The last few years have seen violence against doctors increase manifold, especially in the wake of the COVID-19 pandemic. With social media going ablaze with viral videos of doctors being attacked by patients’ relatives, and with headlines being dominated by these incidents, the Indian Medical Association (IMA) has made repeated appeals to the government to introduce a nationwide law to protect healthcare workers against violence and harassment.
In 2020, the Indian Government passed the Epidemic Diseases (Amendment) Act (2020), which classifies violence against healthcare professionals as a non-bailable offense, punishable by five years of imprisonment or a fine of up to 2 Lakh rupees. In addition, over 22 states in India have adopted the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, commonly known as the Medical Protection Act — or at least a version of it. This act outlaws attacks against doctors and damages to their property.
However, despite legislation, recent incidents indicate that the violence against healthcare professionals, a majority of whom are constituted of junior doctors, medical interns, and final-year medical students, shows no signs of slowing down.
This only begs the question — why are healthcare workers still subjected to such violence? How effective is the current legislation to protect healthcare workers? And more importantly, where is it failing, and why? Why are our doctors still at the brunt of violence, despite strict laws that criminalise it?
Doctors are heavily misunderstood
Many from the medical profession agree that people lash out against doctors in violent ways because of deep misconceptions they have about them. Dr Suresh Kumar, Medical Director of Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi says that people expect miracles from doctors. “Patients’ families think that doctors are magicians, and visiting them can cure them of all their ailments. However, doctors cannot prevent death,” he explains. He further says that in case of tragedies, the doctors are accused of negligence or malpractice.
These accusations come from a place of deep mistrust and suspicion, doctors say. “In the movies and the media, doctors are portrayed in a negative light, and as being unethical. This makes patients very anxious about dealing with doctors,” says Dr Kiranmai Andasu, Professor, Department of Community Medicine at Kakatiya Medical College. These anxieties, coupled with misinformation and a lack of awareness about medicine, lead people to act violently toward healthcare workers, doctors believe.
Elaborating more on the lack of awareness, Dr Suresh Kumar says, “With the advent of the internet, every layperson thinks that they are an expert on medical matters. However, it is more complicated than that, as we treat thousands of patients daily.” He elaborates that doctors have to prioritise between patients on the basis of urgency and severity.
Sometimes, doctors can get caught up in more complicated cases, leading them not to give other patients the attention they demand, which irks the patients enough for them to lash out, says the Medical Director.
“Every patient wants to be given priority, which is not realistic,” he laments. According to him, junior doctors face the bulk of this ire as they deal directly with the patients and their families.
Young doctors’ morale affected, but violence normalised
Many young doctors, naturally, start having second thoughts about entering the medical profession, says Dr Suresh Kumar. “These youngsters take up medicine to serve people and sacrifice a lot in the course of their education. If they think that they are only going to get attacked like this, they will lose their will to do their job properly,” Dr Suresh Kumar says.
However, healthcare professionals are taught to expect this violence as they start their careers. “From the start, we try to counsel students about how patients’ attendants can act out against them, and we try to make them capable enough to handle this behaviour,” says Dr Kiranmai. She also adds that final-year students are given counselling sessions on coping with violence before they begin their internships.
Data from the IMA suggests that 75% of healthcare professionals have been at the receiving end of violence at some point in their careers, with 68% of the violence being from patients’ attendants or relatives. The COVID-19 pandemic has brought more attention to the violence against doctors, but as stated earlier, the violence has not stopped.
Dr Suresh Kumar found it heartbreaking to see junior doctors and other healthcare professionals be attacked by patients’ kin during the pandemic. “We owe junior doctors a lot for putting their lives on the line during COVID,” he declares. Further, he concludes that incidents of violence against doctors should “have no place in a society that calls itself civilised.”
Where is the law failing?
In an article for the London School of Economics Public Policy blog, Ishika Garg, a fourth-year law student at the National Academy of Legal Studies and Research University of Law (NALSAR), Hyderabad, writes that the Medical Protection Act is badly implemented, as it “does not feature in the Indian Penal Code (IPC), which makes it difficult for victims to approach the police for help.”
"All the investigating agencies in India rely on the IPC to register complaints. But not a lot of police officers are aware of this Act, which is why you don’t see a lot of cases under it,” says the law student, who was prompted to write the blog article after seeing viral videos of doctors being hounded by the patient’s relatives during the pandemic.
As for the Epidemic Diseases (Amendment) Act, the article says that despite having penalties for any violence against healthcare workers, it is a sunset clause that lasts only for the duration of the pandemic. “ The Epidemic Diseases Act is only in action in case of an epidemic or a pandemic. The punishment mentioned in the Act would not be applied for everyday violence against healthcare professionals,” Ishika says.
Legislative measures to safeguard healthcare professionals
The most obvious thing that the government can do, is introduce a national law to protect doctors from violence, says Ishika. In the absence of one, she suggests that the Medical Protection Act be included in the IPC.
“Let the government appoint a Review Committee for understanding the gaps and hindrances to the proper implementation, and come up with recommendations to fix them,” she says. She also adds that the Act must have a clause that allows for an in-built review mechanism to update the Act in accordance with the need of the hour.
“In addition to that, all healthcare and police personnel must be made aware of the law and its provisions,” concludes Ishika.
How hospitals can help
Ishika argues that hospitals must take steps to identify and de-escalate violence and protect their doctors, in the absence of a nationwide law.
In her article, she writes that healthcare professionals must first be familiarised with the STAMP Acronym (Staring, Tone of voice, Anxiety, Mumbling, Pacing), which makes it easier for them to identify the signs of potential violence. With this knowledge, any potential escalation can be avoided even before it happens. “Patients’ attendants tend to lash out in violent ways when they are distressed. The IMA and Medical colleges must ensure that doctors are sensitised to recognise and help such people,” she explains.
She also argues that India must adopt a robust framework for hospitals to report incidents of violence, similar to the Code Purple protocol so that the victims can be given timely help, in accordance with the WHO Guidelines.
Meanwhile, hospitals in India are taking extra steps to ensure the safety of their staff. For example, all hospitals attached to Kakatiya Medical College have posters with strict reminders for patients’ attendants to not cause harm to the staff at various locations, along with their consequences, says Dr Kiranmai.
At Maulana Azad Medical College, communication lessons are a key aspect of the curriculum, and students are taught how to approach the case, the patient, and the patient’s relatives, says Dr Suresh Kumar. “In case of violence, we file Institutional FIRs against the perpetrator on behalf of our junior doctors, since they do not want to get embroiled in police cases and want to focus on duty instead,” he adds.
Structural changes needed
It could be understood that at the heart of the angst against Indian healthcare, are structural issues like poor doctor-patient ratios, communication gaps, and infrastructural lapses.
More often than not, people attribute malfunctions in the healthcare system to individual doctors, rather than these issues. Resolving these issues is the most important step in preventing violence against doctors – and is hence the need of the hour.
