Violence against Medical Professionals: Day 2(A 2 days series)

10 March, 2018

WHAT CONSTITUTES VIOLENCE AGAINST MEDICAL PROFESSIONALS?

  • Telephone threats
  • Intimidation
  • Oral abuses
  • Physical manhandling
  • Vandalism is another form of violence particularly common in India

 

WHY DOES IT OCCUR?

  • Lack of knowledge and unreasonable expectations among patients and relatives regarding healthcare and adverse events
  • People attending private hospitals expect exceptional quality service from doctors, as they have paid for it
  • Long waiting times, short consultation times, and poor doctor–patient communication can easily trigger tension whenever doctors fail to meet patients' high expectations
  • Delay in providing care, absence of equipment and drugs during emergencies
  • Demand of advance payment
  • Dissatisfaction with the course of treatment
  • Disagreement with physician on modalities, option and course of treatment
  • The general public has started seeing diseases and death as an avoidable phenomenon so there is growing mistrust towards the intent of doctors
  • Costly surgeries and treatment
  • Adverse medical events evoke a violent response from the public
  • Increased awareness of patients about their rights and their willingness to knock the doors of courts to seek justice
  • Inadequate workforce and infrastructure to treat the huge patient load

 

TIPS FOR HANDLING:

  • Each patient should be adequately examined, investigated and treated
  • Doctors should never assure 100% cure and avoid negligence
  • Patients should be involved in decision making regarding their treatment giving them adequate information about the possible complications
  • Try not to frequently change the treatment plan as well as the cost
  • Calm and quiet approach is required while handling the issue. Staff should not in any circumstances respond in a like manner
  • Effective management strategy should be put in place: a damage control plan, when violence against heath staff seems imminent (not to react tit for tat i.e. anger for anger) and address patient grievances
  • Improve doctor-patient relationship, communicate tactfully with patients and show empathy while communicating news of death
  • The current atmosphere of fear and distrust must be addressed
  • A realistic appraisal of the prevailing situation and communication to the patient and their attendants, relatives should be ensured
  • Report all incidents of physical and verbal abuse (threatened or actual)
  • Security personnel will always be out-numbered by the mob and hence inadequate during such vandalism, however, such establishment should have CCTV cameras installed
  • In case of complications/death a senior doctor should talk to patients/relatives which gives them assurance that best treatment is being/was given to the patient. In desperate situations, the patient must be given the choice of calling another doctor for second opinion if they so desire
  • Second opinion should be given very carefully, with careful choice of words
  • Better patient flow management
  • Reduce the waiting times for everything and if they cannot be done at least explain why these times are there in the first place
  • Training of employees/security to defuse crisis
  • Restrict entry of attendants to clinical workplace
  • Displaying information and also the laws governing the safety of doctors up-front, to satisfy the intellectual class and to make them aware of consequences of violence against doctors
  • Unconcealed closed circuit television with video recording may serve as a deterrent, as well as be used to record evidence
  • Hospitals and clinics must have panic alarms and all threats/episodes of violence should be recorded in a critical incident book. There must be a zero tolerance policy for abuse

LEGAL ASPECTS

 ACCORDING TO THE DOCTORS’ PROTECTION ACT, 2010:

  • Any damage or act of violence against Medicare professionals is an act punishable by law
  • Any damage to the property or the Institution of Medicare service is prohibited. Destruction of hospital beds, burning of ambulances, smashing medical stores is punishable by law
  • Imprisonment to lawbreakers for a minimum period of 3 years and amount of Rs. 50,000 to be imposed if found guilty
  • Offenders of medical professionals/medical colleges can be cognizable or non-cognizable crime depending upon the offences committed
  • Damage to any medical devices and equipment is a punishable offence and the offenders are liable to pay twice the amount of the damaged equipment’s cost
STEPS THAT DOCTORS SHOULD TAKE IN ORDER TO AVOID ANY LEGAL HASSLE
Communication
Improving communication skills will prevent doctors from facing violence in the long run. Even though medical practitioners in their forties and fifties may have cultivated their own methods to communicate with patients, it is imperative that they keep up with the times and train in communication skills from experts as part of their continuing medical education. This should be mandatory for all doctors to practise medicine in India.
 
Do not overreach
Modern medicine is changing rapidly. Hence, it is inappropriate to attempt to treat and do procedures beyond the scope of one's training and facilities as this is fraught with allegations of negligence and consequently of violence. Remaining within one's capability and experience is important in today's litigious environment.
 
Consent
Valid and informed consent is of utmost importance in preventing violence. Despite the rush and low health literacy, consent should not be considered a formality. Detailed consent in the patients' own dialect and language with witnesses (preferable) is mandatory before any invasive procedure. The purpose of treatment/surgery/procedure, its prognosis, the commonly occurring life-threatening and non-life-threatening complications must be explained. The available alternatives, advantages/ disadvantages and the consequences of refusal by the patient of treatment should be explained and mentioned in the consent form. It is also important to do only the procedure for which consent has been taken and not any additional procedure, even if it is in the ‘patient's interest’ unless it is a life-saving additional procedure.
 
Documentation
Proper documentation of the patient's course in hospital may not prevent violence but is important once violence occurs and the police are called. The records are often seized by the police. The doctor(s) later find it difficult to defend themselves because during the emergency they focused on saving the patient and not on maintaining proper records.