The ghastly attack on doctors at Nil Ratan Sarkar Medical College and Hospital on the night of 10 June has become a full-blown crisis for the Mamata Banerjee government in West Bengal, with hundreds of doctors in state-run hospitals tendering their resignations in defiance of the Chief Minister’s diktat to resume work.
Yet, even as the back-and-forth between the government and the doctors continues, the systemic problems that have allowed such assaults against doctors to grow increasingly frequent and occur unabated, are hardly being discussed.
With the root causes not being addressed in any way whatsoever, the attacks on doctors are unlikely to stop.
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Over the past year, there have been repeated incidents of assault against doctors across the country. On some occasions, there have been large protests after. The protesters make certain demands, typically pertaining to the case at hand and an agreement is reached after a couple of days of agitation. But in a few weeks’ time, there is yet another assault. And so it continues.
We spoke to a large number of young protesting doctors across Kolkata to understand what these problems are and how they could be addressed. As they began spilling the ugly truths about their jobs and workplaces, which could get them into “severe trouble” with their superiors, several doctors requested that their identities be kept anonymous.
Woeful Security
The growing frequency of attacks has created an environment of fear for doctors, young and old. A 26-year-old doctor at Calcutta Medical College tells me, “For several months now, I have stopped wearing my stethoscope around my neck whenever I step outside my department building. Initially, I used to feel proud to wear it. But now, fear is the stronger emotion.”
“After the death of a child at Calcutta Medical College recently, people came in and began threatening the doctors. It was very scary for the doctors who were present. This happened around 4 to 5 am on 22 May, and the security guards were nowhere to be seen. The absence of security personnel when you need them is not surprising.”
Another doctor at CMC quips, “The child who died had been brought in a very critical condition. There was nothing more we could have done. But the family and those that came with them were really angry at us, as if it was our fault.”
Given that security personnel were not present then, that situation too could have easily escalated into something worse, like it did at NRS on 10 June.
Multiple such instances of close shaves where the security system has failed the doctors, have contributed as much as the actual incidents of violence in creating the climate of fear in which doctors operate today. Therefore, one of the primary demands of the agitating doctors everywhere has been to ask for increased security at hospitals.
Needed: More Guards and CCTV, Smaller Patient Parties
The following are suggestions from various young doctors about the urgent measures that need to be taken to ensure improved security.
Dr S Kumar, who recently completed his Master in Surgery (MS) in Kolkata, stresses on the need for more guards at the gates, including armed ones. He says, “The number of guards posted should be based on the number of patients that frequent that OPD or ER.”
NRS student Arghadip Das says, “No more than two persons per patient should be allowed inside the hospital. Such a restriction is obviously not being implemented. Why should 20 to 30 people be allowed to enter at the same time for one patient?”
Doctors across different colleges have also been arguing that more CCTV cameras need to be installed and maintained properly.
A common complaint has been that in hostile situations, the security personnel generally adopt the role of passive bystanders rather than skilled intervenors. Instead, they should have clear instructions to de-escalate situations that arise between patient parties and doctors. They should also be provided with adequate training in de-escalation techniques and methods, which they currently aren’t.
But Where’s the Political Will? Missing
Dr Bijit Saha, 26, is among the protesting doctors at NRS, the nerve centre of the agitation. Minutes after delivering an impassioned speech to the congregation of doctors seated under the shamiana near the Emergency gate, Bijit tells me that in his opinion, the real problem lies in the lack of political will.
“Is the police playing its due role in society or are they behaving like puppets? What is the reason behind the police not taking action against the mobs that assault doctors?”Dr Bijit Saha, NRS Medical College and Hospital
Dr Ankit Goel, a 30-year-old doctor at Calcutta Medical College, asks, “Why does police reinforcement take so long to arrive in these cases?”
Following the violence at NRS on 10 June and amidst the subsequent doctors’ agitation, the Mamata Banerjee government’s refusal to pay heed to the demands to increase security has been the clearest example of the lack of political will on the matter. In fact, on Friday, the Calcutta High Court asked the West Bengal government what steps it had taken to ensure security of the doctors.
In the four days of the agitation so far, CM Mamata Banerjee and her government have neither made any substantial effort to engage with the doctors about their security concerns, nor have they announced that they will even consider upgrading or improving security measures in public hospitals.
With greater political will to address these issues, the security setup could be improved significantly, and processes for training and de-escalation strengthened.
‘Junior Doctors Have 36-Hour Shifts, Overworked to Inhuman Extent’
A post-graduate trainee (PGT) in the second year of his MD course (Doctorate of Medicine) at one of Kolkata’s top medical colleges tells me, “The behaviour of doctors is honestly a problem. It’s not possible to be nice and calm to patient parties at all times when you are sleep-deprived and massively overworked. The conditions in which young doctors like us are made to work are inhuman and illegal. We have rostered shifts of up to 36 hours at a stretch. I have routinely worked from 9 am on one day to 9 pm on the next day. And then come in again at 9 am the day after.”
Sayan* (name changed) continues, “Being overworked to such an extent all the time will obviously lead to behavioural issues. Often, doctors end up snapping at patient parties, behaving rudely and irritably. This worsens the relation between patient parties and the doctors, and sometimes leads to a hostile environment.”
But is the impact of being so overworked limited to the doctors’ behaviour and their own health?
