Violence against doctors, growing trust deficit with patients at core of medical system's rot; policymakers must act quickly

A reverse of what is called the God complex operates in India, where godliness is thrust upon doctors and they are still considered to be the guarantors of deliverance and recovery.

Anchal Bhatheja October 28, 2019 16:55:04 IST
Violence against doctors, growing trust deficit with patients at core of medical system's rot; policymakers must act quickly
  • The legislature is also trying to armor health professionals from being assailed and lynched by the disgruntled relatives of patients

  • Nineteen states have laws to this effect, but India still awaits a national legislation

  • The colossal number of reported incidents of violence against doctors and the enormous deaths resulting from medical errors indicate that these are not isolated incidents

In the age of big data, when both gadgets and their possessors are turning smarter and information about everything ranging from diseases, detection, diagnosis, cure and correctives is up for grabs, there is a peculiar flip side. A reverse of what is called the God complex operates in India, where godliness is thrust upon doctors and they are still considered to be the guarantors of deliverance and recovery.

On the other hand, doctors take and try to internalise the Hippocratic Oath which obliges them to abide by the basic tenants of medical confidentiality and non-maleficence, a few lines of which are reproduced here:

“I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. I will keep pure and holy both my life and my art.”

But the psychological patterns of the patients who attribute divinity to doctors or the moral underpinnings of the Hippocratic Oath are unequivocally failing to tone down the trust deficit between doctors and patients.

Violence against doctors growing trust deficit with patients at core of medical systems rot policymakers must act quickly

Doctors took out a protest rally in Kolkata in June 2019. AP

In the light of the recent release of the Global Health Security Index in which India stood at number 57 among 195 countries, it is appropriate to re-examine and re-assess the dynamics of the doctor-patient relationship in India. For, it lies at the core of the nation’s healthcare system.

It is unfortunate to see that medical negligence and at the same time, violence against the medical fraternity is on the rise.  This becomes palpable if one takes a note of the following statistics.

According to a report published by the Indian Medical Association 75 percent of doctors face some sort of physical or verbal violence in the hospital premises and the trepidation of this violence is the reason for stress among at least 43 percent of them. This is a double-edged dilemma in the sense that 5 million people lose their lives due to medical negligence on a yearly basis and nearly 60 percent of these deaths are a direct consequence of miscommunication.

Over time, the multilayered crisis that ails our health apparatus has attained due cognisance and the policy makers, administrators and health professionals have attempted to remedy the situation by adopting retributive means to penalise doctors for being negligent and patients and their kin for being violent.

For instance, if a doctor is negligent in their conduct, they can be made liable under Section 304A of IPC for causing death due to rash or negligent act, especially in the cases when their conduct shows an utter disregard to the life and safety of a patient. Liability can also arise under tort law and contract law. Furthermore, The Supreme court’s interpretation in the landmark case of Indian Medical Association v. V. P. Shantha brought service rendered by the doctors within the purview of section 21O of the Consumer Protection Rights Act, 1986, which  defines “service “and the honourable court also held that patients were consumers within the ambit of section 2 1D of the aforementioned legislation.

At the same time, the legislature is also trying to armor health professionals from being assailed and lynched by the disgruntled relatives of patients. Nineteen states have laws to this effect. But India still awaits a national legislation. The ministry of health recently drafted a bill that provides for a punishment ranging from 3 to 10 years and a fine of 2 to 10 lakh on those who try to grievously hurt doctors and health professionals. This draft bill will most probably see the day of the light soon and become a full-fledged act that will protect the interests of the medical fraternity.

While these legal safeguards are of paramount importance, another underscoring nitty-gritty also deserves attention. The colossal number of reported incidents of violence against doctors and the enormous deaths resulting from medical errors indicate that these are not isolated incidents, but rather stem from a broader all-pervading policy paralysis that ails our healthcare sector.

The reasons for medical errors on the part of doctors and the resulting frustration that takes the form of violence by the kin of patients has a fundamental common reason which is an abysmal doctor to patient ratio. Nearly 8.2 lakh doctors tend to the needs of a massive population of 1.3 billion.

Doctors are generally overworked, which alienates them from the process of multiple surgeries, check-ups and appointments. This burden translates into a dearth of time for every patient. The lack of time and energy at the disposal of doctors reduces the prospects of a healthy relationship between them and their patients. At the same time, it increases the chances of medical negligence. For to err is human but overburdened humans err more.

Consequently, the doctors' alienation from the process of diagnosis and treatment due to sheer numbers of patients makes patients feel  that doctors are arrogant and they do not care enough. This takes away the human aspect out of the process which is otherwise indispensable because empathy and compassion are the cornerstones of healthy practice of a health professional.

Patients are becoming doctors due to the massive information that is at their disposal and can be accessed in milliseconds and doctors are becoming patients due to the huge burden that they bear. This undesirable but real exchange of their inherent roles has made our health system chronically ill.

Specific charging sections are important to deal with isolated incidents of violence and negligence but a final therapy for the Indian medical system should aim at bolstering medical educational institutions and reducing the doctor-patient ratio. A parallel and an equally important step is to equip these newly-inducted professionals with requisite professionalism and integrity.

For “Ayushman” India to come into existence, policymakers need to be proactive while lawmakers draft and enact criminal laws because a penalty for an isolated incident of malpractice, negligence or violence can temporarily numb our medical system. India needs a corrective long-term policy to destroy the root of this ailment.

The author is a second year student at the National Law School of India University, Bangalore

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