Healthcare workers generally are not taught to fear patients, let alone take legal action against them
Grief is too powerful an emotion to be allowed to turn into violence directed at caregivers. As incidents of violence against doctors continue to occur across the country, medical institutions would do well to take matters into their own hands and work to set up doctor-patient protocols to pre-empt and deter reprisals.
Being assaulted by a patient can be a shattering experience for any health professional. Healthcare workers generally are not taught to fear patients, let alone take legal action against them. The morale of doctors is low, when they are left all to themselves to fend for these challenges. The recent incident in a Kolkata hospital gave out very clearly the desperation and the frustration levels of the doctors. Although the rate of depression among physicians is lower than the population at large, the risk of suicide in doctors is very high. According to the Indian Journal of Psychiatry, 30% of Indian doctors and physicians go through depression, while 17% have thought of ending their life. Physician suicide is a public health crisis, and about 4 doctors per 10,000 people commit suicide every year. The rate of suicidal depression is higher in male doctors than female physicians.
Important to debrief & get counselling
After these incidents, it is important for health professionals to debrief and to talk about what happened. Whether with colleagues or counseling, assaulted clinicians need to process these experiences. Acknowledging the hardships that come with violence in healthcare — and helping assaulted staff members navigate subsequent steps — can go a long way. Healthcare facilities work hand in hand with healthcare staff to fight this menace. Ideally, organisations should have informal discussion including counselling inbuilt in the work culture and mentoring and orientation should be provided to all personnel.
While counselling may have a role to play in the mental well-being of healthcare professionals post an event of violence, hospitals need to assure the staff that such things will not happen in future and for this they need to take steps in this direction and initiate immediate action against assaulters. Along with the above, there is also a need to take some active steps to prevent assaults in future as that is what shall give peace of mind to the doctors and other staff at a hospital. Moreover, in case of grievous injury, hospitals should register a complaint and take criminal action against the assaulters.
A case in point is that on this Doctors’ Day this year, Bengaluru doctors learnt self-defence techniques as they feel it is high that they take matters in their own hands, at least where their own protection is concerned. These techniques were not to attack back, but only for defence.
In a chat with Dr. Nilima Kadambi, Chairperson of IMA National Standing Committee for Emotional Well-being of Medical Students & Doctors in India, we explore more on the subject…
Your views on the assaults on doctors and staff in a hospital.
This is a sure sign of the breakdown of values in our society. This also highlights the big gap between what patients in India need and what is available to them. Government has failed to keep up with the times in the public health domain and spends too little of the GDP on healthcare services. Hence, most patients are forced to turn to expensive & unregulated private healthcare providers. Financial & emotional stress adds up to a volatile combination when patient outcomes are not what was expected by their family. And usually, the young duty doctor becomes an easy and soft target to vent their frustrations on through unfair and unhealthy violent behaviour.
How do such assaults affect the morale of workforce?
Doctors and nurses are human beings doing very dedicated duty and providing an essential highly skilled service to the society. The long work hours and poor working conditions and salaries are accepted by us for the higher satisfaction received by being able to help patients by alleviating suffering and saving lives. Atrocious and violent behaviour by patients’ families undermines the core confidence and adds unnecessary stress and fear to an already overloaded profession.
What steps/mental health benefits/counselling can healthcare facilities provide to their workforce?
Individual counselling and institutional level interventions will only give temporary relief to the medical fraternity. To re-build the trust and passion to serve society as doctors and nurses, we will need better laws to protect the hospital staff and strict & prompt enforcement of these laws against perpetrators of such violent & heinous crimes against doctors. Society needs to ensure respect and dignity of the profession as well as safety of the professionals.
You work extensively in emotional well-being. Kindly share some case studies/incidences where you have worked on such situations?
As a part of the IMA National Initiative for Emotional Well-Being we do not intervene or address individuals and hospitals where violence has taken place. That would be the equivalent of closing the stable after the horse has bolted.
Instead, we work towards improving the working conditions of resident doctors and providing medical students & young doctors training in self-care and resilience to face the daily stress and strain of being a medical professional who deals daily with disease, disability, disfigurement, deformity and death in the hospitals. Also, we do workshops for them to identify early warning signs of burn-out and stress-induced mental challenges as well as encourage healthy coping mechanisms and early seeking of professional help when needed.