Dr Lalit Kapoor, President, Federation of Associations of Medical Consultants of India emphasises on the ways to create safe working environment for medical staff
The recent media reportage on the 17-year-old female footballer who died in Chennai post leg amputation or the Rajasthan-based gynaecologist who committed suicide after her patient died due to post-partum haemorrhage, violence due to medical negligence is the most unfortunate trend that fails to fade. The question is not who is right or wrong, that is a debate for another day, the question is ‘How has medical negligence become a freely available and utilised tool to incriminate the medical fraternity before legal protocols or proof of medical errors?
Violence against doctors: The issues at hand
In the recent times, a lot of cases of violence against doctors has come to light. An ongoing study by Indian Medical Association (IMA) reports that 75 per cent of doctors in India have faced violence at some point of time in their life. It could be of varying kinds and degrees, right from verbal abuses, blackmail to physical violence or wrongful extraction of money by reduction of bills and charges. If the health of the patient seeking treatment deteriorates, worsens, or leads to death, it is unfortunately perceived as a matter of medical negligence without assessing the factors like condition of the patient when brought to the hospital, body’s susceptibility to treatment and other pre-existing conditions that could hamper positive patient outcome. The most convenient route adopted by family members is that of accusations towards the consulting doctor and hospital. This brings us to a very pertinent aspect and that is public must be made aware of the difference between medical negligence, medical complications, error of judgment, medical mishap or accident, side-effects and sequelae of a disease or treatment.
Understanding medical negligence vs malpractice vs medical limitations
Medical negligence means the commission of mistakes or errors due to carelessness of the attending doctors and staff, that impacts the patient or wrongful actions or omissions of professionals in the field of medicine, in pursuit of their profession, while dealing with patients. “Essentially, medical negligence is defined as deviation from the standard of care which results in bodily harm or damage to a patient.” Improper or unskilled treatment which causes harm to health, in any form that could cause further damage, incapacitate, or lead to death of the patient results in medical negligence. Medical malpractice is a result of medical negligence i.e., it is a legal cause of action due to a medical error, or low and improper standard of care causing negative impact to the patient. Medical limitations can also cause negative implications on treatment due to the pre-existing condition of the patient, receptibility of the body towards treatment and other factors where the body doesn’t respond to any treatment given.
All the above aspects must be thoroughly evaluated and investigated before drawing conclusions or accusing the attending doctors, staff, or hospital.
How to create safe working environment for medical staff
The ongoing situation draws our attention to creating safe places for our medical staff as everyone is entitled to and has the right to a safe working environment. The first step in creating a safe place is to criminalise such violent episodes and incriminate miscreants immediately. This will send out the right message that violence against doctors is an intolerable act and will not be taken lightly. According to the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2010, violence against doctors and hospitals is a cognisable (punishable) and non bailable offence. Unfortunately, the law is not being implemented stringently and action is not taken seriously, let alone the special law for violence against doctors, the law that incriminates public for violence is also not applied. As per the law, even damages caused to property, or other damages must be reimbursed at double the rate, of losses as per market value. However, implementation of the law is very poor hence there is no disincentive to violence. Offenders should be severely punished, and this should be widely publicised by the media. Then only incidence will go down or else disrespect for law will continue and rule of jungle will prevail.
Educate the masses about limitations and challenges faced at the medical level
The general public who has limited knowledge about medical science must give the ‘benefit of doubt’ and leave it to the experts, be it the medical fraternity as well as the judicial system to evaluate medical negligence rather than take matters into their own hands. Attacking a hospital or doctors can create barriers in treating existing patients and emergency cases. Following violence in a hospital, other patients seeking treatment also suffer. Who is responsible for that? Aggrieved patients have enough grievance redressal mechanisms, be it the expert medical committee appointed by the government, judicial system, medico legal teams, lawyers, consumer court or NGOs that can make sure justice prevails. A preliminary probe must be conducted considering all the medical facts than resorting to illegal methods and arm twisting of doctors. This gets us thinking about ideas on how to protect our doctors; an immediate helpline, dedicated cells for medical violence and detailed download about the case by attending doctors to family members who accompany the sick patient before admission or treatment.
The medical field is already a high-risk environment with burnout, stress and brain drain, to top it up violence has been on an upward rise. We are already seeing doctor-patient ratio in question. Talent retention is becoming a grave concern due to the mounting fear and abuse. How will be ensure quality healthcare in the country if students are discouraged to join the medical profession due to such abuse?
Medicine is a noble profession, when things are going good, doctors get treated like God but when something goes wrong, they are often not even treated as humans. Do not play the blame game, get your facts right, understand medical limitations, evaluate patient susceptibility before you draw conclusions.
Patient safety is our topmost priority however when it comes to violence against doctors, it is time to put a stop here!
One simple question – why there is absolutely no violence against any doctor in developed countries like USA? The answer is NOT that there is absolutely no medical negligence in these countries. If you honestly try to correctly answer this question and do something about it – this “emerging epidemic” can be solved easily. To my medical colleagues in India – Stop pointing at the symptom only without ever trying to cure the underlying disease.