Death, serious illness and accidents: situations which create complete emotional turmoil are often witnessed in hospitals. It is natural to feel mournful, frustrated and helpless when one loses a loved one. Unexpected incidents make the emotional trauma more profound. Even an iota of doubt about the adequacy or correctness of treatment can further trigger the emotional upsurge.
This may lead to unruly behaviour and violence at hospitals. These problems are occurring more frequently in last few years in Indian hospitals. A wide coverage is given by the media when violence occurs and even wider coverage when doctors go on strike. But, a category of victims who often go unnoticed are patients who are under the care of that doctor who was assaulted.
Situations are not uncommon wherein life-saving gadgets and oxygen lines have been broken and vandalised. Patients have suffered and at times, even lost lives during the process of being shifted to other hospitals.
It is precisely for this reason that in almost all the countries a “zero tolerance policy” is adopted regarding violence in hospitals as is applicable at airports. However, it is only in India that zero tolerance policy is applicable for industries such as aviation, but not for health care.
Of late, a series of violent incidences were reported in the government hospitals. High workload, improper living conditions, stress and inadequate rest are factors which make a human more prone to irritability, erroneous behaviour and poor response. Society often does not consider doctors as humans who are just as prone to irritability as any other person and are expected to be patient, calm and smiling, irrespective of their surrounding situation. In addition to that, inadequate facilities in government hospitals and escalating costs in private sector are perfect stimuli for patients and relatives to engage into hospital violence.
In the recent case at Dhule (Maharashtra), a doctor was beaten so badly that he is on the verge of losing his vision. A young man who was allegedly under the influence of alcohol was brought with a head injury to the hospital. The doctor on-duty informed the relatives that the hospital does not have CT scan machine and a neurosurgeon. The doctor suggested that the patient will have to be shifted to another hospital. Thus, giving the patient the truth resulted in him losing his eye.
What can a doctor do if facilities are not available in the hospital?
The truth is that the government is still not taking enough efforts to provide good ‘accident and emergency services’ to the society. We still do not have good ambulances and trained manpower to man them.
Internationally this job is done by paramedics and not by the doctors.
Meanwhile, we are still discussing issues such as “can paramedics give an injection legally?”
We have still not been able to give a legal recognition to the paramedic cadre in healthcare.
On one hand, the Supreme Court and the government have pronounced rights of patients to get emergency services all the time. That is great! As a citizen I also feel that if I meet with an accident or have a medical emergency I must get the medical help. But is this realistic? The Supreme court in its judgement states that it is the responsibility of every doctor to provide “quick assessment, stabilization and transfer” in medical emergencies.
It sounds fairly simple. However, let us analyse this through a hypothetical situation. Imagine that a woman in strong labour pains is brought to an ophthalmologist’s clinic in emergency. The doctor is busy with a cataract surgery. Now what does the doctor do? How does the doctor ‘stabilize’ her?
After working in the field of gynaecology for twenty years I know that a woman heavily in labour will get stabilised only after she delivers! And how does the doctor transfer her? Does the doctor accompany the woman leaving his / her ongoing cataract surgery? Who pays for the transport? Many state governments have started ambulance services for transport. However they are far from being called efficient.
Many are willing to transport only if the patient wants to go to the government hospital. Besides that our law still does not recognise the ‘Samaritan principle’ to provide immunity to the person who provides emergency care. Unless the problems of stakeholders are not accepted, understood and addressed, realistic solutions cannot be found.
The author is Medical Director, Cloudnine Hospital