Generally, as a first response , we try to stay calm and find out what exactly provoked the patient/caregiver.
We recognize that everyone has a breaking point. Healthcare is expensive nowadays and when people spend hard earned money, they demand to get their moneys worth. Any real or perceived “deficiency of service” can provoke ,verbal abuse or in extreme cases violent assault on healthcare professionals.
I always apologize first, with a statement like, “Im sorry that you’re upset,let me find out how i can address this” or something on these lines. A very generic statement where i acknowledge that something is wrong, but without implicating myself or the hospital. This immediately calms the aggrieved party and buys us time to find out exactly what happened.
The primary motive is to avoid escalation. Never allow your ego to exercise its influence and dismiss the concerns of the patient or his providers. It is very common in India for people to go on a rampage, assaulting staff and destroying property.Political influence is later exercised to prevent the perpetrators from coming to justice.
What i have observed is that , a lot of these events involve payments and are most frequently observed in the ICU, Emergency Room or when patients die unexpectedly or on the Operation Table or following a procedure. There is also the all pervasive “VIP Syndrome”, where certain categories of patients feel that their every whim and fancy are to be catered to.
In India only a minor fraction of the population is covered by health insurance. These tend to be the educated urban salaried class.
In the emergency room,in cases like a Road Traffic Accident/Stroke/Myocardial Infarction etc, the patient is rushed to a private/govt hospital. In a private setup, as the patient is being managed in the emergency room, ( we try to stabilize the vital parameters), one of the attending relatives is sent to the Admission counter to get the patient admitted. Most acute emergencies, such as those described above are usually transferred to the Intensive Care Unit following stabilization.
The attending relative is usually asked to pay a large deposit, Rs 30,000 to Rs 50,000 depending on their status as Indian Nationals or Foreign Nationals respectively. (This is at the place I work, and I know this is illogical, I ve heard many complaints personally from patients)
The relatives, usually who are ill prepared and in shock ,demand that all treatment should be started, that the patients life is to be saved at all costs and that they will make payments the following day. (I have seen even slum dwellers make such dramatic statements).
If they can provide at least part of the money up front, the hospital is generally ok with getting an undertaking signed after verifying the identity of the provider.
Problems start when people refuse to pay or start throwing names of local corporators, MLAs , MPs Ministers etc. They then usually bring a mob , who threaten all staff members from the sweeper to the treating Consultant, and generally cause mayhem.
In the ICU, where you have patients with debilitating /chronic illnesses, and have been confined in Intensive care for weeks or months, the hospital bills can and will go upto double digit lakhs. After spending so much money, the patient may still not be responding to treatment , or may even start to deteriorate. People sell their houses, land and jewellery in order to save their loved ones, and in the end all they may receive is a curt “Sorry” and a dead body. To realize that you have or will lose all your assets in a month, and have entered the ranks of the financially insolvent, after having lived a comfortable middle class life for decades , is a terrifying realization indeed.
The mixture of these fears /insecurities /probable loss of a loved one+financial insolvency+feeling of utter helplessness is very toxic. A powder keg that requires only one wrong word or move from any hospital staff to ignite it and cause mayhem.
De escalation of the situation our primary goal. As doctors we are also responsible personally for our nursing and auxillary staff. After any episode of violence , there is always an internal investigation, and any doctor found responsible for unnecesarily escalating a situation will face punitive action.
Amit Anand, Doctor, Intensive Care, Spaceflight Enthusiast, Flight Simulation