Violence & aggresion against doctors dr vidushi sharma & dr suresh k pandey, kota india

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July 1st is celebrated each year as Doctors’ Day in India. This day has been chosen as a mark of respect to the contributions made by Dr. Bidhan Chandra Roy, who left an indelible mark in the history of medical profession in India. July 1st was his birthday as well as the day of his demise in the year 1882 and 1962 respectively. Dr. Roy was not only a physician par excellence, but also a freedom fighter, a leader and Chief Minister of west Bengal for 14 years.
In today’s world, sadly doctors do not hold the same place of respect as they did during the time of Dr. Roy and there is a steadily declining mutual trust and erosion of the doctor patient relationship. While patients often complain that doctors are proud, indifferent, do not give them expected care, take hefty fees, are dominating and confuse them with a lot of medical jargon; doctors are also bitter about the increasingly aggressive attitude of patients, who are willing to fight at the drop of a hat, do not respect doctors or their work, always blame doctors for everything without understanding the disease and its consequences. This scenario is not good for society at all as hospitals and clinics are supposed to be safe havens for the treatment and care of the sick and diseased, and we can’t afford to let them turn into battlegrounds.
Violence against doctors is becoming global phenomenon. Of late incidence of violence against doctors has increased. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial fault, or no fault of theirs. At least in one instance, a doctor was shot dead by angry relatives.
Preventions: 1. The most important step is to restrict entry of public. At no stage hordes of relatives should be allowed at the patient's bedside. Entry should be strictly by passes and this must be implemented through good security, preferably by ex-army personnel. 2. Security guards must be placed inside the hospital at sensitive areas like ICU, Operation theatre and casualty.
3. Much needs to be done to improve doctor– patient relationship. This must begin by the doctor informing the relative of what is going on. As the patient is being investigated diagnosis need not be given out. There should be no hyper bole nor understatements. Under no circumstances must the previous hospital or referring doctor be criticized. Words such as ‘You have come too late’ must not be used. This puts the blame on the patient. Who then retaliates by criticizing doctors. In desperate situations patients must be given a choice of calling another doctor (second opinion) if they feel so. The suggestions of organ donation must only be made in brain death. When the prognosis is serious the senior doctors must talk to the relatives. Security must be provided to the doctors at all times and at all places when they are at work. 4. The Medical Association has taken up with the Government the need to make violence against doctors a non billable offence. Unfortunately the law has not implemented during many instances.
BRIEF BIODATA, DR. VIDUSHI SHARMA, MD (AIIMS), FRCS (UK)


Dr. Vidushi Sharma did her basic medical education (MBBS) from All India Institute of Medical Sciences, New Delhi, India. She then did post graduation in Ophthalmology from the prestigious RP Centre for Ophthalmic Sciences, AIIMS, New Delhi. Thereafter pursued ophthalmic education in UK and obtained FRCS degree from the Royal College of Surgeons, Edinburgh, UK. She then joined as a Senior Resident in the Oculoplastic Unit of RP Centre AIIMS and worked there for three years. She then pursued her interest in Oculoplastic surgery further at the Sydney Eye Hospital, University of Sydney, Australia and did a fellowship in Oculoplastic surgery and Pediatric ophthalmology subspecialties.
Dr. Vidushi returned to India and set up the SuVi Eye Institute and Research Centre (www.suvieye.com) with her husband, Dr Suresh K. Pandey, at Kota, Rajasthan, India in February 2006. She has p

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  • Ever wondered why lawyers do not get beaten? They are a close knit group & do not present a soft target like doctors.Think about it.All this loss of status & explanation,attitudes & avarice are true to all professions.If doctor's learn to present a united front with ability to mete out severe & serious retaliation,these will cease.
    Dr.Santanu Gooptu.
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Violence & aggresion against doctors dr vidushi sharma & dr suresh k pandey, kota india

  1. 1. Violence Against Doctors Dr. Vidushi Sharma MD (Ophthalmology, AIIMS), FRCS (UK) SuVi Eye Hospital & Lasik Laser Centre, Kota, RAJ., INDIA ( www.suvieye.com ; Email: [email_address] , Phone +91 744 2433575, +91 9351412449) Dr. Suresh K Pandey (MS, Ophthal;, PGIMER), ASF (USA) SuVi Eye Hospital & Lasik Laser Centre, Kota, India www.suvieye.com ; Email: [email_address] , Phone +91 744 2433575, +91 9351412449 )
  2. 2. Doctor’s day, July 1 Dr. BC Roy – Physician, freedom fighter, leader and Chief minister of West Bengal for 14 years
  3. 3. Violence Against Doctors Presentation by Dr Vidushi Sharma During Doctor’s Day Celebration at Indian Medical Association, Kota, Rajasthan, India July 1, 2011
  4. 4. Key Issues <ul><li>What is the extent of problem? </li></ul><ul><li>Why does it occur? </li></ul><ul><li>What can be done? </li></ul><ul><li>“ </li></ul>Violence Against Doctors
  5. 5. What constitutes violence? <ul><li>Telephone threats </li></ul><ul><li>Intimidation </li></ul><ul><li>Oral abuses </li></ul><ul><li>Physical manhandling </li></ul>Violence Against Doctors “ incidents where people are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or health”.
