Last year in May, Dr Ashok Ramesh (name changed to protect identity), who had been tending to a patient who had undergone surgery for a severe open thigh fracture, was attacked on the premises of the Bowring and Lady Curzon Hospital in Bengaluru by an unknown woman. Ramesh, a postgraduate medical student of Bangalore Medical College, is an orthopaedic resident at the hospital.
Ramesh said that dressings on open fractures, like the one this patient had, needed to be changed frequently, and he and his fellow colleagues would normally change the patient’s blood-soaked bandages every morning. “One day we had OT [operating theatre] duty so we didn’t do his dressing in the morning, but planned to do it in the evening,” said Ramesh, explaining that doctors didn’t tend to other patients before they went into surgery to minimise the risk of infection in operating theatres.
When he returned to the orthopaedic ward that evening, he was detained by a woman who questioned him about the care of the patient. Ramesh refused to engage in a conversation with her because she was not among the family members who had brought the patient to the hospital. “I did the patient’s dressing,” said Ramesh. “When I finished and came out, I don’t know what happened, but she suddenly came running and hit me.”
Protests in vain
In the days after the incident, with little help coming from the police or the hospital management, more than a 100 resident doctors from Bangalore Medical College went on strike to ask for better security in their workplaces. Ramesh said that despite filing a complaint with the police, no action has been taken against his assailant.
“After Dr Ramesh’s attack, the hospital management assured us that they would get lots of CCTV cameras installed and put up new tenders for more security guards,” said Sudhindra Kanavehalli, secretary of the Karnataka Association of Resident Doctors. “But we don’t see that happening.”
But this wasn’t the first time doctors in that hospital were assaulted. In November 2013, a man slapped the doctor attending to his father at the Bowring and Lady Curzon Hospital. The man was among a group of 30-odd relatives visiting the patient. Some of them even chased the doctor out of the ward.
Similarly, on April 30, an angry mob attacked students at MVJ Medical College – which runs a private teaching hospital on the outskirts of Bangalore – after a patient admitted with pneumonia and septicemia died. The 400 students who protested in the following days were given assurances that many other resident doctors had heard before – that action would be taken and security increased.
Violence in the ICU
Kanavehalli, who is a critical care anesthesiologist, said that attacks against doctors most often happened in emergency rooms and intensive care units, where tensions run high over critically-ill patients.
A survey by the Indian Medical Association last year supports Kanavehalli’s observation. It found that doctors faced most violence when they were rendering emergency services, and that half of such incidents occurred in intensive care units.
The survey also found that 75% of doctors across the country had faced some sort of violence while performing their professional duties and that in almost 70% of such cases the perpetrators were escorts of the patient.
“In all these places of high interaction like emergency operating theatre or casualty or ICU – these places need more security,” said Kanavehalli. “Doctors are also often abused in the obstetrics, gynaecology and paediatric wards.”
The same story has been playing on a loop in hospitals across the country. Resident doctors say the attacks are getting more frequent and more violent.
On June 14, a premature baby died in Delhi’s Chacha Nehru Bal Chikitsalaya for the lack of a ventilator. Angry family members roughed up doctors and hospital staff, which was captured by Closed Circuit Television cameras in the ward.
The resident doctors say that much of the friction between doctors and patients stems from the lack of patient counselling because government doctors are so overworked that they don’t have time to spend with patients and their families.
Vineetha is a junior resident doctor in her third year at the gynaecology department at Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals in Mumbai, better known as just JJ Hospital.
She sees at least 200 patients in a day when manning the out-patient department. Then there are entire days spent between the operating theatre, post-operative patient care, in the labour room and on emergency care rotations. “We are here 24-7,” she said. “Even patients keep asking us if we have had time to sleep or eat, because they see us here all the time.”
Too few doctors
There is one doctor for every 11,528 patients in government hospitals across India, according to the National Health Profile of 2015. This is a far cry from the World Health Organisation’s prescribed one doctor for every 1,000 patients.
Tensions only escalate in poorly-equipped government hospitals.
“In most government hospitals, every few months there won’t be an adequate supply of drugs,” said Kanavehalli. “Sometimes even emergency drugs are not available, even in ICUs, because of a lack of funds. If we prescribe these drugs from outside, the patient thinks that we are getting a commission by not giving what the government has provided.”
Great expectations
Another factor is the irrational expectations from patients’ family members, complained Sagar Mudanda, president of the Maharashtra Association of Resident Doctors. “There are small nursing homes that refer patients to a big government tertiary care hospitals, and we get patients who are highly morbid and close to death,” he said. “Because of the internet everyone thinks they have medical knowledge. People say they have read on Google that this disease can be treated this way or that way."
Mudanda said that despite repeated entreaties by junior doctors, the hospital managements haven’t managed to implement basic procedural changes like restricting the number of visiting family members.
“The local culture is that if something happens to someone in the mohalla, everyone wants to come and see the patient,” he said. “If we stop them then they go to the local MLA who will call the hospital to ask why we are stopping them.”
Doctors locked and loaded?
Karnataka, Maharashtra and Delhi are three of eighteen states that have enacted laws against verbal or physical abuse of medical personnel. But resident doctors say these legislations haven’t made much of a difference. Often, said Mudanda, police are unaware of the provisions under which to book cases of assault of doctors.
With only sporadic attention being paid to their safety, resident doctors in Maharashtra decided in May to jolt the authorities with an outrageous demand. They asked Chief Minister Devendra Fadnavis to allow them to carry firearms at work to protect themselves.
Meanwhile, they are also seeking help through more conventional routes. “There has been a plan of making a national body, a central organisation of resident doctors,” said Kanavehalli. “We also want to petition Prime Minister Narendra Modiji directly about this issue.”