To be attributed to Ms. NiiraRadia, Chairperson, Nayati Healthcare

The on and off relationship between the doctors and patients remains one of the biggest paradox in Indian Healthcare market. The extreme sentiment that defines the relationship has been the painful reality of Indian Healthcare system – fluctuating from Bhagwaan to Shaitaan (on being asked to pay the bill), from appreciation to resentment, from pedestal to hospital bed.

While violence against medical practitioners is on the rise all over the world, the situation in India is unparalleled. The IMA (Indian Medical Association) has reported that over 75 per cent of all doctors in India come across some form of verbal or physical violence from patients and their families.

Although the Prevention of Violence against Medicare Persons and Institution Act is applicable in 19 Indian states, it has remained unsuccessful in protecting medical practitioners from such recurring incidences of violence and vandalism. Healthcare falls under Essential Services Maintenance Act (ESMA) which is heard only when the administration wants to crush the protests by the doctors and other medical staff.

‘Essential services’ call for a special treatment from the society and the government alike. Ideally, there should be no stone left unturned to make it congenial for the best outcomes, as it is an essential service. However, that has not been the case of late. Let’s understand the reasons behind the compounding violence and aggravation against doctors in the society.

Growing distrust and hatemongering

Violence against doctors and the deterioration in the doctor-patient relationship today is largely the result of the growing negativity and increasing distrust towards the healthcare sector, which in turn stems from the negative portrayal of the sector. Social media is highly unregulated and tends to spread negative content more than positive one.

Cases of medical failure are often sensationalized through social media. Such incidents emanate suspicion in the general public towards medical practitioners. The same doctors who were seen as saviours until recently, are now being painted as demons. During the recent World Cup match, one of the most repeated commercials was by a leading insurance aggregator website. The ad showcased rising bill with a blood filled thermometer. Whoever curated that campaign was definitely ill-informed about the medical sector.

Increasing mob frenzy

There is also an increasing mob frenzy in the country, which needs to be checked urgently. India bears witness to a highly skewed distribution of healthcare infrastructure. Most healthcare facilities are concentrated in the metros. Patients from smaller towns often travel long distances for treatment. The time and cost of travel, along with the emotional trauma, compounds the situation.

Pretty often, these patients do not receive proper care at primary care centres. They often spend excessive time and money reaching proper tertiary healthcare services in larger cities. This further results in deteriorated condition of the patients’ due to long distance travel.

This brings us to the most painful reality of the Indian healthcare sector. Private healthcare providers are wary of venturing into the hinterland. The government must find some ways to incentivize the healthcare sector, encourage setting up of more healthcare centres in the tier 2 and tier 3 cities. This would bring best of healthcare services closer to the people, so that critical illnesses due to travel can be addressed.

Ignorance and unawareness

People often reach the hospital only at a critical stage, thus calling for urgent hospitalization and intensive care at times. This leads to an otherwise avoidable increase in the cost of treatment. ICU treatment is expensive worldwide. However, in India, the cost of intensive care facilities is one of the lowest in the world.

Another notable point is, in smaller towns and rural India, insurance penetration is dismal and the patient has to spend money from his/her own pocket. Hospitals often witness situations wherein the relatives of the patient go on a frenzy upon seeing the medical bill and refuse to pay. At times, they also seek guaranteed medical results in return of the ‘excessive’ cost of the treatment.

At this juncture, it is important to understand that doctors pour in their heart and soul to save every life. People hold the doctor and the hospital responsible for the loss of their family members due to medical complications. The patients’ relatives and acquaintances need to understand that every patient is different and every disease is not curable. Every doctor strives for the best outcome. However, achieving positive results is not possible in every case.

This takes us to an important question: Why do we have misguided public? There certainly lies a bigger picture. It’s appreciable that a medical practitioner in India has far more patients to see as compared in the West. Hence, time given to the patient is comparatively less. The simplicity of communication, tone and manner becomes paramount and probably the first milestone that needs to be crossed while explaining the disease to the patient.

If doctors communicate in a manner the patients and their relatives don’t understand, or use medical jargon, they end up pushing them to Dr. Google. If doctors don’t communicate with patients in simple terms, they will fail to understand the situation. That said, it surely does not give the public the right to violence.

Skewed doctor-patient ratio

The medical sector in India is severely understaffed when it comes to healthcare providers, especially doctors. Becoming a doctor is difficult – it requires years of hard work, persistence, study and experience to become one. The doctor patient ratio in the country remains lopsided with one doctor per 1,453 people. This is in stark contrast to the WHO recommended ratio of 1:1000. The situation is even worse in tier 2 and tier 3 cities, where 80 per cent of the Indian populace resides. Patients and/or their relatives creating ruckus over waiting period is a common sight in the country.

Way forward

The solutions have to be comprehensive and proactive – not mere ‘band aid’ measures. We need to have preventive, anticipatory and therapeutic approach to the problem. These measure have to be present at the level of the hospitals, State Governments & the Central Government. Also, these steps should not only be by way of guidelines, but should be enforceable rules monitored closely by the regulatory authorities.

It is also important to educate people that violence against doctors tends to inhibit the advancement of quality healthcare services in our country. If one encounters and/or suspects medical negligence, they should resort to legal procedures, rather than abusing and assaulting the hospital staff physically or verbally.

It is of utmost importance that the government ensures a congenial environment in the hospitals – both government and privately run. The government must create provisions and laws aimed at mitigating such attacks. An assault on doctors should be declared a cognizable offence, as in the case of an assault on public servants on duty.

The Law against Medicare Violence is available for some years but it has not worked for various reasons. It needs to be strengthened. One effective way of strengthening it is to make it akin to Dowry law or Domestic Violence Law. The onus should fall upon the accused to prove himself not guilty. Hospital violence is equal to (if not worse) Domestic violence, in terms of the damage that it causes.

Consider ‘no-fault liability’ for compensation in medical negligence (in place of Consumer Courts, which are causing acrimony between healthcare seekers & givers) as is available in New Zealand, Sweden & Denmark. This will not only provide simpler, broader & quicker mechanism for compensation but will also remove acrimony. It will help improve doctor patient relationship. We can work out its nitty gritty to suit Indian Scenario.

Further, there should be an ombudsman to handle customer grievances in the medical field. Currently, a medico-legal case takes 5-15 years to get closed. For the doctor to leave his or her duty and travel every time for the case hearing is a big drain on the already inadequate pool of qualified doctors.

Indian doctors are considered the best worldwide and the healthcare sector has been witnessing a steady growth of patients from around the world and is already becoming an international medical hub. Violence against the fraternity, only spreads doubts and creates trust deficit. The biggest challenges is that the key stakeholders doctors, hospitals, state & central policy makers, industry associations work in silos and they need to come together to a larger consensus to deliberate on how to build a better India.