Necessity of making doctors feel "safe"

Written by: JABIR R. MISTRY, Class of 2023

The highlight of this blog is unlawful acts of violence towards healthcare professionals, existing laws, and counter- measures for self protection & avoiding such circumstances. 

At present times we are witnessing an increment in unlawful acts and violence in our society against doctors. Health professionals are dedicating their lives for wellbeing of community since centuries. Such circumstances Impact our society at a much greater level. 

Research and studies have shown that rules against violence towards medical professionals are being regulated by appropriate bodies. As we see an increment in social media usage, sharing of misinformation through videos and images by public has also given a boost to such actions. Crimes done towards doctors are mainly connected to professional activity. 

Geographically, violence against healthcare professional has occurred in the form of physical violence, verbal abuse, aggressive gestures, blackmail, and cyber-bullying is observed in the United States, Australia, India, China, Pakistan, Nepal, Sri Lanka. 

Indian medical association has reported 75% of cases face verbal abuse, physical assaults and due to fear of violence 43% doctors were under stress. Factors that caused violence against doctors are, absence of post-graduate training in emergency medicine, long working hours of up to 120 hrs a week for doctors, demonisation of doctors in news media. Errors in infrastructure, poor mechanism for grievance redressal, delayed legal procedural outcomes, a poor emergency network among hospitals, poor communication skills of healthcare workers, resource poor emergency settings (fewer drugs, fewer facilities for investigations), high patient load, lack of proper training of healthcare staff, high work load, and excessive political interference in hospital affairs. 

A study conducted in Italy showed healthcare workers have a 16 times greater risk of suffering workplace violence than workers in other sectors and around 50% experience workplace violence in the course of their career. This study shows statistics of 1988- 2019 and Variables such as perpetrator, motive and location of the crime were obtained through forensic psychiatric department. 

Over the period considered, 21 doctors were killed in Italy in connection with their professional activity. In 52% (n = 11) of cases, the killer was one of the doctor’s patients, in 29% (n = 6) of cases it was a patient’s relative, in 19% (n = 4) an occasional patient (first consultation). The location of the homicide was a community clinic in 48% (n = 10) of cases, the street in 19% (n = 4) of cases, the doctor’s home in 14% (n = 3), the hospital in 14% (n = 3) and the patient’s home in 5% (n = 1). In 57% (n = 12) of cases the perpetrator was not affected by any mental disorders. The motive for the homicide was revenge in 66.7% (n = 14) of cases; in 28.6% (n = 6) the revenge was preceded by stalking. 

There have been several cases in past portraying the misconduct by doctors in workplace that is the reason we have regulatory bodies to control such acts. Judicial system has laws for such activities and these should be maintained. 

"International encyclopedia for laws" has a category of "Medical Law" focusing on the ethics for medical practice. 

Proportional distribution of murders of doctors by location in Italy, from 1988 to 2019(pie chart)

Clinical features of perpetrators of murdering of doctors in Italy, from 1988 to 2019 (psychiatric comparison) 

Age distribution of doctors murdered and their perpetrators in Italy, from 1988 to 2019 (graph) 

Every country has their own laws with regards to malpractice by medical professionals and crimes against them.Ministry of Health and Family Welfare has published a letter "MECHANISM TO PREVENT VIOLENCE AGAINST DOCTORS" :-Further, violence against healthcare professionals is a criminal offence and needs to be dealt suitably by the State / UT Governments under provisions in Indian Penal Code (IPC) / Code of Criminal Procedure (CrPC) so that doctors/ clinical establishments discharge their professional pursuit without fear of violence. 

COUNTER MEASURES

a) Security of sensitive hospitals to be managed by a designated and trained force,

b) Installation of CCTV cameras and round the clock Quick Reaction Teams with effective communication / security gadgets particularly at Casualty, Emergency and areas having high footfalls,

c) Well-equipped centralized control room for monitoring and quick response,

d) Entry restriction for undesirable persons,

e) Institutional FIR against assaulters,

f) Display of legislation protecting doctors in every hospital and police station,
g) Appointment of Nodal Officer to monitor medical negligence,

h) Expeditious filling up of vacant posts of doctors and para-medical staff in hospitals / Primary Health Centres (PHCs) to avoid excessive burden / pressure on doctors and to maintain global doctor-patient ratio,

 i) Better infrastructural facilities and medical equipment and provision of extra monetary incentive for the doctors and para medical staff serving in hard/remote areas as compared to major and metro cities with better career prospects, etc. 

To put it in a nutshell,we as a society should have accountability and responsibility for our actions. Malpractice and misconducts should be condemned but in a legal way. Taking steps in a sensible manner is the way to an ideal society. "Together we can be the change".