Trust Deficit in Medical Services Promotes Violence Against Doctors

Medical Services and the Rising Threat of Violence Against Doctors

In November, a renowned oncologist at a government hospital in Chennai was stabbed several times by the son of a cancer patient, allegedly for providing incorrect medicines to his mother.

WHO data shows that between 8-38 percent physicians have experienced violence at least once in their medical career.

Not all such incidents occur in the immediate aftermath of a treatment gone wrong. A dentist in China was knifed more than 30 times in 2016 by his patient 25 years after treatment. The patient was demanding compensation for discoloration of his teeth.

In Asia, China and India experience the highest incidence of violence against doctors, at 90 percent and 77.3 percent, respectively. South Asia is the third least peaceful region, ahead of only the Middle East, North Africa and sub-Saharan Africa. India and Bangladesh have low Global Peace Index rankings and doctors face high incidences of abuse.

Medical vandalism also takes place in countries with greater economic prosperity and public safety records. A large number of primary care physicians in developed nations such as Germany and Bulgaria also face significant incidents of violence.

Singapore ranked fifth in the Global Peace Index 2024. However, 70 percent of hospital staff faced incidents of physical abuse perpetrated mostly by old male patients.

Hostile accusations, undeserved and spontaneous attacks, dreadful hurt and murder are the ascending order of violent activities faced by doctors, with a high likelihood of injury, psychological harm of varying degrees, and many times death.

The most violent venues are emergency and intensive care units (ICU) and the most violent time is visiting hours. Common reasons for violence emerging from this researcher’s field study are death of patients, lack of medicine, delay in treatment, and inadequate attention.

Medical Services Community and their Experiences of Abuse

During fieldwork in December, a staff nurse in Faridabad district, Haryana, shared that facing verbal abuse was a normal event for doctors, which they would try to reduce by communicating facts amicably with the villagers.

A medical officer at a community health centre in Faridabad district said he was attacked in the ICU of BK Hospital, a government hospital, in March 2023 by the relatives of a patient who was taking time to recover. The accusation: neglecting the patient.

A medical officer at another community health centre narrated an incident from January 2024 following cough syrup shortage at the health centre when a villager threw the slip on his face after tearing it aggressively:

“Apne parchi rakkh apne pass, Jab dena hi nhi tha to parchi kyun banwayi” (Keep your slip to yourself; why did you ask us to make this slip if you didn’t intend to give us the syrup).

The officer said the cough syrup would often finish due to repeated and unnecessary demand.

A similar incident occurred in January 2023 during a shortage of tuberculosis medicines, when many patients were detected with the multi-drug resistant infection. Some frustrated patients vandalized the furniture at the community health centre, throwing stools before the chief medical officer and shouting in front of the patients.

An auxiliary nurse midwife (ANM) from the same district disclosed that patients would often abuse doctors during delivery when they administered injections, blaming the doctor for alleged, and often unsubstantiated, negligence in care.

Another ANM stated that rural women often did not reveal their pregnancy for four months due to which they missed the first Ante Natal Checkups (ANC), which is the primary cause of high-risk pregnancies.

In an incident when some patients came for delivery with severely low hemoglobin levels and no ANCs, thus posing high risk, a female medical officer remarked, “It is normal to witness abusive comments from patients when they get frustrated, mostly in high-risk pregnancies when the patients do not want to go for referrals due to shortage of time and fear of the situation.”

A health worker noted that vandalism had increased during the Covid-19 pandemic. Villagers once uprooted the gate of the community health centre she worked in, destroyed the glass window panes and broke the iron doors after the death of their relatives from not getting the required vaccines in time.

Despite the shortage of doctors, a substantial number of medical graduates choose not to enter the professional field and prefer more lucrative and safer jobs such as consulting, digital health startups and wearable technology development, pharmaceutical options like drug development, clinical trials and regulatory affairs, and non clinical alternatives such as policy-making, hospital operations and strategic planning.

Loss of Public Trust

The underlying violence against doctors is the result of loss of public trust in healthcare personnel primarily due to systemic inefficiencies.

These trust issues emerge as ‘neglect’, resulting in retaliation and revengeful assault towards personnel in medical services, the sole providers of trust during a health emergency.

Violence against doctors will continue if public trust in the health system is not improved through behaviour change strategies — such as training doctors with the ability and skill to work effectively in culturally diverse environments — and their promotion through social media and the involvement of local governance in advocating these behaviours.

The public health system has come a long way since the Bhore committee was set up in 1946 towards establishing a healthcare framework through promoting equitable access, preventive care, control over epidemics, health education, and economic benefits to poor families.

However, resource constraints, inconsistent quality of care and limited focus on personalised treatment plans reduce public trust in medical services providers.

Solutions

Lack of awareness of health policies related to prevention of violence, non-reporting of violence by doctors, lack of consensus among authorities and bureaucratic delays in remedial proceedings leads to its perpetuation.

Violence against doctors via cyber bullying, a feature of our digitised lives, can be captured, rectified and resolved through better data and digital platform privacy norms.

A legal mechanism for preventing violence against doctors, with the revision of existing medical service legal provisions, can offer a platform towards creating a database of violence against the medical fraternity and usher greater accountability towards remedial actions.

Policy measures can be adequately combined with institutional structures through active grievance redressal cells engaged in tracking violent behaviours, monitoring and evaluation, providing institutional and psychological support to promote professional conduct in the hospital premises and promoting harmonious doctor-patient relationship policies.

As part of grievance cell activity, mediation by appointed representatives during such attacks to provide a clear distinction of medical duties, explain the patient’s health condition and any systemic blockages to the family can help to address patients’ anger towards the medical staff.

An indemnity insurance against bodily injury/ death or legal suits caused by error or negligence is a must for every doctor and hospital, whether public or private.

These policy measures can be charted out by health policy makers, along with rectifying actions such as fines and taking corrective legal action for harm caused due to violence.

Medical Services professionals who sustain the edifice of the healthcare system deserve to not only be protected against violence but respected and valued for their services to society.

Dr. Vijayetta Sharma is Associate Professor of Public Policy at Manav Rachna International Institute of Research and Studies. She has been a Post-doctoral Research Fellow at Indian School of Business (ISB). Her research areas are maternal and child health, health policy and governance.

Originally published under Creative Commons by 360info™.