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Revered once, doctors today face brickbats

August 14, 2007

Aggrieved patients and their relatives in America may sue their doctors but in India they beat them up! Or perhaps attack and burn the hospital down. This disturbing trend seems to be on the rise in India. Such incidents are common, whether it’s in Mumbai, Kolkata, Bangalore or Jalandhar. Just yesterday some relatives attacked a nursing home in Mumbai because a 10-month old child died there. This is the third such incident in Mumbai in the last fortnight.

It’s easy to blame our slow and tortuous criminal justice system for such mob fury…but the malaise runs deeper than that.

Our medical bodies are seen as being partial to doctors and people feel they will never get justice. It is difficult to prove a doctor’s negligence in court as the doctor community here is thickly bonded. Just about a decade ago, doctors resented even being questioned about their actions. Such arrogant attitudes can create suspicion amongst the public. Revered once, doctors today face brickbats.

The fact that a sizeable chunk of our citizens are not educated compounds the problem. Many semi-literate people believe that doctors are magicians who will cure the patient whatever the problem.

Its not just docs who suffer…mob justice is common in India
Whether its because of an eve-teasing incident or due to errant driving, there is always a chance that a mob can collect and people will take the law into their own hands. Why, a few years ago a mob lynched a criminal in court!!

How bad the situation gets generally depends on who is behind it…a group of ordinary citizens or a group of hoodlums with political backing. Political hoodlums were the ones who destroyed Singhania hospital – and all because their leader died there! Hundreds of people lost their livelihood. Recently in Mumbai a nursing home was attacked even though a baby was brought in dead…this makes one feel that the hooligans who attacked the nursing home could not be relatives of the baby.

Rioters are usually not punished either
And whether the damage is done by a furious public or hoodlums from a political party – the culprits are rarely brought to book. Another reason why mob justice prevails.

Any solutions?
Coming back to the attacks on doctors, the only way to improve the situation as I see it (I am not even saying improve the criminal justice system because that is a given…and it will take years before it happens.) is to:

1) Appoint counselors in hospitals to counsel not just terminally ill patients, but also relatives of patients. Hospitals are supposed to hire counselors for this purpose but not all hospitals do. Perhaps that is why its the smaller hospitals and nursing homes who are most often targeted…but it could also be because of the lack of security at these places.

2) Hospitals should ensure that doctors are approachable and that they de-mystify the disease and spend time talking to the patient.

A study has revealed that relatives of severely ill patients undergo “symptoms suggestive of post-traumatic stress disorder – PTSD…” This same article (in the Indian Journal of Critical Care Medicine) says:

The unexpectedness of an accident and the subsequent intensive care admission can be a stressful event for the relatives of trauma victims. Anxiety in the relatives during the hospitalization is understandable…various factors combine to create a psychologically devastating condition in relatives of ICU patients.

Major issues are lack of information about the nature of the illness, incessant reminders of the potential complication during consent for investigations, procedures or surgery, financial burden of hospitalization and most importantly restricted access to the patient.

Docs are busy but patients feel they are indifferent
A good number of doctors continue to maintain a distance from their patients and in my opinion this creates resentment amongst patients and their relatives. Doctors are often loath to explain the treatment and do not like to meet patients and relatives, specially after the operation is over…probably because they are busy or overworked. After all, they too are human. But patients without access to information and support are going to come to the worst conclusion. That the doctor is not bothered. There simply has to be some interface between the patient and the doctor…a psychologist is ideal. Its shocking but in hospitals today patient deaths are impersonal announcements.

The absence of transparency + a slow justice system + the weak persecution of rioters + the lack of communication between patients and doctors + the psychological disturbance of relatives of sick patients leads to a confrontation (often violent) between patients and doctors. Just blaming the law and the patients will not cure this problem.

