Pulse

Doctors need anti-violence Bill & some communication skill

PT Jyothi Datta | Updated on September 14, 2019 Published on September 14, 2019

Increased healthcare spend and improved facilities will reduce doctor-patient friction

Over a fortnight ago, a 73-year-old doctor was attacked at a tea plantation in Assam after a worker had died at the plantation hospital. The doctor succumbed to his injuries.

But wounds from violence against doctors have been festering for a while now, forcing the Centre to outline a Bill that protects medical personnel and infrastructure from violence.

Even in casual conversation, doctors bring up the threat of possible violence they face from patient families. Naturally, they laud “The Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill (2019) for the penalties, compensation and imprisonment it defines for violence. (see box)

Doctors point to bouncers and armed presence in hospitals, besides insurance that they are contemplating, in the face of violence.

And yet, when they speak on the promise of anonymity, there is an acceptance that medical professionals too need to introspect and play their part in dispelling the distrust between them and patients. While there is no dispute that violence of any form is unacceptable, doctors want this conversation to also include Government and its abysmal spending on healthcare. Low spends cause doctors to be overworked and facilities to get stretched, laying the ground for doctor-patient friction.

Abysmal conditions

Senior doctors at Government-run hospitals point to the daunting task their young colleagues face in the casualty wards at night, where less than a handful of them handle 50 to 100 patients in various stages of criticality. “Naturally if someone dies, their families will feel the doctor did not pay attention to them,” says a senior surgeon. He alleges that patients are often brought to Government hospitals at a late stage when other hospitals refuse admission. When the patient dies despite the best medical intervention given the circumstances, the doctors face the brunt of the family’s anger.

Government-run hospitals face shortages in terms of equipment like ventilators, doctors, paramedic staff, nurses, counsellors, etc, say doctors. “Resident doctors stay in abysmal conditions, some are there for 36 to 48 hours without rest, while in developed countries they work in eight-hour shifts,” says a senior doctor. It is not uncommon for doctors to get tuberculosis because of low nutrition and immunity.

Government needs to increase its healthcare spending to more than 2.5 per cent of GDP by 2025 so hospital facilities improve and doctors are able to provide better services to patients.

Another doctor points out that violence against them reflects the general violence in society. And since patients are aware that some bad elements in the profession take kick-backs, etc, they view all doctors with the same lens, he says. A former head of a private hospital says they had bouncers on location as 70 per cent of the staff were women.

Heal thyself

That said, doctors agree they need to communicate more and with a little patience and compassion. Medical education and hospitals need to train doctors with soft skills to speak to patients. Private hospitals may have counsellors, but Government ones suffer from sheer shortage of hands at all levels. Doctors, nurses and para medics need to be trained on having those difficult conversations with patient families, says Dr Ajay Bakshi, founder of healthcare start-up BuddhiMed Technologies and former head of Manipal Hospitals and Parkway Pantai (part of IHH Healthcare that bought Fortis Hospitals). The UK’s NHS runs such training programmes.

Several doctors across the country agree that patient families tend to trust a doctor’s decision if a counsellor or someone senior explains to them why a procedure was done or a drug given. Even in case of a complication or death, if the patient family is kept informed, there is less chance of violence against the doctors, says a Government-hospital surgeon. During billing, if the process is transparent and explained, there is less likelihood of passions flaring up. Hospitals must have a patient grievance redressal cell too.

The Centre must focus on getting in more skilled doctors and support staff and equip these establishments with better facilities. This will put the onus on doctors and medical staff to devote a little time and compassion to patients while treating them without fear or favour.

 

Published on September 14, 2019
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