A doctor who announced patient's death was kicked in the stomach. Another doctor who suggested that a patient should be hospitalised, got his hand broken by the kin of the patient. The doctor, who was kicked in the stomach, decided to leave Kerala due to mental trauma. Violence against health personnel is increasing in Kerala. Every month at least 10 to 12 health workers are attacked. So much so that it has reached a point when the high court has instructed that a case be filed within an hour of the attack. What happened to Kerala which once considered doctors as Gods? How did the doctor-patient equation go so wrong? How will these recent incidents of attack affect the health sector? Indian Medical Association President Dr. Sulfi Noohu examines. He had written on Facebook that the doctor who was kicked by the relative of the dead patient told him that she was quitting the profession. The note became viral.
In recent times there seem to be too many attacks on doctors and hospitals. How will this affect the healthcare industry?
The attacks against medical practitioners will also affect the morale of the public. Kerala was one of the first states to introduce a Hospital safety law. But there are no strict conditions. The law is weak. There are many loopholes for attackers to escape.
The police, who are supposed to ensure security, are not doing much because of this. Nowhere else in the world can you witness such kind of attacks on medical practitioners. They beat, tear women's clothes, break hands, and all when death is reported. Only because the law is not strict, the attacks on doctors are on the rise for the past few years. After June 2021, there are 138 cases of violence against health workers including doctors. There have been 42 cases so far this year. Government intervention is needed to change this situation.
Why are such incidents persisting without keeping them under control? Isn’t there enough security in hospitals? Can the hospital authorities be blamed for this negligence?
Security in hospitals is there only for namesake. Here even in medical colleges, we have police aid posts only for namesake. Even if it is a big institution like the medical college in Kozhikode, the aid post is only at the entrance or reception area. The police cannot immediately intervene in the affairs of the ward and so on. It is not enough to set up aid posts, there should be more people hired for security. Shouldn't there be a mechanism for the police to reach there if someone misbehaves inside the hospital, in the super speciality block? They need to be there without being called when something happens. There is an emergency system to bring the doctors to the hospital when seriously ill people are brought to the hospital. Similarly, there needs to be a system to notify the police of violations. Security staff is also required at all locations. Another important fact to be considered is that there should be restrictions on the number of people to be allowed inside government hospitals. The government has suggested that hospitals should have CCTV cameras. But most hospitals don't have cameras. Surveillance systems including cameras should be ensured.
Why are such attacks increasing in hospitals? Are the authorities hesitating from taking action or are there people who are supporting these attackers?
I think there is a general attitude in society that it is fine to harm doctors when such incidents happen. This needs to be changed. Then only can we find a solution. Also, the attackers have this confidence that the doctors, authorities, or medical practitioners won't retaliate. After all, they won't be in the mindset to do that. In the health sector, both men and women are getting attacked. But unfortunately now women doctors are not even given the usual consideration. Violence against women are here as in every other sector. Female doctors, nurses, and nursing assistants are mostly women. Then the intensity of the attack increases.
Will the attack against doctors affect the functioning of the hospitals? Are there any changes in the attitude of healthcare workers? What is defensive medicine?
Of course. This situation leads to various problems. Nobody knows that either. The treatment itself goes awry. The problem isn’t about attacking doctors but about how this affects the public. Imagine if a heart patient arrives at the hospital, the immediate focus of the health practitioners would be to save his/her life as soon as possible. Usually, doctors never hesitate to take risks for that. But now they are afraid. If something goes wrong, they will be blamed for the mistakes in the treatment process later. For example, if something goes wrong while giving first aid like CPR, they will be transferred to a hospital with better facilities. That is, the doctor will be reluctant to take the risk. Because they are hounded by the fear of getting beaten if they take a risk. This is defensive medicine.
Doctors are on the defensive now. It has come to a situation where the doctors are worried more about their own safety than the patient's life and it is dangerous. Doctors in Kerala should not be pushed into it. This is not the only problem. Violence takes place in hospitals. Most of the people there are sick. One should remember that there are patients out there who have serious health challenges. When attacks occur in the emergency department, the treatment of other patients there is also delayed. A surgeon has to postpone surgery on many of his patients during days when they are under treatment because of an attack.
Even doctors are under stress. What should be done in these trying situations?
Doctors are scared. These attacks are affecting them in two ways. More than the physical pain, they are affected mentally. We should remember that they were attacked when they were trying to save someone’s life. That’s the big issue. The doctor who was kicked while informing about the death of a patient in Thiruvananthapuram Medical College apparently said—“I don’t need this job.” One can imagine the trauma she must have gone through considering the long hours she gives to a hospital. Another patient broke the hand of a surgeon and he used to do surgeries with that hand. So if you have a complaint against the doctor or the treatment, you should approach the court of law. Isn’t that what we should do?
What are the steps to be taken to prevent the attack on doctors? Is IMA trying for legal remedy?
The High court verdict was a relief. The relief that at least someone understands our situation. The government is just seeing it as any other attack. Like saying such things happen in every sector. But the court’s observation was so precise. We have asked for an amendment to the Hospital Act. The court has also said that reports should be submitted before the 16th of this month. The IMA is approaching the government demanding the amendment. It is the duty of the police to defend us from these attacks. The attackers should be strongly punished. If no action is taken within 24 hours, charges should be filed against the police. The cases should be transferred to fast-track courts. If there is assurance that strong action will be taken, the violence will decrease.