Part – 2

Violence in the ICU

Kanavehalli, who is a critical care anesthesiologist, said that attacks against doctors most often happened in emergency rooms and intensive care units, where tensions run high over critically-ill patients.

A survey by the Indian Medical Association last year supports Kanavehalli’s observation. It found that doctors faced most violence when they were rendering emergency services, and that half of such incidents occurred in intensive care units.

The survey also found that 75% of doctors across the country had faced some sort of violence while performing their professional duties and that in almost 70% of such cases the perpetrators were escorts of the patient.

“In all these places of high interaction like emergency operating theatre or casualty or ICU – these places need more security,” said Kanavehalli. “Doctors are also often abused in the obstetrics, gynaecology and paediatric wards.”

The same story has been playing on a loop in hospitals across the country. Resident doctors say the attacks are getting more frequent and more violent.

On June 14, a premature baby died in Delhi’s Chacha Nehru Bal Chikitsalaya for the lack of a ventilator. Angry family members roughed up doctors and hospital staff, which was captured by Closed Circuit Television cameras in the ward.

The resident doctors say that much of the friction between doctors and patients stems from the lack of patient counselling because government doctors are so overworked that they don’t have time to spend with patients and their families.

Vineetha is a junior resident doctor in her third year at the gynaecology department at Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals in Mumbai, better known as just JJ Hospital.

She sees at least 200 patients in a day when manning the out-patient department. Then there are entire days spent between the operating theatre, post-operative patient care, in the labour room and on emergency care rotations. “We are here 24-7,” she said. “Even patients keep asking us if we have had time to sleep or eat, because they see us here all the time.”

Too few doctors

There is one doctor for every 11,528 patients in government hospitals across India, according to the National Health Profile of 2015. This is a far cry from the World Health Organisation’s prescribed one doctor for every 1,000 patients.

Tensions only escalate in poorly-equipped government hospitals.

“In most government hospitals, every few months there won’t be an adequate supply of drugs,” said Kanavehalli. “Sometimes even emergency drugs are not available, even in ICUs, because of a lack of funds. If we prescribe these drugs from outside, the patient thinks that we are getting a commission by not giving what the government has provided.”

Great expectations

Another factor is the irrational expectations from patients’ family members, complained Sagar Mudanda, president of the Maharashtra Association of Resident Doctors. “There are small nursing homes that refer patients to a big government tertiary care hospitals, and we get patients who are highly morbid and close to death,” he said. “Because of the internet everyone thinks they have medical knowledge. People say they have read on Google that this disease can be treated this way or that way.”

Mudanda said that despite repeated entreaties by junior doctors, the hospital managements haven’t managed to implement basic procedural changes like restricting the number of visiting family members.

“The local culture is that if something happens to someone in the mohalla, everyone wants to come and see the patient,” he said. “If we stop them then they go to the local MLA who will call the hospital to ask why we are stopping them.”

Doctors locked and loaded?

Karnataka, Maharashtra and Delhi are three of eighteen states that have enacted laws against verbal or physical abuse of medical personnel. But resident doctors say these legislations haven’t made much of a difference. Often, said Mudanda, police are unaware of the provisions under which to book cases of assault of doctors.

With only sporadic attention being paid to their safety, resident doctors in Maharashtra decided in May to jolt the authorities with an outrageous demand. They asked Chief Minister Devendra Fadnavis to allow them to carry firearms at work to protect themselves.

Meanwhile, they are also seeking help through more conventional routes. “There has been a plan of making a national body, a central organisation of resident doctors,” said Kanavehalli. “We also want to petition Prime Minister Narendra Modiji directly about this issue.”



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