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  • Violence Against Doctors DR Vidushi Sharma & DR Suresh K Pandey, KOTA INDIA

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    LATE Dr B C ROY: July 1st was his birthday as well as the day of his demise in the year 1882 and 1962 respectively. Dr. Roy was not only a physician par excellence, but also a freedom fighter, a leader and Chief Minister of west Bengal for 14 years. In today’s world, sadly doctors do not hold the same place of respect as they did during the time of Dr. Roy and there is a steadily declining mutual trust and erosion of the doctor patient relationship. While patients often complain that doctors are proud, indifferent, do not give them expected care, take hefty fees, are dominating and confuse them with a lot of medical jargon; doctors are also bitter about the increasingly aggressive attitude of patients, who are willing to fight at the drop of a hat, do not respect doctors or their work, always blame doctors for everything without understanding the disease and its consequences. This scenario is not good for society at all as hospitals and clinics are supposed to be safe havens for the treatment and care of the sick and diseased, and we can’t afford to let them turn into battlegrounds. Also worth serious concern is the fact that recently there has been a huge decline in the number of medical aspirants and many of the toppers at school level have no inclination to join the medical field due to long and arduous training and very little rewards even after this grueling 10-15 year long training period. Other professions are far more lucrative in comparison and less stressful. Mostly the children of very successful doctors are also reluctant to join the medical field. Of course, the decline in trust and values is a global phenomenon and affects all spheres of life, and the capitalist mentality and corruption have also affected the medical profession, but we should not generalize these negative qualities. We still have many good doctors who sacrifice their sleep and family life everyday to care for the sick at odd hours. For every case of alleged medical negligence, there are thousands of cases each day, where the doctors have helped save many lives and relieved patients of pain and sickness. Doctors also need to adjust to the heightened patient expectation in a changing society and make every effort to improve the communication between doctors and patients and to keep it pleasant. Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK), Dr Suresh K Pandey, Director & Eye Surgeon, SuVi Eye Institute & Lasik Laser Center, C 13 Talwandi, Kota, RAJ. www.suvieye.com Phone +91 744 2433575, +91 9351412449 E-mail: suvieye@gmail.com, www.suvieye.com

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    Violence Against Doctors Dr Vidushi Sharma &; Dr Suresh K Pandey, KOTA INDIA

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    LATE Dr B C ROY: July 1st was his birthday as well as the day of his demise in the year 1882 and 1962 respectively. Dr. Roy was not only a physician par excellence, but also a freedom fighter, a leader and Chief Minister of west Bengal for 14 years. In today’s world, sadly doctors do not hold the same place of respect as they did during the time of Dr. Roy and there is a steadily declining mutual trust and erosion of the doctor patient relationship. While patients often complain that doctors are proud, indifferent, do not give them expected care, take hefty fees, are dominating and confuse them with a lot of medical jargon; doctors are also bitter about the increasingly aggressive attitude of patients, who are willing to fight at the drop of a hat, do not respect doctors or their work, always blame doctors for everything without understanding the disease and its consequences. This scenario is not good for society at all as hospitals and clinics are supposed to be safe havens for the treatment and care of the sick and diseased, and we can’t afford to let them turn into battlegrounds. Also worth serious concern is the fact that recently there has been a huge decline in the number of medical aspirants and many of the toppers at school level have no inclination to join the medical field due to long and arduous training and very little rewards even after this grueling 10-15 year long training period. Other professions are far more lucrative in comparison and less stressful. Mostly the children of very successful doctors are also reluctant to join the medical field. Of course, the decline in trust and values is a global phenomenon and affects all spheres of life, and the capitalist mentality and corruption have also affected the medical profession, but we should not generalize these negative qualities. We still have many good doctors who sacrifice their sleep and family life everyday to care for the sick at odd hours. For every case of alleged medical negligence, there are thousands of cases each day, where the doctors have helped save many lives and relieved patients of pain and sickness. Doctors also need to adjust to the heightened patient expectation in a changing society and make every effort to improve the communication between doctors and patients and to keep it pleasant. Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK), Dr Suresh K Pandey, Director & Eye Surgeon, SuVi Eye Institute & Lasik Laser Center, C 13 Talwandi, Kota, RAJ. www.suvieye.com Phone +91 744 2433575, +91 9351412449 E-mail: suvieye@gmail.com, www.suvieye.com

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    Violence Against Doctors DR Vidushi Sharma & DR Suresh K Pandey, KOTA INDIA

