How to prevent hospitals from becoming battlegrounds

The recent contretemps at a major Jodhpur hospital which involved striking doctors and dying patients is not an isolated event. There have been several similar instances in the past and there will be more in the future if the issues leading to such unfortunate confrontations are not resolved. In fact, just as the Jodhpur imbroglio cooled off, another similar storm flared up at New Delhi’s AIIMS.

It would be simple to throw the Hippocratic oath at striking medicos and remind them about their ethical obligations. Doctors belong to the noblest of professions and are not expected to go on strike. But they are also human and cannot be expected to docilely accept blind violence.

A few years ago, a hospital in Thane (near Mumbai) closed down when supporters of a politician ransacked it after their leader died during an operation. Though this happened in a private hospital, most attacks occur in over-crowded, under-staffed, ill-maintained, poorly-administered government hospitals. Due to the operational failure of the three-tiered concept of our public healthcare system (primary health centres, district hospital, city hospital), the referral system is non-functional and patients land up directly at the big city hospitals. Doctors in these hospitals are, therefore, overworked and stressed out. Because of this, they tend to be brusque in their interactions with patients, which the latter misinterpret as callousness.

Indians are gregarious by nature. One sees this characteristic in the crowds that gather at festivals, house-warmings, naming ceremonies, marriages, etc. Unfortunately, having relatives and friends accompany a person to the hospital not only creates congestion and confusion but also strains the staff’s patience. This can lead to a state of tension between the well-wishers and the attending doctors and nurses — and pandemonium if the patient dies.

Because of inadequate diagnosis and care in the earlier stages of the healthcare system many patients are brought in who are really hopeless cases. But the well-wishers accompanying them are not fully aware of this and expect miracles to be performed at the “big” hospital. Shortage of time prevents the doctors from patiently explaining the limitations.

When the patient cannot be saved, the disappointment turns to fury. Accusations of malpractice, inadequate attention, improper treatment, flow fast and furious and violence against the doctors and staff can result if security is not adequate. Since it is the younger lot of medicos such as interns and duty doctors who form the front ranks and interact directly with patients and relatives, it is this set of doctors which bears the brunt of any violence and they are in the forefront of protests and strikes.

What has been noticed in many of these confrontations is that the patients and their supporters belong to an influential section of
society, such as politicians or businessmen or administrators. They know they can create scenes and mayhem and get away with it. The police, as usual, come in too late, by which time the situation has turned into a minor riot. To gain control, they then proceed to belabour everyone in sight, which may include the staff, or onlookers, as happened in Jodhpur.

This is not a situation that should be tolerated with a shrug since it can have a copycat potential which is multiplied by the publicity given to them by the electronic media. Hospitals should not be turned to battlefields. This will only endanger the well-being of the other patients. Some suggestions to improve the state of affairs are in order.

First, the administration of hospitals should be turned over from civil servants and senior doctors to professional managers. These managers should be given adequate powers to maintain proper discipline and enable them to run a shipshape hospital with the right infrastructure.

Second, hospitals must earmark a separate waiting area for those accompanying patients, which is well barricaded from the medical care area. Access to the patient should be limited to just one or two persons at a time, even during visiting hours. This should be enforced even for politically well-connected patients. Security should be strengthened, so that in case of any untoward incidence, the situation can be controlled.

Third, there must be a medical public relations officer in every hospital who will interface between doctors and patients. In the case of critical patients, the function of the PRO will be to explain to the relatives the gravity of the case and prepare them for the worst in case the line of treatment does not succeed. Such explanations will mitigate the shock to relatives in case of a fatality.

Fourth, we need to have a medical ombudsman for every major hospital who will arbitrate on complaints of improper care, unnecessary and expensive tests, and incorrect diagnosis — which are the main grouses of patients.

Lastly, all medical courses should include special training in bedside manners, interaction with relatives of patients, and communicating and explaining the nature of ailments.