.
These persistent attacks on doctors need to be absolutely condemned. Perpetrators need to be arrested and strong action must be taken against them at the earliest. This kind of violence cannot, and should not be condoned.
Unfortunately, one can say, with almost absolute certainty that these incidents are going to be repeated again, as has happened in the past. They always follow a pattern.
This Is More Than Just a Security Issue
A young resident doctor, who works at the frontline of our overburdened, poorly funded and understaffed public health system, gets beaten up, abused or humiliated. Resident doctors go on strike demanding security.
A minister or chief minister, depending on the scale of the strike, mouths words of sympathy and two to three days into the strike, threats are issued to doctors to get back to work. The strike is called off till the next attack.
This has become all too familiar. And this pattern will not change until we realise that this is not just a security issue. Neither is it a case where the Indian patient has become an impatient being.
The problem, most simply put, is about access to accountable, affordable healthcare for every citizen. No civilised nation, particularly one with dreams of becoming a superpower, can morally justify millions of people (63 million according to the latest Parliamentary standing committee report of March 2016) being pushed into poverty due to healthcare expenses.
Most governments, state and central, do not put enough money into infrastructure, diagnostics, drugs or human resources, leading to a poorly-funded and poorly-run public health system.
This has led to high levels of frustration and distress among patients, which sometimes boils over.
To add to this, many local politicians and their supporters, rather than working to fulfil people’s demand for better healthcare, take the easy way out by beating up doctors on duty to prove their “dabbang” credentials.
Corrupt Practices Seem to Be an Acceptable Norm
There is also the crisis of eroding ethics in the profession and a consequent loss of reputation of doctors. The image of doctors has taken a beating as corrupt practices seem to have become an acceptable norm in the profession.
Blatant malpractices, like the one where doctors did unnecessary hysterectomies on thousands of poor women across the country to collect insurance money, has been widely reported. These surely cannot be expected to inspire patients’ confidence.
In this context, when patients and families, frustrated with delayed care (public health) or over-expensive care (private health) finally lose their patience (which actually is not that often considering how many people suffer), its gets directed at the first visible representative of the profession, which is usually the youngest and most vulnerable resident doctor.
Why Do We Talk About Patients as Us-vs-Them?
A study, published in the National Medical Journal in 2016, shows that about 40 percent of doctors in a public hospital face some kind of violence at the workplace, of which, 70 percent are by patients or their families, and 30 percent by co-workers.
Eleven percent of the violence was physical and the rest was verbal. Seventy-five percent of these events took place in the emergency/casualty, and interestingly, “poor communication skills” was considered the most common factor, by the doctors themselves, to be the cause of the violence.
Despite multiple studies showing that the Emergency/Casualty is the most common site of violence, we have left it to be manned by our youngest and most inexperienced, without enough seniors on rotation to help them deal with the most serious cases, and navigate tense desperate patient families.
While it is easy to frame it as a security issue, we need to ask ourselves – How many times have we as a profession, through our professional associations, sought better care for patients?
It is almost always about improving our salaries, our work conditions, and our right to profiteer from patients.
Across the world, professional associations of doctors have fought for patients’ rights and better access to healthcare. Why haven’t we done the same in India? Why do our representative bodies talk of patients in terms of us-versus-them?
Is it because in our medical education, there is no stress on ethics, and our social responsibility as healthcare providers? Is it because we are steadily being taught to look at patients merely as consumers and clients? Why is there a lack, no, an absolute absence, of teaching the skills of communication and empathy? Why do we, the seniors in the profession and our representative bodies, always teach our younger colleagues to see the patient as the adversary?
The violence against doctors maybe a part of a wider culture of mobocracy, but we need to look deep inside our profession, our healthcare system and ourselves for the answer.
The Medical Profession Needs to Advocate for Patients
It is interesting to hear what Dr Zhong Nanshan, former president of the Chinese Medical Association, had to say to their National People’s Congress (the largest gathering of political representatives in China) regarding increasing incidence of violence against doctors in China, as reported in The Lancet in 2014.
Patients experience long waits for short appointments and are suspicious of expensive investigations or medications that might benefit the doctor or hospital more than themselves. Media revelations of poor practice and of questionable relationships between some doctors and industry inflame attitudes further. Thus for some, resorting to violence might seem the only way to express dissatisfaction with the medical system in general, and with specific doctors in particular.
He went on to add:
Patient dissatisfaction in China should be considered not as the cause of violence against doctors, but as a symptom of a flawed system that victimises both patients and doctors alike. Fixing this damaged relationship is at the core of healthcare reform... The solution must come from within... led by medical professionals themselves.
That sounds familiar! The difference is that I cannot imagine the president of our medical association making such a scathing indictment of our profession and our healthcare system.
If we do not stand up for patients’ rights as a profession, patients will never see us as their advocates. We shall, unfortunately, remain adversaries and the violence will be difficult to stop.
(Dr Sumit Ray is a Senior Consultant, Critical Care Medicine. This is an opinion piece and the views expressed above are the author’s own. FIT neither endorses nor is responsible for the same.)
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