India’s Doctors Fight Mobocracy, Trust Deficit & COVID-19
After attacks on doctors across India, Indian Medical Association is observing 18 June as National Protest Day.
As if contentious comments made by Baba Ramdev or dealing with a daily cascade of patients in sweltering PPE kits was not enough, the medical fraternity is horrified by the news of violence on doctors by disgruntled mobs.
After a series of such incidents in the last two weeks in Assam, Bihar, West Bengal, Delhi, Uttar Pradesh, Karnataka and other places, the Indian Medical Association (IMA) has decided to hold a nation-wide protest with the slogan 'save the saviours' on 18 June.
Increasing Cases of Violence Against Doctors
The photographs of two such manhandled doctors—Dr. Seuj Kumar Senapati of Udali Care Center, Hojai, Assam after a COVID-19 patient succumbed to pneumonia and Dr. Deepak in Tarikere, Karnataka where a young child Bhuvan succumbed to dengue—are being widely shared on social media.
This plummeting of trust in doctors - at the root of the violence - is a global phenomenon. Social scientists believe a higher level of education, the spread of the internet, and the failure of institutions themselves are probable reasons. According to a 2014 study published in the New England Journal of Medicine, trust in doctors declined from 73 percent in 1966 to 34 percent in the United States of America.
The initial findings of an ongoing study conducted by IMA has revealed that 75 percent of doctors have faced at least some form of violence. Still, violence on doctors remains an under-reported phenomenon, with many doctors falling prey to frenzied witch-hunts.
From Overworked Doctors to Patients Googling Symptoms
The Primary Health Centres (PHCs) established to attend to patients at the grassroots level, are often ill-equipped and understaffed to treat sick patients and are forced to refer a sizeable chunk of patients to the tertiary care hospital.
The ability to spend time with patients is considered crucial to successful treatment and diagnosis. However, a doctor in a tertiary care hospital, catering to 100-300 patients in a small time window every day, cannot devote adequate time to each patient needed to develop trust. For patients sweating in the queue for hours, this experience can be mistaken for neglect, leaving a patient partially satisfied.
Additionally, being inundated with an array of new sources of information, any patient will surf the internet before consulting a doctor and reach a possible diagnosis in his mind.
Such a patient will ask questions which, doctors are reluctant to answer because of the paucity of time and patience. Even if they answer, any difference from the facts present on the internet is going to sow the seeds of distrust among the patient.
Media Feeding Skepticism Against Doctors & Treatments
The media often sensationalises stories of organ theft, medical negligence, and malpractices. Media persons barging into hospitals, scapegoating doctors, reaching conclusions without proper assessment of facts feed into the prevailing skepticism towards medical care.
The mindless sharing of posts on social media without proper facts influences a lot of like-minded people, creating 'echo chambers’. Often these ideas stick—even wrong information seen multiple times can morph into the ‘truth’.
When a handful of doctors err, everyone is ready to jump onto the bandwagon of negative bias. However, very few are interested in raising their voice when a doctor suffers uncivilised aggression.
As doctors change cities, choosing metros over their hometowns and corporate hospitals over local government hospitals, the traditional concept of the 'family doctor' or a doctor who is considered a part of the local community is fast vanishing, instilling further doubt in the general public.
A Sluggish Judicial System
Non-deployment of security personnel and an ineffective justice redressal system often ignite violence.
"The common man lacks faith in the judicial system. Thus, in instances of patient death, people believe in exacting immediate revenge, seeking their pound of the flesh using physical means," the September-October 2016 issue of Indian Heart Journal stated.
Protecting doctors require special laws beyond the provision of existing criminal laws, because, after any such incident, not only the doctor, but his patients have to pay the price of disrupted clinical establishments, stoppage of works, or strikes.
However, a bill framed by the Health Ministry of India to safeguard medical personnel in 2019, was opposed by the Home Ministry stating, "Over time, members of other fraternities like lawyers and police may also demand an exclusive law to safeguard their interests."
What are the Implications of Eroding Trust?
As trust in medical authorities declines, alternative sources of authority have filled the gap—online prescriptions, swearing by YouTubers, other systems like Ayurveda or Homeopathy.
The pervasive practice of defensive medicine has emerged where a doctor orders multiple expensive tests without relying on his clinical judgment, as the test reports can act as evidence in case of a dispute. When patients don't believe in their doctors, there is a high probability that they won't indulge in clinical trials or experimental medication, thereby undercutting innovation.
There is also a greater chance of doctors working in peripheries or private setups, concerned by news of verbal attacks, will not treat but refer patients to other centers even in cases of emergency.
Doctors Have to Earn Trust too
Doctors can no longer expect patients to respect them just because they are doctors. It has to be earned. They need to be better communicators: ask questions and show that they care to dispel any suspicion in patients' minds, offer timely updates to anxious relatives, and share comforting reports of progress.
"Always tell the patient what you are doing, why you are doing it, and reassure them that you have done it before or maybe you haven’t done it before. All that needs to be very transparent,” writes Dhruv Khullar in his piece in The New Yorker.
Aetcom (Attitude, Ethics and Communication Manual) has been introduced in the medical curriculum for this purpose.
Deployment of security personnel, security-checking, confiscation of weapons, reducing the number of accompanying relatives can act as primary ways of prevention whereas stricter laws, convicting criminals, and fast-tracking of justice can stop triggering mob violence.
Like the Canadian physician William Osler said, “The good physician treats the disease, the great physician treats the patient who has the disease.”
(The author is a medical student at Maulana Azad Medical College This is a personal blog and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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