  6. 6. We are not alone! <ul><li>US </li></ul><ul><ul><li>Gynecologists – threats and actual murder over abortion </li></ul></ul><ul><ul><li>More than half of ER nurses – physical violence – spitting, shoving, kicking </li></ul></ul><ul><ul><li>Survey of 170 university hospitals – 57% of all ER employees threatened by weapons over five year period </li></ul></ul>Violence Against Doctors
  7. 7. UK <ul><li>Half of all doctors – some degree of violence or abuse, 20% of these physical (BMJ, 2003) </li></ul><ul><li>Among GPs, threat of violence at 1 in 500 consultations </li></ul>Violence Against Doctors
  8. 8. China <ul><li>In 2006, > 5,500 medical workers injured by patients or relatives </li></ul><ul><li>June 2010 </li></ul><ul><ul><li>a doctor stabbed to death by son of a patient who died of liver cancer </li></ul></ul><ul><ul><li>3 doctors severely burned when office set on fire by patient </li></ul></ul><ul><ul><li>a pediatrician jumped through the window to escape angry relatives of a dead newborn </li></ul></ul>Violence Against Doctors
  9. 9. China <ul><li>In Fujian, a patient died, relatives took a doctor hostage, threw bottles injuring 5 employees and the hospital paid $ 31,000 to the family </li></ul>Violence Against Doctors
  10. 10. Others <ul><li>Kuwait – 86% doctors – verbal insults or imminent violence, 28% physical attacks </li></ul><ul><li>Israel – 54% to 79% rate of violence in physician surveys </li></ul><ul><li>Europe – Intoxicated patients flooding ERs </li></ul><ul><li>Australia – half of doctors physically attacked at least once </li></ul>Violence Against Doctors
  11. 11. We are not the only ones! <ul><li>US survey – Police personnel and taxi drivers had the highest risk of workplace violence </li></ul><ul><li>Work related homicide – 0.15 per 1,00,000 HCWs, 0.71 for all occupations </li></ul>Violence Against Doctors
  12. 12. So, why discuss? <ul><li>Health care settings – revert back to safe havens for caring </li></ul><ul><li>Mostly result of misunderstanding, mishandling </li></ul><ul><li>Eminently responsive to corrective measures </li></ul>Violence Against Doctors
  13. 13. Why? <ul><li>More demanding society </li></ul><ul><li>More availability of knowledge </li></ul><ul><li>More aggression in society </li></ul><ul><li>More violence on roads, public places, even schools </li></ul>Violence Against Doctors
  14. 14. Why among Doctors? <ul><li>Not all adverse outcomes end up in violence and not all violence is related to adverse outcomes </li></ul><ul><li>Different precipitants </li></ul><ul><ul><li>Israel – prolonged waiting (46.2%), dissatisfaction with treatment (15.4%) disagreement with physician (10.3%) </li></ul></ul><ul><ul><li>UK – Intoxication, mental illness, prolonged waiting </li></ul></ul>Violence Against Doctors
  15. 15. Malpractice cases <ul><li>Not just a result of heightened patient expectations and entrepreneurial lawyers </li></ul>Violence Against Doctors
  16. 16. Why? <ul><li>Archives of Internal Mecicine, 1994 </li></ul><ul><li>Perceived lack of caring and/ or collaboration in health care </li></ul><ul><ul><li>Perceived unavailability </li></ul></ul><ul><ul><li>Discounting patient and family concerns </li></ul></ul><ul><ul><li>Poor delivery of information </li></ul></ul><ul><ul><li>More than half – mal-occurrence suggested by health professional </li></ul></ul>Violence Against Doctors
  17. 17. Increased expectations <ul><li>“ often the result of unrealistic expectations by poor families who, having traveled far and exhausted their savings on care, expect medical miracles” </li></ul><ul><li>“ Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.” </li></ul>Violence Against Doctors
  18. 18. a <ul><li>“ It is not the </li></ul><ul><li>strongest </li></ul><ul><li>of the species </li></ul><ul><li>that survives, </li></ul><ul><li>nor the </li></ul><ul><li>most intelligent , </li></ul><ul><li>but the one most </li></ul><ul><li>responsive to </li></ul><ul><li>change.” </li></ul><ul><li>Charles Darwin </li></ul>Violence Against Doctors
