India seems to lead the world in Violence against Doctors – What action is Govt. taking?

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New Delhi/Nagpur: The strike of Resident Doctors of Maharashtra has entered the fifth day today with MARD, their association not ready to relent despite Rulings of High Court and assurances regarding their safety.

This brings us to the question – are such happenings restricted to India or do they happen elsewhere too?

And if they do – how do those countries deal with it?

The situation in China

It was rather surprising to learn that China, despite being a Communist country, where health care is expected to be in the public sector, the practise of attacking hospitals is rather rampant.

A study initiated by Harvard University, USA showed that:

“However, the local moral worlds within Chinese hospitals are now fraught with tension and the growing friction between patients and physicians has resulted in verbal abuse, threats and physical assault. Medical mobs, called yinao, regularly protest at hospitals or harass hospital administrators in exchange for money. In 2011, a 10 province survey in China found that over half of the physicians had been verbally abused, one-third had been threatened and 3.4% had been physically assaulted by patients in the past 12 months. The level of violence observed in China is more common compared with violence against medical professionals in other countries.

The response of the Government?

A thorough study was carried out of not only the Medical front, but the financial, the economical and the moral too, to find out what had gone wrong.

They identified that various factors including low salaries of Doctors and Health care workers, and a low outlay in their budget to Health care ( which is still 15%!!) had led to erosion of trust between Doctors and patients. This was taken very seriously.

There is a quotation of Confucius that is cited –

A seeker of wisdom asked Confucius about the essential elements of governing a state. Confucius replied, “It is to provide food, protect people with weapons, and gain trust from people.” The seeker asked further which should be abandoned first if the state is forced to choose between foregoing food, weapons or trust. Confucius advised to abandon weapons first, then food. However, he advised never to abandon trust. He explained, “Trust is more important than life itself.” This story suggests that trust is important within Chinese social relationships.

The example of Israel

Over recent years there has been an increasing prevalence of verbal and physical violence in Israel, including in the work place. Physicians are exposed to violence in hospitals and in the community. The objective (of the study) was to characterize acts of verbal and physical violence towards hospital- and community-based physicians.

Methodology of Survey
A convenience sample of physicians working in the hospital and community completed an anonymous questionnaire about their experience with violence. Data collection took place between November 2001 and July 2002. One hundred seventy seven physicians participated in the study, 95 from the hospital and 82 from community clinics. The community sample included general physicians, pediatricians, specialists and residents.

Results
Ninety-nine physicians (56%) reported at least one act of verbal violence and 16 physicians (9%) reported exposure to at least one act of physical violence during the previous year. Fifty-one hospital physicians (53.7%) were exposed to verbal violence and 9 (9.5%) to physical violence. Forty-eight community physicians (58.5%) were exposed to verbal violence and 7 (8.5%) to physical violence. Seventeen community physicians (36.2%) compared to eleven hospital physicians (17.2%) said that the violence had a negative impact on their family and on their quality of life (p < 0.05). The most common causes of violence were long waiting time (46.2%), dissatisfaction with treatment (15.4%), and disagreement with the physician (10.3%).

Conclusion
Verbal and/or physical violence against physicians is common in both the hospital and in community clinics. The impatience that accompanies waiting times may have a cultural element. Shortening waiting times and providing more information to patients and families could reduce the rate of violence, but a cultural change may also be required concluded the study.

In USA – Nurses found to be at great risk

(We found this in a scientific journal called Atlantic. Excerpts given below

“Here’s an alarming statistic: Around one in four nurses has been physically attacked at work in the last year. Patients often kick, scratch, and grab them; in rare cases even kill them. In fact, there are nearly as many violent injuries in the healthcare industry as there are in all other industries combined. Healthcare workers make up 9 percent of the workforce.

There are currently no federal rules mandating that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. State-specific measures include requirements that hospitals develop violence-prevention programs, such as teaching de-escalation techniques, and increased penalties for people convicted of assaulting healthcare workers. In October, California passed the toughest guidelines in the country, obligating healthcare employers to develop tailored violence-prevention plans for each workplace with employees’ input. But the problem has gotten so bad that the U.S. Department of Labor is considering setting nationwide workplace-safety standards for hospitals in order to prevent this kind of abuse.

Patients with dementia or Alzheimer’s and patients on drugs were the most likely to hurt nurses, according to one study published last year in the Journal of Emergency Nursing. The study surveyed more than 700 registered nurses at a private hospital system in Virginia, and 76 percent said they had experienced physical or verbal abuse from patients and visitors in the previous 12 months. About 30 percent said they had been physically assaulted.

Working directly with patients in emotional and physical pain has always put healthcare workers at risk of violence. But in the past decade or so, there has been a 110% spike in the rate of violent incidents reported against healthcare workers.

Courtesy: Nagpur Today

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