The recent attack on junior doctors in West Bengal is not new to India. Unfortunately, several attacks on health-care professionals in the past have happened all over the country. According to a 2015 Indian Medical Association survey, up to 75% of physicians have faced violence at work. Intensive-care units, emergency departments, and post-surgical wards are described as the most vulnerable areas.
Some politicians tried to portray this latest attack as a religious clash. But repeated violence against doctors in India is only a sign of a failure in the healthcare system.
I am a physician, and unfortunately, I have witnessed violence at the workplace myself. In 2009, I was working as an emergency department junior resident at a prestigious hospital in New Delhi. During one of the night calls, I was attending a patient with head trauma. I had just finished the initial stabilization of the patient, and I had to ligate a bleeding vessel in his scalp wound. I sent the patient for a CT scan of the head to rule out internal bleeding.
While the patient was in the radiology department for the CT scan, a group of boys appeared in the emergency room, where several other patients were receiving treatment for life-threatening conditions. The youths ransacked the whole emergency room and destroyed critically needed emergency supplies. Armed with iron rods, they were looking for the guy I had just treated for a head injury.
They started beating a few of us, but under no conditions were we going to reveal the whereabouts of our patient. We knew they were there to harm our patient. We told them we had just discharged that patient. They keep destroying the property in the hospital; fortunately, none of us suffered serious injuries. They told us the person we had treated had seriously injured one of their friends in a university campus fight, and they would not leave without him. They wanted to do justice right there.
At this point, we called the local police and informed them about the incident. No one from the police department showed up to investigate. Fortunately, the attackers left after about 30 minutes. We all tried to put everything together and restart treatment of our patients to the best of our abilities.
Similar incidents have been reported all over the country. There is absolutely nothing new in the recent West Bengal incident. This is a time of great distress. This is also time for great introspection. Who are we mad at? Patients? Other religion? Or our system? Government? Or we should only be mad at our medical community?
In my view, all of these incidents are results of more deep-seated system failures. Definitely, the broken primary health-care system in India plays a big role. Tertiary health-care centers are overburdened. Doctor-patient interactions do not have time to develop into doctor-patient relationships. Even if there is no medical negligence, there is not enough time for the physician to sit down and talk to the person in grief, to show empathy.
At the same time, we do not have systems in place that ensure the safety of physicians and nurses, especially in high-tension places likes emergency rooms, ICUs, post-operative wards and other areas in the hospital. Who is responsible for these systemic failures? If we introspect as a medical community, we will only find ourselves accountable for this.
No one else will come from somewhere else and provide us what we need. We will have to put systems in place to ensure the safety of health-care personnel and the safety of our patients. Initiatives have to come from within the medical community. Protesting against the government is not going to fix this problem. Despite repeated incidents over the years, the Indian Medical Association (IMA), state medical associations, the Medical Council of India (MCI), local bodies, or administrations in hospitals that are primarily dominated by doctors have not made any efforts to define the problem and come up with an action plan to combat this situation. We all need to introspect and take necessary steps to ensure the safety of medical personnel and the safety of our patients.
Here is what we need to ask ourselves to ensure safety.
- Do we have policies at each hospital to ensure no more than one attendant is allowed with each patient? If so, do we have measures to check intermittently if these policies are being implemented? Do we have endorsement from state medical boards, the IMA or MCI on these policies?
- Have we designed our emergency rooms and hospitals in a way that unsolicited personalities do not enter hospital premises (locked doors, locked hallways, automated locked doors at multiple levels can only be opened by electronic IDs)?
- Do we have appropriate security personnel at the entry to the emergency department and hospital entrance?
- Do we have contingency plans? If a security breach happens, what is the response? Can we lock ourselves and our staff in a designated area where no one else can enter?
- Do we provide adequate training to our medical students and other trainees on how to deal with stressful situations? How to resolve such conflicts? What to say and what not to say in these situations? How to mitigate the risk? Are we getting training in this regard at regular intervals?
There are many more steps that can be taken. What are we trying to achieve? We will have to come out of our hierarchical system and let the new voices come up and find solutions. The first step toward making any change would be to change the hierarchy in our medical system.
We also must speak up against the inhumane work hours trainees in the Indian medical system go through. If there are no duty-hour regulations for our trainees, how do we expect a resident who has not slept in 48 hours to show empathy?
What are we demanding from the government? This all needs to be fixed from within the medical community.
This will not happen miraculously in one day. This will need system building at the national level and at each hospital. We need to designate departments and personnel at every level to ensure safety. Once systems are in place, continuous processes will need to be put in place to ensure continuous improvements. In the long run, strengthening our primary health-care system is required to reduce the burden on the tertiary care centers so that doctor-patient relationships can be restored.