Health care on drip

75% doctors have at one time or another faced verbal or physical abuse, according to a study

In March, doctors in four government hospitals across Maharashtra were assaulted by angry mobs, which prompted junior doctors to go on a flash strike. This triggered a public health crisis in the state and more than 500 surgeries had to be postponed or cancelled. The same month, more than 1,000 doctors took to the streets in Chennai to protest the assault on a doctor, again in a government hospital. 

Doctors in private hospitals too have faced violence recently. In February, a mob attacked a hospital in Kolkata after a girl, who had been admitted with stomach pain, died. Another hospital came under fire for asking the relatives of a deceased patient for fixed deposits as security before releasing the body. 

A study conducted by the Indian Medical Association (IMA) shows that 75 per cent doctors have at one time or another faced verbal or physical abuse. There are multiple reasons for this. 

K K Agarwal, the president of the IMA, says that the patient has moved from the Bhakti Yuga, marked by complete faith in the doctor, to Jnan Yuga, when the patient is well-informed about his illness and medication, while the doctor is still stuck in the time when raising questions was considered insolence, a challenge to his authority. 

An online survey started by the IMA on Wednesday threw up some interesting results: 72 per cent of the 500-plus respondents wanted the doctor to introduce himself upfront and mention his qualifications; 92 per cent felt the doctor ought to listen to them in greater detail; 85 per cent felt that the doctor must explain everything about the illness, treatment and medication; and 79 per cent said that the doctor should check with them if they have understood the treatment. Clearly, there is a communication gap the doctors need to work on. 

Also, the first point of contact for any patient — and his attendants — is invariably a junior doctor who is likely to err and is often unable to communicate properly, which leaves the patient very angry. 

In private hospitals, doctors underplay the risks in order to not scare the patient away. This often results in the cost exceeding the initial estimate, leading to bitterness and violence. Some “top-end” hospitals are known to have engaged bouncers for their doctors’ safety. 

Public anger is high. Respect for doctors in private hospitals has got replaced with suspicion. Sensing it, Mamata Banerjee, the astute chief minister of West Bengal, recently summoned the private hospitals and gave them a mouthful — she went to the extent of comparing them with slaughterhouses. She next pushed through the Assembly a Bill to make it criminal for hospitals to engage in over-billing, decline an accident victim and hold on to a dead body till the bills are cleared. Hospitals in the state will have to offer patients fixed rates for procedures covering the entire gamut of treatment with scope for the final Bill exceeding the initial estimate by only 1 per cent. The Bill also envisages a regulator for private health care. Jharkhand reportedly too has such a Bill ready for private health care providers. 

There are doubts if such sledgehammer steps will help the cause of health care. Regulation and enforcement work far better than price controls. Police Raj is hardly the right way to rein in deviant doctors. 

In the government hospitals, the problem is one of capacity. In all the recent cases of violence, friends and relatives of patients were not happy with the line of treatment and vented their frustrations on the doctors. Maybe the treatment was faulty. Maybe the doctors communicated in an insensitive way. In either case, it is clear that there is a huge capacity constraint in the government’s health care system. 

Doctors are always inundated with patients, so they are unable to give enough time to each patient, something that leaves people deeply dissatisfied. It is not uncommon for a specialist in a government hospital to see up to 90 patients in a day. In Maharashtra, one of the assaulted doctors had clocked 36 hours of duty when he had to face the fury of the mob, and was looking at 45 patients in a ward, seven of whom were critically ill. In most hospitals, such is the shortage of nurses that attendants do all their work. Doctors are aware that this is not right but turn a blind eye because otherwise there will be mayhem. As a result, hospitals at any given time are swarming with attendants — anything goes wrong and there is nothing to stop them from pouncing on the doctors. 

What is thus required is heavy government presence in health care. This will ease the pressure on doctors in government hospitals and also put a check on private hospitals — the patient should have the option to choose a government hospital if he finds private health care too expensive. Currently, the state of such hospitals drives people away. Health insurance is minuscule in the country; otherwise, the insurance companies could have stopped private hospitals from overbilling. 

Unfortunately, building capacity does not seem to be the government’s priority. So, hospital violence, like road rage, is here to stay.