(photo copyrighted to me and is for representational purposes only)

Related Reading: Docs to be penalised for lack of post operative care
Doctors don’t like the idea of being tried by consumer courts
Doctors in the dock for arm amputation after a fracture
India is facing a shortage of doctors
Also:
A comparision of violent crime in different countries of the world
Shortage of policemen in India
Riots in Maharashtra for a flimsy reason

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21 Comments leave one →
  1. August 14, 2007 10:40 am

    //Docs are busy but patients feel they are indifferent//
    exactly…. in USA the doctors who spend less time with their patents or have a harsh voice are more likely to be sued.

    often it has been found that the tendency to make mistakes has less correlation with being sued than the manners

  2. August 14, 2007 1:46 pm

    Nita, it is not that simple. It is not the patients who are always at fault. Due to the commercialisation of this profession some times the doctors take the wrong decision too.The govt. hospitals are too crowded and the in the private hospitals you are not sure wheter the doctor is giving the right opinion or commercial gains are forcing them to take the wrong decision.

  3. August 14, 2007 1:48 pm

    Prerna, I am afraid you did not read my post carefully… I have clearly said right in the begining:
    //Our medical bodies are seen as being partial to doctors and people feel they will never get justice. It is difficult to prove a doctor’s negligence in court as the doctor community here is thickly bonded.//
    More important – the main point of my post was to criticize the method of redress and see whether there are any solutions to this, and this post is not to judge whether in general doctors are right or wrong because I am sure you will agree that it depends on the individual cases.
    If a doctor is wrong, surely you don’t suggest that they attack the doctor or the hospital? Ofcourse not, and that is what the post is about. Why patients behave like that and how they can be helped.

  4. August 14, 2007 1:49 pm

    Last night there was a mini-documentary on the local public TV station about racism in Canada. I know the overall subject is different, but it was about “mob rule” or “mob justice”. Back in the first twenty years of the 1900’s the Klu Klux Klan was very popular here. A KKK magazine published in Canada had a circulation of over 200,000 in a country of 8-9 million. The mini-doc was about a court case which was the first to ever specifically decide against the KKK’s method of using intimidation or “mob rule” against “African-Canadians”.

    A London, Ontario, young couple wanted to marry. He was black, she was white. Her mother wrote to the KKK asking for help in keeping the marriage from happening. The Klan sent seventy-five representitives to the city where they used intimidation — including cross burnings, threats and leaving “guards” outside his home to make sure they couldn’t meet. Eventually there was enough of an outcry from local black representitives — lawyers, priests, union leaders, etc. — that the local police stepped in. The initial charges were based on old-British law regarding wearing masks during the nighttime for the purposes of possibly committing a crime (paraphrase).

    The lower court convicted one of the KKK men and fined him $50 (the max sentence was 5 years hard time). This was seen as a legal victory for the KKK and their methods. 3000 members of the KKK held a rally outside the Court House the day the sentence was laid out, actually protesting the sentence was too harsh. They then spent months recruiting members in London (Ontario) in a door-to-door campaign, including handing out pamphlets to school kids.

    So the intimidation — including leaving carlods of men outside the mans home — continued. Again pressure was put on the government, this time at the Provincial level, until the Provincial Supreme Court took on the appeal. The PSC upheld the verdict, but changed the sentence to five months in jail. The verdict summary warned that the Courts would no longer tolerate “mob rule”, as there was no law against interracial marriage.

    As the man neared the end of his sentence the KKK applied to have a parade in London (Ont), but for the first time — and based on the PSC decision — their request was denied. The case itself didn’t outlaw racism, it really only upheld the “no masks at night” law, but basically that one little tweak put an end to any sort of “mob rule” in Canada.

    More laws, over a number of years, were put into place which officially banned “the mob” and eventually other laws were legislated to better protect minorities. But it started with the courts siding with the individual against “the mob” and the government enforcing those rulings with laws and police action.

    The KKK in Canada never recovered either. Their membership dropped every year afterwards until the mid 1930’s when they were reduced to basically a gang of old white dudes who could have their national membership meeting in the backseat of a Buick.

  5. August 14, 2007 2:16 pm

    Gabriel, your comment is not too far out, as my post is about mob justice!
    Its interesting, the way the society in canada changed, due to the strong arm of the law. It might interest you to know that out here this mob behavior to prevent inter caste and inter community marriages is very much alive and thriving. At times the couple is killed…I guess jail is the only way to stop these miscreants. Anyone who takes the law into his own hands should be severely punished.

