Ailing doctor-patient ties need urgent cure

BITTER PILL Resident doctors are often forced to face violent relatives of patients who can quickly turn into mobs given the lack of adequate security, endangering the entire hospital

MUMBAI/NEWDELHI: “We know stoppage of work amounts to contempt of court and violation of the oath we took upon entering the medical profession, but what can we do when violent attacks have become such a regular feature of our lives?”

This statement by a student-doctor at the medicine department of the Lokmanya Tilak Municipal General Hospital and Medical College in suburban Mumbai sums up the problem that drove Maharashtra’s 4,000-odd medical students to bunk work for six days – starting Sunday.

Since March 12, 2017, there have been six instances of patients’ kith and kin attacking doctors at public hospitals across Latur, Dhule, Nashik, Sangli and Mumbai districts. A particularly glaring incident was the assault on Dhule civil hospital doctor Rohan Mahamunkar, who was admitted to the intensive care unit after being blinded in one eye.

The state’s resident doctors have two major demands: one, restrictions on the entry of patients’ relatives to ensure that mobs don’t gather at hospitals and, two, additional security personnel on the premises.

There’s nothing new about their demands. Though the government promised additional security and visitation curbs after several similar protests in the past, they have mostly remained on paper.

THE DELHI EXPERIMENT

Resident doctors at leading public hospitals in Delhi went on eight flash strikes over the past 18 months to demand security. After people created a ruckus in the gynaecological emergency room of the Lok Nayak Hospital, two CCTV cameras and an alarm system were installed to alert the guards and the chief medical officer. “While I am not sure if the alarm system works, I do know that there is nobody monitoring the CCTV feed. Of what use is such security?” asked a doctor on the condition of anonymity.

After a big strike in 2015, the Delhi government promised to depute 500 home guards at its hospitals. “We hardly ever spot them,” said a Lok Nayak doctor. “There’s always someone who is not happy with the treatment received by their loved ones. When they’re present in large numbers, the dissatisfaction turns into violence.”

Adequate security can prevent such incidents, claimed Dr Parul Tank, a consultant psychiatrist at the Asian Heart Institute. “If there are enough guards, even an aggressive man will think twice before resorting to violence,” he said.

However, security guards are not always the solution to such issues. The Lok Nayak Hospital has private security guards, but they can do little when doctors are attacked by angry mobs. “Also, limiting the number of patients is difficult. It swells up within minutes if the patients’ health starts deteriorating,” said Tank.

THE VULNERABLE ONES

Government hospitals in small cities are the most affected by this issue. Last week, a mob of 35-40 people assaulted doctors and a nurse at the Nasik general hospital, which had only four guards to protect the staffers from over 700 people. “We demanded more security from the superintendent of police, but we are yet to hear from him,” said medical superintendent Dr Said P Jagdale.

Dr Gadre said that while security guards and CCTV cameras are important, better enforcement of the Maharashtra Medicare Service Persons and Medicare Service (MMAPMS) can provide a more permanent solution.

With increased availability of information from informal channels, patients’ families now desire informed participation in the treatment process. “Earlier, unethical practices would go. But the doctor’s word is not final anymore. Relatives want to actively participate in therapeutic decisions,” said professor Sachin Divekar, an expert.

LACK OF PUNITIVE ACTION

Though the Indian Medical Association makes assaulting doctors a non-bailable offence punishable by imprisonment of up to seven years, nailing the guilty parties can be tricky. Dr Sagar Mundada, former president of the Maharashtra Association of Resident Doctors, said: “There hasn’t been a single conviction under the MMAPMS Act since it was enforced in 2010.”

An official with the Directorate of Medical Education and Research said police take a lot of time to book the accused under the MMAPMS Act, and fail to file the charge sheet in time. “The cases are not even heard most of the time,” he added.

In Delhi, the emergency department witnesses over 70% of the violence. “Everyone wants to be treated first, but we have no choice but to look at those in a more critical condition,” said Dr Harjit Singh of AIIMS.

Dr Abhay Shukla from the Jan Swasthiya Abhiyan attributed the people’s frustration to lack of resources, equipment and medicine – which, in turn, are caused by a “debilitated” health budget. “In the end, it is the overworked frontline resident doctors who fall victim to physical assaults.”

WITH INCREASED AVAILABILITY OF INFORMATION FROM INFORMAL CHANNELS, PATIENTS’ FAMILIES NOW DESIRE INFORMED PARTICIPATION IN THE TREATMENT PROCESS