  19. 19. Indian Scenario <ul><li>Bombay Hospital Journal 2009 </li></ul><ul><li>Casualty – bleeding patient, delay in attention; serious patient, delay in admission </li></ul><ul><li>ICU – death, denying entry passes </li></ul><ul><li>OT – DOT, repeated delay or postponement of surgery, wrong surgery </li></ul><ul><li>Wards – denial of access to case papers, </li></ul>Violence Against Doctors
  20. 20. Causes <ul><li>Lack of communication between doctor and patient </li></ul><ul><li>Poor image of medical profession </li></ul><ul><li>Lack of faith in judicial system and police </li></ul><ul><li>Mobocracy (small time “leaders”) </li></ul><ul><li>Desire to achieve 2 minutes of fame/ notoriety </li></ul><ul><li>Caste based and other such politics </li></ul>Violence Against Doctors
  21. 21. Causes <ul><li>Insufficient security </li></ul><ul><li>Insufficient laws – e.g. compared to attacking a policeman on duty </li></ul><ul><li>Frustration with systemic problems of government hospitals – from dysfunctional equipment to lack of staff </li></ul>Violence Against Doctors
  22. 22. How to deal? <ul><li>Not meet anger with anger </li></ul><ul><li>Address the grievances, but also call for help </li></ul><ul><li>Doctors must form groups, which can take over in such instances </li></ul>Violence Against Doctors
  23. 23. Law <ul><li>Non-bailable offence </li></ul><ul><li>Offenders liable to pay upto twice the purchase price of damaged eqipment </li></ul>Violence Against Doctors
  24. 24. Prevention <ul><li>Doctors who can’t communicate well are more likely to end up in court. </li></ul><ul><li>“ In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science.” </li></ul><ul><li>Dealing with human beings in extraordinary moments of fear, anxiety, and doubt  </li></ul>Violence Against Doctors
  25. 25. Communication <ul><li>Communication, communication, communication about costs, complications and challenges </li></ul><ul><li>Doctors must make efforts to educate and inform the public at large about diseases and medical problems </li></ul>Violence Against Doctors
  26. 26. Communication <ul><li>The doctor’s focus is more on keeping up with rapid advances, yet patient satisfaction comes primarily from a sense of being heard and understood </li></ul><ul><li>Doctor can never be God </li></ul><ul><li>Help people adjust to the sickness, pain and death that are central to being human </li></ul>Violence Against Doctors
  27. 27. Medical Training <ul><li>Old fashioned training </li></ul><ul><li>Reorient to changing perceptions </li></ul><ul><li>Language that implies skepticism – “patient believes”, “patient denies” </li></ul><ul><li>Specially in India, visit private practices </li></ul>Violence Against Doctors
  28. 28. Time Barrier to Communication <ul><li>Lack of time can be managed </li></ul><ul><li>Use paramedical staff </li></ul><ul><li>Delegate the work of repeated explanations </li></ul><ul><li>Counselors </li></ul>Violence Against Doctors
  29. 29. Patient expectations <ul><li>Doesn’t make me feel inferior </li></ul><ul><li>Doesn’t make me feel its my mistake </li></ul><ul><li>Doesn’t rush me </li></ul><ul><li>Is respectful and sensitive </li></ul><ul><li>(Knows my medical history) </li></ul>Violence Against Doctors
  30. 30. Clear explanations for waiting Violence Against Doctors 30 min wait from this point 15 min wait from this point
  31. 31. Prevention <ul><li>Display information on boards, counters etc. </li></ul><ul><li>Try not to escalate costs later or change plans frequently </li></ul><ul><li>Also display rules regarding consequences of violence in hospital </li></ul>Violence Against Doctors
  32. 32. Mutual Acceptance <ul><li>Accept diversity of patient backgrounds </li></ul><ul><li>Accept the right of patients to respect and sense of fair play </li></ul>Violence Against Doctors
  33. 33. Mutual Acceptance <ul><li>Accept limitations of medical science </li></ul><ul><li>Acceptance of doctors’ need to work peacefully </li></ul><ul><li>Restrict public entry, strictly by passes </li></ul><ul><li>The systemic problems of Government Hospitals – we are all responsible </li></ul><ul><li>Doctors expected to carry on the socialist tradition in a largely capitalist society </li></ul>Violence Against Doctors
