The recent strike of doctors across Maharashtra (and other parts of the country) against violence unleashed on them by disgruntled relatives of patients have thrown up uncomfortable questions. Whenever and wherever, violence must be abhorred and condemned in all its forms. Without doubt, all healthcare providers should be ensured safety at places of work. Violence at place of work can have negative and disastrous effects on the employee satisfaction and work performance. Having said this, it is also essential that the medical community should do an introspection and try and find the flaws within; flaws which need to be rectified to avoid ugly situations at work. Unfortunately, the medical fraternity either fails or turns a blind eye to realize that we live in a society which institutionalizes violence. The recent misbehavior and violence (with impunity) by a Member of Parliament with an Air India employee is a glaring example of this. The real problem is when violence ceases to be violence, when it loses the contempt it deserves and this is what the young Indian doctors should be more worried and angry about.
Violence as a means of justice is a common parlance in the present-day Indian society but a large part of the intellectual class (including doctors) remains insensitive to it till it turns on them. Working with some of the best brains in medicine in the country, I wonder how many of my seniors, colleagues and juniors would even know about the tomb stones in India’s graveyard of monumental injustices and violence. Unfortunately, most of my professional brethren haven’t even heard about the Khairlanji massacre, don’t understand the reasons behind the Bhagalpur blindings, don’t care about what happened at Naroda Patiya and fail to understand the logic behind the Narmada Bacahao Andolan. We, the doctors, live in a glass house where we see the society pass by but cannot feel it’s pain or share its grief. This insulated existence of the present-day doctor is in sharp contrast to the physicians of the years gone by. The family physicians of the 60s and 70s were a part of the society they served, sharing each loss and every triumph.
In India, doctors are considered god, another fact which wraps each one of us with pride and to an extent haughtiness. Having worked in the West, I have not seen this form of idolization of the medical practitioner where the doctor-patient relationship is nothing more than professional. We Indians have a penchant of accepting the divine status too soon. The acceptance of this god-like status by the Indian physician is also a cause of concern and a reason for violence against doctors. Gods are not supposed to mint money. Gods are not supposed to have flaws and if they do, the illiterate and the deprived faithful unleash violence to break the molds they have so devotedly constructed. The doctors of the land should realize that acceptance of a divine status is the acceptance of violence as an adjunct unless they are ready to sacrifice much more. The rampant corporatization of medical practice and erosion of medical ethics in private and public set ups is another reason why these ‘gods’ face music now and then. Misbehavior, over-treatment, under-treatment and blatantly expensive treatment forms an important part of the present day medical culture but unfortunately not many among us are willing to fight against it. I am yet to find a statement by an authorized/statuary body of medicine or surgery in the country outrightly condemning malpractices of its own members. The Indian Medical Association, the Indian Orthopaedic Association and the Association of Surgeons of India maintain an apathetic silence in such matters. This hood winking continues till coercion from the other side becomes threatening.
Also, the medical fraternity and young doctors of our country should realize that we work with limitations of infrastructure. The poor conditions of government hospitals particularly in the interiors of the country is no secret. Lack of proper infrastructure leads to improper care and hence a threat of violence. With one doctor for every 2000 people, the situation is bound to get out of hand at times. Unjustified violence can be common practice. The working hours for residents who form the backbone of public funded healthcare is dreadfully out of proportion but no one, not even the medical fraternity, wants to raise the issue with the relevant administrative authorities. Thus, it would be prudent not to make any struggle as the present one in Maharashtra, a fight against the patients. It just can’t be doctors versus patients. Doctors cannot and should not turn against patients, in fact the anger should be used against the administrative lapses of infrastructure which lead to ugly scenes in hospitals. Efforts should be made on part of the doctors to send the message that they are not against patients. A simple way to assert the point would have been to run out-patient clinics outside their hospitals during the days of strike.
Solutions like beefing up security within hospital premises can only provide temporary relief. Most solutions to the problem lie within the training of medical personnel. Sensitizing the budding doctor to the poor and the underprivileged can be a simple solution which would reap huge dividends in the long run. Compassion, unfortunately cannot be taught. Teaching behavioral sciences at undergraduate and post graduate levels can be helpful. Acquainting the young doctor to prejudices of the society is a method to make them stand against institutionalized violence which in turn will bring compassion. Thus, the young doctors should realize that the violence they suffer breeds within the society they live. To be insensitive to violence with others, is inviting violence to self.
Prof. Shah Alam Khan, Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi
(Views are Personal)