    Uploaded by

    Dr Suresh K Pandey
    LATE Dr B C ROY: July 1st was his birthday as well as the day of his demise in the year 1882 and 1962 respectively. Dr. Roy was not only a physician par excellence, but also a freedom fighter, a leader and Chief Minister of west Bengal for 14 years. In today’s world, sadly doctors do not hold the same place of respect as they did during the time of Dr. Roy and there is a steadily declining mutual trust and erosion of the doctor patient relationship. While patients often complain that doctors are proud, indifferent, do not give them expected care, take hefty fees, are dominating and confuse them with a lot of medical jargon; doctors are also bitter about the increasingly aggressive attitude of patients, who are willing to fight at the drop of a hat, do not respect doctors or their work, always blame doctors for everything without understanding the disease and its consequences. This scenario is not good for society at all as hospitals and clinics are supposed to be safe havens for the treatment and care of the sick and diseased, and we can’t afford to let them turn into battlegrounds. Also worth serious concern is the fact that recently there has been a huge decline in the number of medical aspirants and many of the toppers at school level have no inclination to join the medical field due to long and arduous training and very little rewards even after this grueling 10-15 year long training period. Other professions are far more lucrative in comparison and less stressful. Mostly the children of very successful doctors are also reluctant to join the medical field. Of course, the decline in trust and values is a global phenomenon and affects all spheres of life, and the capitalist mentality and corruption have also affected the medical profession, but we should not generalize these negative qualities. We still have many good doctors who sacrifice their sleep and family life everyday to care for the sick at odd hours. For every case of alleged medical negligence, there are thousands of cases each day, where the doctors have helped save many lives and relieved patients of pain and sickness. Doctors also need to adjust to the heightened patient expectation in a changing society and make every effort to improve the communication between doctors and patients and to keep it pleasant. Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK), Dr Suresh K Pandey, Director & Eye Surgeon, SuVi Eye Institute & Lasik Laser Center, C 13 Talwandi, Kota, RAJ. www.suvieye.com Phone +91 744 2433575, +91 9351412449 E-mail: suvieye@gmail.com, www.suvieye.com

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    Doctors day, July 1

    Dr. BC Roy Physician, freedom fighter,

    leader and Chief minister of West Bengal for 14 years

    Violence Against Doctors


    Dr. Vidushi Sharma
    MD (Ophthalmology, AIIMS), FRCS (UK) SuVi Eye Hospital & Lasik Laser Centre, Kota, RAJ., INDIA (www.suvieye.com; Email: suvieye@gmail.com, Phone +91 744 2433575, +91 9351412449)

    Dr. Suresh K Pandey


    (MS, Ophthal;, PGIMER), ASF (USA)

    SuVi Eye Hospital & Lasik Laser Centre, Kota, India

    Violence Against Doctors


    Presentation by Dr Vidushi Sharma During Doctors Day Celebration at Indian Medical Association, Kota, Rajasthan, India July 1, 2011

    Key Issues
    What is the extent of problem? Why does it occur? What can be done?

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    What constitutes violence?


    Telephone threats Intimidation Oral abuses Physical manhandling
    incidents where people are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or health.

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    We are not alone!


    US
     Gynecologists threats and actual murder over abortion  More than half of ER nurses physical violence spitting, shoving, kicking  Survey of 170 university hospitals 57% of all ER employees threatened by weapons over five year period
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    UK
    Half of all doctors some degree of violence or abuse, 20% of these physical (BMJ, 2003) Among GPs, threat of violence at 1 in 500 consultations

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    China
    In 2006, > 5,500 medical workers injured by patients or relatives June 2010
     a doctor stabbed to death by son of a patient who died of liver cancer  3 doctors severely burned when office set on fire by patient  a pediatrician jumped through the window to escape angry relatives of a dead newborn
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    China
    In Fujian, a patient died, relatives took a doctor hostage, threw bottles injuring 5 employees and the hospital paid $ 31,000 to the family

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Others
    Kuwait 86% doctors verbal insults or imminent violence, 28% physical attacks Israel 54% to 79% rate of violence in physician surveys Europe Intoxicated patients flooding ERs Australia half of doctors physically attacked at least once
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    We are not the only ones!


    US survey Police personnel and taxi drivers had the highest risk of workplace violence Work related homicide 0.15 per 1,00,000 HCWs, 0.71 for all occupations
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    So, why discuss?


    Health care settings revert back to safe havens for caring Mostly result of misunderstanding, mishandling Eminently responsive to corrective measures

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Why?
    More demanding society More availability of knowledge More aggression in society More violence on roads, public places, even schools

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Why among Doctors?


    Not all adverse outcomes end up in violence and not all violence is related to adverse outcomes Different precipitants
     Israel prolonged waiting (46.2%), dissatisfaction with treatment (15.4%) disagreement with physician (10.3%)  UK Intoxication, mental illness, prolonged waiting
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Malpractice cases
    Not just a result of heightened patient expectations and entrepreneurial lawyers

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Why?
    Archives of Internal Mecicine, 1994

    Perceived lack of caring and/ or collaboration in health care


       

    Perceived unavailability Discounting patient and family concerns Poor delivery of information More than half mal-occurrence suggested by health professional

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Increased expectations
    often the result of unrealistic expectations by poor families who, having traveled far and exhausted their savings on care, expect medical miracles Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.
    Charles Darwin

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Indian Scenario
    Bombay Hospital Journal 2009

