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Wednesday, June 03, 2015

Violence against doctors

The rising knowledge base on the internet, growing awareness of the limitations on healthcare professionals, and a general rise in intolerance levels among lay people, combined with adverse publicity through insensitive media have made violence against doctors a "daily" affair - especially in India. The trend is disturbing, to say the least. Had it been limited to angry shouting or shunning the particular doctor, it would have been all right. The problem is, the violence is now actually causing harm to doctors and their hard-earned property. 

It would be difficult to trace the time-line of this process. Doctors were, at one time, perceived to be honorable, noble professionals whose only avocation in life was to save lives. Changes in society have caused this thinking to get eroded over time. And, it is not just doctors who are responsible for the decline in moral values. Today, the medical education sector is completely at the mercy of immoral, dastardly businessmen and politicians, who have increased the cost of learning to unthinkable levels. When I did my M.B.B.S., the cost of the entire course to me was less than Rs. 3000/= ... which, even 30 years ago, was not a very big amount. We earned back our investments during our internship, which paid us Rs. 450/= per month as stipend. Thus, there was no angst, or desire to earn back my investment, and doctors in my time turned out to have good morals and a more altruistic attitude towards sick people. Post-graduate education was almost free; we just had to buy our books. In fact, as house-physicians and registrars, we got paid every month for the hard work that we put in. 

Today, the investment is in lakhs of rupees, and for post-graduate entry into the choicest of branches, the investment amount is in multiples of 1 crore! (1 crore is 10 million, and 65 Indian rupees is equivalent to 1 USD). How can society then expect today's newly graduating doctor to be altruistic, to treat patients at low cost, to be charitable? Their first goal will be to get back their investment, not to give free treatment, right? Thus, society has reaped what it sowed. Today's doctors are not the brightest students either ... those who have deep pockets, regardless of their intellectual levels  are doctors today, while the truly deserving student with an economic disadvantage is often the one who misses out on becoming a doctor. So, you not only have avarice, but also incompetence added to your pot of miseries. 

Coming now to the media: in India, doctors were at the receiving end when one Mr. Aamir Khan, in his signature program on changing society, painted all doctors in the black. Falling short of calling them blackguards of today's India, he messed up the minds of his millions of viewers by convincing them that doctors over-investigated, over-referred, over-treated and over- everything in their bid to bleed their patients dry of money. This may be true of about a percent of doctors, and you will find that most such doctors are actually in this profession only for business and profit, and not for doing any good to society. The damage Mr. Khan caused to the image of the entire medical profession is yet to be mitigated. A small episode within a recent movie again showed doctors to be the modern scourge of society (Akshay Kumar in Gabbar Is Back, 2015). 

The negative media exposure that doctors got through the above few examples raised the intolerance of patients. Often, they do not know the effort doctors put in to save the lives of their near and dear ones. Do they realise that often they are the guilty ones: they bring their patient late ... just so as to try some alternative therapy, so that admission  and its higher costs can be avoided. Sometimes, they are actually not interested in saving the old parent or grand-parents' life, and make a show of causing violence to hide their dark deeds when the old person dies due to late arrival. Again, I am not saying that all care-takers are bad, but over 20% are in fault, regardless of their intention ... mostly because they do not have the finances necessary to bring their sick family members or friends in for emergency care.

In the last several months, tens of attacks have taken place in various parts of India, Pakistan, Bangla Desh and other South Asian countries. These populations have similar ethnic and ethical backgrounds; they have the same access to media; they have the same mental make-up. Is it therefore surprising that similar attacks are taking place in each of these countries? However, the problem is most serious in India, where doctors have been brutally and mercilessly beaten up for being the messenger of bad news rather than being negligent. Swift justice is meted out by a crowd of the relatives of the patient, accompanied by the student wing of recognised political parties (read hooligans) who break the hospital's furniture, create mayhem, beat up the doctor and his staff (including helpless nurses who are from the same society that the patient and their relatives are), and file a police case and a consumer court complaint against the doctor and his nursing home. Harrowing stories of doctors getting critical injuries and getting admitted to ICUs have emerged. 

But, I hear that doctors are now organising themselves to hit back at the belligerence with more of their own. When an attack of such nature is anticipated, doctors send out messages to all the other doctors of their area, and a group of doctors assembles at the venue before the news of a patient's bad turn or demise is communicated to the relatives. The relatives are clearly told that violence of any kind will be recorded on cameras installed at different locations of the hospital or nursing home, that there is a law that will punish the perpetrators with heavy fines and imprsonment plus recovery of the costs of the damage caused to the property and the treatment costs to healthcare staff who get injured in the attack. 

In the coming months, the entire issue will be more and more clear as society and doctors are at loggerheads with each other. I hope that good sense prevails. 

Thank you for reading this article. Although it does not directly address a health issue, it is highly relevant and appropriate that we are even discussing it in a public forum. 

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