“Not just behaviour, being so overworked naturally also affects our judgement. We are involved with a lot of patient work, and so there is a likelihood of errors affecting patients too.”
Unless this systemic issue is looked into and these inhuman work conditions acted against, junior doctors will continue to be on the edge of their nerves, increasing the likelihood of arguments and escalations with patient parties. Under no circumstances can the doctors’ behaviour, or that of the patient parties, justify assault. Yet regardless, drastic steps must be taken to change work conditions that make such hostilities more likely.
What Official Directives Prescribe
The standing Central government directive to hospitals states that “continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time” (emphasis added).
The directive further says, “The Junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch subject to the condition that the working hours will be flexible as may be decided by the Medical Superintendents concerned keeping in view the workload and availability of doctors for clinical work.”
The Unfortunate Reality
Each point in the directive is flouted rampantly, and routinely. For example, about the weekly off that should be due, Sayan* says, “At the most, we get two days off in a month. Sometimes not even that.”
The 48-hour week guideline, if not evident already, is not followed. Even the rosters that are sent to the students allocate working hours far in excess of that. PGT doctors complain that they often have to work anywhere between 96 to 108 hours a week. That’s more than double the prescribed limit.
And as previously mentioned, continuous active duty or one shift regularly goes on for up to three times the prescribed limit of 12 hours, which is 36 hours.
Doctors Explain Why Patient Parties Feel Wronged
Dr Saibal* (name changed), a 24-year-old doctor at Calcutta Medical College, weighs in on why a lot of patients feel wronged at government hospitals, “You have to wait in the queue for up to three hours at Out Patient, and then you finally get to meet a doctor for only 1 to 2 minutes. Then, you have to wait for your medicines again at the pharmacy line which is sometimes a kilometre long. That wait takes another two to three hours.”
Saibal* adds, “At the end of it, often you find out that the medicines are not available. On other occasions, they’re not available in enough quantity. Say you need 15 doses but the pharmacy only has 5 doses. On top of that, even the quality of medicines available at the government hospitals is poor. In the end, when something goes wrong, all the anger comes out on the doctor.”
Other doctors who are seated around chime in, “Resources are not as per requirements. Patient overload is hugely disproportional. Sometimes, patient parties will come in and see that patients are lying on the floors in the orthopaedic wards, for example.”
One of the doctors adds, “That doesn’t necessarily mean that we are not tending to them.”
But the doctors agree that conditions like these aggravate the patient parties enormously. Say, someone comes in to the hospital and sees his relative, who has been admitted there, lying on the hospital floor. Later, if anything happens to that patient or goes wrong with his health, the patient party will naturally have a tendency to blame the hospital. In these cases too, it will typically be the doctors and not the hospital administration who face the fury of the patient party.
Dr Ashok Mahalanabish, a radiologist at NRS, says, “The public health system is in distress. The key problem is not corrupt doctors as it is made out to be, but instead it is the distress of resources.”
The Perception Problem
Speaking to the protesting doctors at different colleges in Kolkata, one gets the sense that there is a widespread frustration among doctors that they are perceived negatively by large sections of the public. Many of them expressed a similar sentiment, “There is a narrative that all doctors are corrupt chors (thieves), that we are criminals.”
We doctors are neither gods nor criminals. It’s high time that people understand that.Dr S Kumar
One of the doctors at NRS says, “Of course, there will be a small section of doctors who are corrupt or unethical. But that is the case with every single profession there is.”
The perception problem that doctors and hospitals face is two-fold. Those who visit private hospitals accuse them of rampant corruption, overcharging patients, inflating bills by asking patients to undergo a dozen tests when only a couple are required, and the like. At public hospitals however, the complaints are different. There, the problems cited are regarding poor facilities and services, and allegations of neglect and improper care.
While doctors agree that these problems do exist, they argue that the narrative is far exaggerated and that as a result, even when there is no wrongdoing on their part, the patient parties refuse to accept that.
This overwhelming perception that most doctors are corrupt leads to the patient parties believing that surely, not enough must have been done to save their patient, and doctors say that this is one of the key underlying causes for instances of physical aggression against doctors.
Dr Ryan Kaiser, a 26-year-old doctor at Calcutta Medical College, laments that doctors make the news only when someone dies. “There needs to be more awareness raised about the life-saving efforts made by the doctors and about the difficult cases in which we manage to rescue the patient. The people never get to hear about that. The Public Relations departments of public hospitals should be functioning properly, but a lot of the onus for a fair representation of doctors lies on the media.”
Ryan adds, “On so many occasions, there are families who come and give us sweets after patients recover from difficult conditions, but that is not the image of doctors that you will see represented anywhere.”
“The media is criminalising doctors,” says Dr S Kumar, arguing that when large sections of the mainstream media present doctors only in a poor light, it leads to a sentiment of disaffection against all doctors.
The extent to which media representation has shaped the public perception of doctors is a contentious issue, but according to most members of the medical community that I spoke to, journalists and anchors are definitely to blame.
So much so, that even as I interviewed one of the young protesting doctors at NRS, another doctor passed by making a jibe, “What is the point of talking to these journalists? O jei ronger shirt poreche, shei rongeri journalism korbe. (He will do journalism of the same colour as the shirt he is wearing.)”
I was wearing a yellow shirt that day.
Note: The asterisk (*) has been used to denote that an individual’s name has been changed to protect their identity.
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