    Casualty bleeding patient, delay in attention; serious patient, delay in admission ICU death, denying entry passes OT DOT, repeated delay or postponement of surgery, wrong surgery Wards denial of access to case papers,
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Causes
    Lack of communication between doctor and patient Poor image of medical profession Lack of faith in judicial system and police Mobocracy (small time leaders) Desire to achieve 2 minutes of fame/ notoriety Caste based and other such politics
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Causes
    Insufficient security Insufficient laws e.g. compared to attacking a policeman on duty Frustration with systemic problems of government hospitals from dysfunctional equipment to lack of staff
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    How to deal?
    Not meet anger with anger Address the grievances, but also call for help Doctors must form groups, which can take over in such instances
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Law
    Non-bailable offence Offenders liable to pay upto twice the purchase price of damaged eqipment

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Prevention
    Doctors who cant communicate well are more likely to end up in court. In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science. Dealing with human beings in extraordinary moments of fear, anxiety, and doubt

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Communication
    Communication, communication, communication about costs, complications and challenges Doctors must make efforts to educate and inform the public at large about diseases and medical problems
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Communication
    The doctors focus is more on keeping up with rapid advances, yet patient satisfaction comes primarily from a sense of being heard and understood Doctor can never be God Help people adjust to the sickness, pain and death that are central to being human
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Medical Training
    Old fashioned training Reorient to changing perceptions Language that implies skepticism patient believes, patient denies Specially in India, visit private practices

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Time Barrier to Communication


    Lack of time can be managed Use paramedical staff Delegate the work of repeated explanations Counselors

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Patient expectations
    Doesnt make me feel inferior Doesnt make me feel its my mistake Doesnt rush me Is respectful and sensitive (Knows my medical history)

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Clear explanations for waiting


    30 min wait from this point

    15 min wait from this point

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Prevention
    Display information on boards, counters etc. Try not to escalate costs later or change plans frequently Also display rules regarding consequences of violence in hospital
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Mutual Acceptance
    Accept diversity of patient backgrounds Accept the right of patients to respect and sense of fair play

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Mutual Acceptance
    Accept limitations of medical science Acceptance of doctors need to work peacefully Restrict public entry, strictly by passes The systemic problems of Government Hospitals we are all responsible Doctors expected to carry on the socialist tradition in a largely capitalist society
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Costs
    Our training centres and global opinion leaders will have to rethink the costs involved It costs around $800 million in trials to bring a drug to the pharmacy. Form different guidelines for India
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Accept responsibility
    To err is human, to admit superhuman In poor prognosis cases, senior doctors must talk to the relatives Allow second opinions No charge for managing complications Show humanity in financial dealing after death

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Poor Image
    Increase positive news

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Doctors Expectations
    From administration - Implement laws by the letter and spirit Media 1. publish both views, avoid sensationalism, seek an expert opinion preferably from another city 2. more positive 3. do not ascribe wrongful intentions

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only 2 minutes longer on average

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Strengthening Doctor Patient Relationship


    Phone Call after Surgery Greetings during New Years & Festival (e.g. Diwali)

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Display of Warnings & Other information


    Display warning in hospital premises mentioning the consequences of violence against doctors in hospital Display flow chart/plan in Emergency Room

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Medical Training
    US no role model Steadily declining faith in physicians and perception of physician indifference and greed Must align with the concept of Doctor as a service provider

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Doctor Patient relationship


    Many malpractice suits occur not because of malpractice, nor even because of lack of good care but as an expression of anger about some aspect of doctor-patient relationship and communication Patients may want compensation, accountability, or just to be heard
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Patient communication skills


    Ask the right questions Be prepared Accept realistic treatment goals Dont be melodramatic or overly helpless

    Violence Against Doctors

    Dr. Vidushi, MD, FRCS

    Do not let things go so far!


    Pay hospital bills before you take the dead body Doctor sahib busy hain, wait karte raho You are paid to do so Mantri ji ko phone lagaon Neta ji ki chitthi padho Bhai sahab se phone pe baat karo

    Big challenge to remain calm in the face of provocation and let things blow over
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Patient-Driven Quality according to Importance (US Survey)

    Violence Against Doctors

    Source: The Quality Connection in Health Care by Lynne Cunningham

    Dr. Vidushi, MD, FRCS

    Conclusion
    Medicine is not magic, do not expect miracles in spite of all the hype Medical results can never be 100%, doctors never INTEND to fail, but sometimes failure is inevitable Do not blame doctors for all problems that plague government set-ups DOCTORS TREAT, HE CURES!
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Conclusion
    Cure where possible, care always, communicate maximum We may have our own numerous problems, but most patients are more troubled than us Never comment adversely on another health workers efforts
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Thank You
    Violence Against Doctors Dr. Vidushi, MD, FRCS

    Violence Against Doctors


    Dr. Vidushi Sharma
    MD (Ophthalmology, AIIMS), FRCS (UK) SuVi Eye Hospital & Lasik Laser Centre, Kota, RAJ., INDIA (www.suvieye.com; Email: suvieye@gmail.com, Phone +91 744 2433575, +91 9351412449)

    Dr. Suresh K Pandey


    (MS, Ophthal;, PGIMER), ASF (USA)

    SuVi Eye Hospital & Lasik Laser Centre, Kota, India

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