  6. August 14, 2007 2:52 pm

    Your suggestion regarding use of a counselor/psychologist is excellent. Also, this person should not be titled in that way as there is a huge stigma associated with it. They should be called something generic – say they run a ‘Relatives Relationship Cell” or something like that.

    I do not see any other way of mitigating the damage mob violence causes.

  7. August 14, 2007 2:58 pm

    Mahendra I wish I could take the credit for the suggestion of the counselor. :) But actually I have read about it somewhere…and I also read that this is the normal practice is some European countries, the counseling part I mean. I like your idea of calling it a ‘Relatives Relationship Cell” though. That would give some measure of focus and direction to the effort.

  8. August 14, 2007 3:30 pm

    There are some common (IMHO) reasons for mob violence in hospitals:
    1. The (usually dead) patient’s relatives think (and rightly, too) that if they start creating a hullah and break a pane or two, the scared hospital management would hastily waive off their bills.
    2. The doctor gets angry with the relatives (only if that happens do the relatives get angry) for their questions about why this or that is going wrong.
    3. A leader or Minister dies, and his supporters (possibly half a species more evolutionarily evolved than quadruped mammals) give vent to their love and grief for thier master.
    4. The doctor is actually a scum-bag who did something devious and got caught in the cover-up. This is only too common in the district level small, eccentric ‘centers’.
    5. One of the nurses or ward-boys insulted the relatives a couple of days back, and they kept mum hoping the patient’s care should not suffer if they protested then.
    Just my two rupees! :-)
    (not yet subjected to mass pleasure or displeasure, only because of empathy and willingness to admit wrongs of self and, especially, others! ;-) )

  9. August 14, 2007 5:17 pm

    Violence never helps and I would never recommend violence.

  10. August 14, 2007 6:40 pm

    It’s question of our legal system.. How does legal system protects both hospitals n patients. People take law on their hands b’coz they donot have faith on our legal system.

    1. Is there any legal monitoring on every treatment given by Doctor to it’s patient? Do they enforce policy n procedures in hospitals to maintain the data/records (History, examination, evaluation, diagnosis, prognosis and intervention ) accessible in timely manner? These things certainly provide self protection on patient-initiated claims n litigation and on otherside they easily expose malfunctioning in the system.

    2. Is there any push from govt. for implementing Acts like HIPAA(Health Insurance Portability and Accountability Act) in USA?

  11. August 14, 2007 7:29 pm

    It seems to me, when medical care is dispensed under pressure of the need to service large populations of patients, hasty and inadequate communication between the medical service providers and those recieving treatment tends to occur. The frustration, lack of trust, confusion and rage that are inevitable emotions could be countered by:

    increasing the number of doctors, so that individually they are less stressed
    having policies in place to provide adequate flow of information
    treating patients less like faceless, dependent “things”
    public education
    and laws established and enforced against mob rule

    Particularly in a culture where many persons are illiterate, your solution for “communicators and counsellors” seems to be a useful one, and every medical center, no matter what size, should have a number of “interface” professionals between doctors and patients.

  12. August 15, 2007 12:11 am

    I think the counseling is a great idea. I’d like to see it implemented here in the States too. Especially after reading of how relatives can show symptoms of PTSD.