  34. 34. Costs <ul><li>Our training centres and global opinion leaders will have to rethink the costs involved </li></ul><ul><li>It costs around $800 million in trials to bring a drug to the pharmacy. </li></ul><ul><li>Form different guidelines for India </li></ul>Violence Against Doctors
  35. 35. Accept responsibility <ul><li>To err is human, to admit superhuman </li></ul><ul><li>In poor prognosis cases, senior doctors must talk to the relatives </li></ul><ul><li>Allow second opinions </li></ul><ul><li>No charge for managing complications </li></ul><ul><li>Show humanity in financial dealing after death </li></ul>Violence Against Doctors
  36. 36. Poor Image <ul><li>Increase positive news </li></ul>Violence Against Doctors
  37. 37. Doctors’ Expectations <ul><li>From administration - Implement laws by the letter and spirit </li></ul><ul><li>Media – 1. publish both views, avoid sensationalism, seek an expert opinion preferably from another city </li></ul><ul><li>2. more positive 3. do not ascribe wrongful intentions </li></ul>Violence Against Doctors
  38. 38. <ul><li>In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only 2 minutes longer on average </li></ul>Violence Against Doctors
  39. 39. Strengthening Doctor Patient Relationship <ul><li>Phone Call after Surgery </li></ul><ul><li>Greetings during New Years & Festival (e.g. Diwali) </li></ul>Violence Against Doctors
  40. 40. Display of Warnings & Other information <ul><li>Display warning in hospital premises mentioning the consequences of violence against doctors in hospital </li></ul><ul><li>Display flow chart/plan in Emergency Room </li></ul>Violence Against Doctors
  41. 41. Medical Training <ul><li>US no role model – Steadily declining faith in physicians and perception of physician indifference and greed </li></ul><ul><li>Must align with the concept of Doctor as a service provider </li></ul>Violence Against Doctors
  42. 42. Doctor Patient relationship <ul><li>Many malpractice suits occur not because of malpractice, nor even because of lack of good care but as an expression of anger about some aspect of doctor-patient relationship and communication </li></ul><ul><li>Patients may want compensation, accountability, or just to be heard </li></ul>Violence Against Doctors
  43. 43. Patient communication skills <ul><li>Ask the right questions </li></ul><ul><li>Be prepared </li></ul><ul><li>Accept realistic treatment goals </li></ul><ul><li>Don’t be melodramatic or overly helpless </li></ul>Violence Against Doctors
  44. 44. Do not let things go so far! Violence Against Doctors <ul><li>You are paid to do so </li></ul><ul><li>Mantri ji ko phone lagaon </li></ul><ul><li>Neta ji ki chitthi padho </li></ul><ul><li>Bhai sahab se phone pe baat karo </li></ul><ul><li>Pay hospital bills before you take the dead body </li></ul><ul><li>Doctor sahib busy hain, wait karte raho </li></ul>Big challenge to remain calm in the face of provocation and let things blow over
  45. 45. Patient-Driven Quality according to Importance (US Survey) Violence Against Doctors Source: The Quality Connection in Health Care by Lynne Cunningham
  46. 46. Conclusion <ul><li>Medicine is not magic, do not expect miracles in spite of all the hype </li></ul><ul><li>Medical results can never be 100%, doctors never INTEND to fail, but sometimes failure is inevitable </li></ul><ul><li>Do not blame doctors for all problems that plague government set-ups </li></ul><ul><li>DOCTORS TREAT, HE CURES! </li></ul>Violence Against Doctors
  47. 47. Conclusion <ul><li>Cure where possible, care always, communicate maximum </li></ul><ul><li>We may have our own numerous problems, but most patients are more troubled than us </li></ul><ul><li>Never comment adversely on another health worker’s efforts </li></ul>Violence Against Doctors
  48. 48. Violence Against Doctors Thank You
  49. 49. Violence Against Doctors Dr. Vidushi Sharma MD (Ophthalmology, AIIMS), FRCS (UK) SuVi Eye Hospital & Lasik Laser Centre, Kota, RAJ., INDIA ( www.suvieye.com ; Email: [email_address] , Phone +91 744 2433575, +91 9351412449) Dr. Suresh K Pandey (MS, Ophthal;, PGIMER), ASF (USA) SuVi Eye Hospital & Lasik Laser Centre, Kota, India

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