Three in four doctors in India have faced physical and verbal violence in the workplace
More than 75% doctors have faced physical or verbal violence at work at least once in their life, according to a report published in the medical journal The Lancet. Over 40% have faced it in the last one year, according to the report.
The problem is multifactoral. Overcrowding in public health facilities forcing doctors to spend less time with patients, corruption and over-charging for services (in which the referring doctor gets a cut) leading to the breakdown in the doctor-patient trust are some of the reasons recognised by the study.
“Doctors are forced to spend less time listening to the patients or their care-givers. The concept of shared decision making is almost absent. The average conversation between a doctor and a patient might last just a few seconds,” said Dr Vijay Nath Mishra, professor of neurology at Sir Sunderlal Hospital, Varanasi.
The violence registry
The IMA will launch a registry where doctors can report any incidence of violence along with evidence such as videos, photos, CCTV footage, and newspaper clippings. The doctors’ body will then conduct an investigation and do a root-cause ananlysis.
“This will help us in understanding why violence is happening, predict when the violence might happen and look at measures to prevent such incidences,” said Dr Dr KK Agarwal, president of the Indian Medical Association (IMA).
What do patients want?
“Confrontations happen because of the anger caused by non-fulfilment of desire. Hence, we need to understand what the patients really want,” said Dr Aggarwal.
A survey done by the IMA found that 90% of the patients wanted doctors acknowledge and address them, 92% wanted doctors to listen, 89% wanted the doctors to explain what the illness is, what the line of treatment is and keep them informed throughout. Around 75% of the people also wanted their doctors to review – ask them if they understood and, if not, help them understand.
40% of the respondents also wanted the doctors to thank them. “The patients said that they always thank the doctors, but they wanted that the doctor thank them in return as they gave them an opportunity to treat their relative. We called the study ALERT – Aknowledge, Listen, Explain, Review and Thank,” said Dr Aggarwal.
Interventions that can help
• Do not delay – “Tell the patients beforehand if they need to wait. Don’t call them at sharp 8 o’ clock and then make them wait for whatever reason,” said Dr Aggarwal.
• Spend more time – Doctors would need at least 20 minutes with every patient if they need to discuss their ailment in detail. This is usually not possible in the public sector hospitals due to the sheer load.
• Cost estimates should be proper – “The cost estimated for the treatment should vary only by a maximum of 10%. Most scuffles happen in the billing sections because the cost shoots up,” said Dr Aggarwal.
• Remove junior from the designation of doctors – If resident doctors are called junior doctors, patients would not want to trust them, even if they are well qualified to handle the case. Hence, junior should be removed from the designations and they shouldn’t be addressed as such too.
• Have a designated person who receives the brief – “Very often we tell what the patient is going through to anyone from the family who approaches, the information may get miscommunicated as well. So, it is important to have a designated person whom the doctors would brief,” said Dr Aggarwal.
• Have display boards outside OT – “Knowing whether their loved one has gone into surgery, have they come out to the recovery room. Even little informations, when received immediately can help. So, display boards outside operation theatres and ICU may help,” said Dr AK Agarwal, academic dean, Indian Institute Of Health Management Research.