  13. August 15, 2007 6:40 am

    Neeta,
    Your suggestions for preventing such violent incidents are excellent in theory. I strongly feel that the first option of “counselling” will not work in India. This is because India has not YET completely BECOME America. Indians are more straightforward when it comes to handling feelings unlike Americans. We have a strong family support and family members do the counselling (although its not technically called counselling). Americans just love getting “professional help” for everything in life, right from getting up in the morning to going to bed at night. Psychological counselling for dumb reasons is big business in America but it thrives because people here lead isolated lives. I really hope that this “fad” does not take strong roots in India. If its ordinary citizens that are engaging in mob violence to get justice that is actually a good thing. But if it is political goons, then definitely not.
    Your second point about doctors “demystifying” the disease for their patients and spending more time with their patients is not a characteristic of “allopathy”. Western medicine has lots to lose if the doctors actually started doing this. Demystifying the disease for the patients means “empowering” the patient. If the patient gets “true” information about various diseases, allopathic doctors will be out of business. Moreover we know very well how a majority of people in India get their degrees, including medical degrees. Just because someone is a doctor, it does not automatically mean that the person is truly a “learned” or “knowledgeable” person. Most doctors (largely in India and to some extent in USA) do not know anything about the disease except identifying symptoms and prescribing medicines. I believe that a true doctor is one who actually helps his patients in a way that they will never need to visit the doctor again. But with western commercialisation and western medicine gaining power in India, this is hardly the case today. Today if you go to an allopathic doctor ONCE, he will make sure that he extracts every rupee out of your pocket by means of various unnecessary tests and treatments. He won’t stop at that. He will put so much fear into your head that you will run to him at the slightest discomfort. (Since health is my favourite topic, I could go on and on, but I will stop here).
    I do not believe that all violence is bad. Violence in order to get justice is perfectly acceptable. And I do not believe that one can safely walk in a slum in India. In fact we NEED a lot more sincere and bold policemen constantly patroling every nook and corner in India. I don’t think a lot of women living in India would say that its safe at all on the streets. No matter how good or bad looking a girl or a woman, she will always be the target of eve-teasing. And I personally would consider Gandhiji’s non-violence nothing but cowardliness. When someone is inflicting injustice on you, it is your duty to retalliate and at such times violence should be used if required.

  14. August 15, 2007 11:52 am

    Peace06:
    I was enjoying reading your comment (in spite of the broad generalisations about the medical profession) till you spoilt it by advocating violence. In a just society, only the Law should wield violence. In specific instances, as a purely defensive measure, violence is just. Not beating up a doctor and a couple of billing clerks!

  15. August 15, 2007 11:53 am

    Nita,
    A feedback: the text font in the comment box is a little too small. I am making spelling errors because of this! :-)

  16. August 15, 2007 3:33 pm

    Rambodoc, I agree but unfortunately I have no idea how to correct this. I think it is something to do with the theme I have chosen. In my earlier theme this problem wasn’t there…unfortunately there are not many choices (of themes) for those who need two sidebars +custom header.

    Peace, I was trying to think of a response to your comment…but frankly I find that words fail me. I grant you that you have made some good points…but I think you have made some sweeping statements. About violence I am afraid I cannot agree with you.

  17. August 15, 2007 4:35 pm

    rambodoc: most WordPress themes have small response boxes, and small fonts, there’s nothing Nita — or anyone else — can do to change that. If you’re having difficulties with either try writing your response in “Notebook” or an equivalent Text Editor program, then copy and paste it into the response box. If you’re having spelling issues, copy and paste the text into Word or WordPerfect and performing a spell check before putting it here… if you’re having difficulties reading the generic fonts used in the actual posts, there are ways to increase the font sizes by changing your browser settings on your computer.

  18. August 15, 2007 9:44 pm

    Here’s something funny for readers. I do believe you have heard about newstarget.com. (This is not a response or anything directly related to your post).. Enjoy!–

    http://www.newstarget.com/disease-mongering-engine.asp

    LOL !!!!!!!!!!

  19. October 15, 2007 10:11 am

    Thanks Mahendra. That is a very interesting article, but try telling that to a patient who has been at the receiving end of a doctor’s indifference! I mean, though doctors are human and need to program themselves for detachment, we patients are simply not understanding enough! :) We expect a lot!!

  20. October 15, 2007 8:07 pm

    For anyone interested in this topic, I’d recommend Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande.

    It’s some of the best writing I’ve seen recently, combining the scientific rigour of an academic text with the gripping nature of the best thrillers.

    Gawande has lots to say about how to reconcile a patient’s desire for perfect care with the reality of what doctors can provide.

    I’ve reviewed it on my blog here

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