When doctors need critical care

The shocking attack by a patient on a doctor at the Kottarakkara Taluk Hospital in Kerala has brought to the fore the recurring issue of violence against healthcare professionals. Doctors are well within their rights to demonstrate their anger and demand better protection. However, we need to see this phenomenon in a wider perspective such that any policy action taken will address the issue at its root rather than superficialities.

To start with it, it would be useful to remember that attacks on doctors do not stem from any societal animus against them. They remain a universally respected profession, and it serves no purpose for lobbies like the Indian Medical Association to make their case in terms of victimhood. It would be better for medical professionals and policymakers to put their heads together to locate the sources of patient-side anger and introduce measures to make hospitals safe not only for themselves but for all other services involved in healthcare, and at the same time address the systemic infirmities triggering patient anger.

While the Kottarakkara incident, in which a patient stabbed a young doctor to death, seems to have been triggered by psychosis, most violent incidents can be traced back to two sources of anger: grief over the loss of a loved one and the exorbitant cost of treatment. Doctors have the unenviable task of having to manage patient expectations while performing their own medical duties. Their craft dictates that they refrain from getting involved emotionally with the outcomes of their treatment. To patients’ families this can make them seem insensitive to their anxieties, and thus death can often turn grief into anger. It would be of great help to both doctor and patient alike if hospitals employed specialist counsellors to handhold patients and their relatives through pre-surgical anxieties, post-op trauma and failure of treatment. At the same time, hospitals would do well to specially train all their ancillary systems—from orderlies to billing staff to the insurance desk—in dealing with patient anxieties. Very often the strain of dealing with these aspects of accessing healthcare wear down the coping capacities of patients’ families. Acknowledging and addressing this aspect would immensely help calm anger in the event of adverse outcomes.

Secondly, doctors and hospital administrations must acknowledge a universal fact in India: the cost of specialist healthcare can break the back of most families in India, even those insured by the state. Out-of-pocket health expenditure in India stands at 48 per cent; in states like Uttar Pradesh as high as 71 per cent. While many doctors do waive their fees in individual cases, off-hospital expenditure on food, lodgings and travel can still be a huge burden. This aspect of the problem is not something doctors primarily can do much about, but they can press policymakers to bring about reforms of the specialised healthcare system. Several solutions can be implemented in this respect, to mitigate if not cure. One could be to decentralise advanced diagnostic services down to the taluka level to minimise the expenses of patient travel. Another could be to institute a three-tier system of medical referrals so that cases not needing specialist attention are dealt with at the local level, thus easing the pressure on super-specialities facilities.

These are systemic solutions and are in the long run likely to be more efficient even if they are more difficult to implement at first. They stand a better chance of succeeding than some of the solutions proposed every time a doctor is manhandled. Posting more security guards in the wards will do nothing to calm patient anxieties and stop attacks on doctors.