Doctor-patient conflicts become common, especially at government hospitals: Who is to blame?

CHENNAI: While the quintessential job of a doctor or a medical professional is to treat the sick and save lives, the process of doing so can take its toll in more ways than one, especially in government hospitals (GHs). Doctors working in the public sector are often exhausted with case overload, leaving them with very little time and patience to engage with and properly communicate with patients and/or attendants.

They are often accused of being abrupt, curt and lacking empathy and compassion while interacting with the attendants, making the latter feel slighted and even insulted. This leads to doctor-patient conflicts, which are now common in almost all GHs, warranting enhanced safety measures and improved services.

While many attendants and families of patients sympathise with overworked doctors, they also expect to be informed and updated about their loved ones’ medical condition and treatment protocols without being humiliated.

Unwilling to listen

“My mother was battling fourth stage breast cancer in 2021. When we visited the oncologist at a multi-speciality GH, he told her there was nothing he could do since it was the last stage. While I understand that’s the truth, a bit of reassurance or empathy from him would have been appreciated,” recalled Jayanth*. “Whenever she mentioned pain, doctors would not even talk to her properly, or even let her explain. They would just shut her down saying he’ll prescribe medicines after looking at the case sheets, which he would fling it on the table. It was very painful to watch my mother being treated with such disdain.”

This is not an isolated case. Several patients and their attendants, especially those being treated in super speciality departments, told DT Next that doctors would shout at them if they tried to discuss alternate treatment options.

“I was merely trying to understand if there was an alternative treatment option for my brother-in-law with kidney failure. He required a transplant. He was being treated at a GH, and since a transplant would take time, we wanted to know if anything else can be done. But the doctors shouted at me asking if I knew better than them. I’m aware that I’m not a doctor but they could talk to us after explaining the options available,” rued says Maria*.

Doctor are humans too

On the other hand, many doctors opined that often, attendants rely on online information and question them on their treatment options.

“When 20-30 attendants flock around an exhausted doctor, and demand 20 answers for 20 different questions, it’s humanly impossible to be calm. Patients and attendants should also realise that treatment cannot be brought over to the counter in a few minutes. A standard treatment protocol needs to be followed,” pointed out Dr V Vignesh, secretary, TN Resident Doctors Association.

The comparison of GH to private hospitals is inevitable, though unfair, as the former handles 10 times more patients than the latter. GH doctors urge the State government to limit the number of patients one doctor has to handle per day, and the postings to be decided accordingly. “Doctors also require fixed working hours with regular off-days to process patient deaths and unfortunate events,” he added.

Though more than one lakh medical aspirants across Tamil Nadu appear for the National Eligibility cum Entrance Test every year, attacks on doctors, work overload, limited human resources and misinformation have added to the challenges in the field.

“I’ve witnessed doctors shouting at the staff and attendants and throwing case sheets but that was the scenario around 20-25 years ago,” recalled a GH doctor. “In the era of social media platforms and 24/7 media, the public knows where to vent it out and talk about it. So, doctors don’t behave that way most of the time.”

He added that doctors do not operate on any personal enmity with patients, and that attendants too should be careful while talking to nurses and listen to their suggestions. “We’re aware of the challenges in the public health sector, but we choose to serve. Attendants and loved ones of patients should trust doctors. Having said that, there should be better communication between patients and doctors to educate them about the treatment provided,” he opined.

Counselling to grieving kin

The lack of clarity on the illnesses, treatment protocols and procedures is one of the many triggers for doctor-patient conflicts. GH doctors see and treat over 100 patients in a single day; so, it’s not feasible to offer the right counselling, especially while breaking bad news to patients’ kin.

“In such a scenario, there is a need for a specialised counselling team to offer personalised guidance to patients. The team can offer clear explanations about the nature of the disease, treatment methods, and medication, their side effects and other impacts. A treatment enquiry desk must be available with trained personnel,” explained Dr Anand Kumar, nodal officer, Tamil Nadu Multi Super Speciality Hospital, Omandurar.

Vignesh concurred, and pied in: “Patients have unrealistic expectations about survival and treatment, so it’s necessary to have pamphlets and information sheets about common diseases, complications and prognosis for attenders to be educated.”

Doctor-patient ratio skewered

The number of patients visiting a GH has increased over the years, especially after the introduction of advanced facilities and addition of new specialities. For example, Rajiv Gandhi Government General Hospital, which had an outpatient count of 6,500/day before 2021, now sees about 12,000 patients. However, the number of additional postings have not been increased in the same ratio.

“When a doctor is treating patients for 24 hours and more, it’s natural to be mentally and physically exhausted. With limited resources, it affects the medical treatment too,” said Dr Sundaresan, state president, Government All Doctors Association.

Doctors request the government to have a shift system for medical professionals. “A shift system ensures there’s a handover process, which will enable the person starting his/her duty to be aware of the patient history, medication given, treatments provided and other details. This also keeps patients and their families updated,” he added.

Dr Dhruv Chauhan, National Council Coordinator of Indian Medical Association-Junior Doctors’ Network averred that doctors nationwide have been demanding strict laws like Central Protection Act for years and have made peaceful protests. But, despite multiple attacks that endanger the lives of doctors, no action has been taken yet.

“Patients in India believe the problem rests only with the doctors but in reality, it’s a systemic issue. If not corrected soon, it will hamper the healthcare services. What’s worse is that it might prompt doctors from taking any risk with regard to treating a patient,” he pointed out.