Doctors Day is celebrated to recognise the contribution of doctors to individual life and communities. The date may vary from nation to nation. In our country it is celebrated on July 1 which is birth and Death Anniversary of the most famous physician of India Dr BC Roy.

The annual celebration is to spread awareness about the contribution of doctors to the society. Although Doctors Day is supposed to be celebrated by patients to thank them but in reality it is usually celebrated by doctors themselves in India.

The medical profession is one of the riskier professions. Knowingly doctors are taking risks of getting infected with dreaded infection like TB, AIDS, Hepatitis etc from patients and getting post radiation cancer from radiation exposure in performing their duties.

But taking that much risk and working in odd conditions and hours, they are being rewarded with verbal and physical violence. Verbal aggression or violence is so common that none of the doctors can claim that he has not encountered verbal abuse from the patient’s side for no fault.

“No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damage.”

This paragraph from a reputed journal from the USA, written 135 years ago shows that violence against doctors is not new, and that it has been reported from all over the world, but the trend of violence against medical doctors is rising rapidly in our country, which is alarming. In 1996 the 49th World Health Assembly declared violence a major and growing global health problem.

Several such incidents have been reported from India in the past however, this menace has not been highlighted adequately earlier.

The recent violent act done in Kolkata has elicited the attention of mass media and also of the political system.Being an orthopaedic surgeon with an experience of 40 years and dealing with simple to life threatening accidents, I have yet to see the patient, friends and family of road traffic accidents victim who own the responsibility of an accident.

On the contrary, they blame others for the cause of accidents and  blame doctors for any complication if it occurs during treatment even knowing very well that the complication occurred due to his or her own mistake.

I would like to cite the example of one my patients who was being treated for old infected non-union of thigh bone fracture.

Infection got controlled, fracture was healing and patient was walking for past four months with a plaster. However, he sustained a fracture again and blaming me, started to threaten me with dire consequences. The matter was brought to the notice of police.

Most of these problems are very small in the beginning but they take alarming shape and the outcome of the conflict becomes horrendous. Most of the times, the conflict is not because of the medical negligence.

But if conflict is analysed minutely then the reason turns out to be mainly non medical problem and rarely medical.

If you analyse the incidence of the violence against the doctors, the cause is often monetary-- either one doesn’t want to pay the pending hospital bills during treatment or anticipate the hefty monetary compensation after the treatment.

Those who are well to do or well educated prefer the monetary compensation and will take legal course. However, with it comes to those who are not well to do or well versed with the medical or legal knowledge, then incident escalates to verbal and/or physical violence against the doctors.

The other causes of medical violence are the social and psycho-social problems. In the majority of the cases (60-70%), such violence takes the form of either verbal abuse or aggressive gestures and rest of them turn out to be physical violence. It seems that these incidents are either reactive or hostile. As long as they are reactive, it can be understood easily. Like the death of a younger person having no known medical problem or a medical problem not known to the friends and family.

When deaths occur suddenly in the hospital then the reaction can be understood by the medical staff. But it becomes very difficult to understand when a person dies either after fatal accidental injuries or after the complication of chronic medical problems after many days of hospitalisation.

After the declaration of death, family and relatives become violent and, things go wrong up to such an extent that the people start using verbal and physical force with mob mentality, disturbing the working of the hospital and damaging hospital property or using the force or threatening the medical doctor with death. It looks as if the people are prejudiced or hostile to that doctor.

A study conducted by the Indian Medical Association found that 75 per cent of the surveyed doctors had suffered some form of physical violence while on duty. Most of these assaults were by relatives of very ill patients admitted in ICU and emergency.

The medical profession demands hard work almost round the clock. These hard working hours are already changing the mindset of younger generation, hence not many boys and girls are interested in joining the medical field. Now even the children of doctors are not interested to go in the medical field specially after witnessing such experiences of hard work only to face verbal and physical abuse.

It is apparent and paradoxical situation in our country where significant numbers of patients are not even educated and having no knowledge or experience of the medical field.

However such people are evaluating the knowledge, skill and efficiency of those doctors who are experts in their field to allege that a particular doctor has treated the patient wrongly.

Most of the times, these violent acts are based on the perception of patient’s family and friends rather than reality. A hostile attitude of the relatives creates the problem. The moment patients reach the emergency they presume that doctor is not giving any attention to them.

The prejudiced hostile attitude is root cause of the violence against the doctor. This prejudice hostile attitude is increasing day by day in such situation some time the mass media act as a fuel in the fire.

 There is hardly any day that we do not hear or read and see some such report in mass media. The problem is prevalent in almost every hospital.

The situation becomes quite difficult in emergency patients when patients are being brought by hordes of people. Everybody expects that doctor should attend to their patient and should leave others patients immediately which he is attending.

They get socked that doctor is not giving importance to them because they think they are VIP in their own way. The issue of medical treatment takes a backseat while their ego takes the frontseat. Second thing which annoys such people is the formalities of the hospitals which have to be met.  The third issue relates to the payment while the fourth issue is that the patients and all relatives want to know about the patient’s diagnosis, prognosis and treatment approach in detail while also wanting everything to be fixed quickly.

None of them can understand how much difficult it is for a doctor to fulfill the various expectations of many friends and relatives of the patients, particularly when most of the smaller hospitals do not have many staff and security personnel to check these people.

As Doctors Day was started to celebrate the achievements of the doctors by the patients their family and friends, in the current scenario how can one expect such patients to celebrate the occasion? Many cases of abuse or violence against the doctors are being ignored and rarely reported by most of the doctors especially in busy hospitals or in the reputed hospitals thinking and understanding very well that this will ultimately harm the reputation of the doctor and/or the hospital.

However, I am sure doctors of my standing or experience might have memories of many such abuses in their practice. There should be an understanding that vandalism and violence in a hospital or clinic is a criminal offense and any civilised society should have low tolerance for such heinous acts.

Disputes between patients and hospitals or doctors are not to be sorted out through violence, but in a civilised society, there are avenues for dispute redressal which should be used.

I personally feel that the situation is pathetic and this kind of the street justice is commonly seen in the medical practice now. If the situation is not controlled, it will be a serious threat to medical profession. No one can say for sure that he will not need medical help from womb to tomb. 

The union health minister Dr Harsh Vardan has taken quick action to make a bill for the violence against the doctors a non-bailable offence with minimum 12 year jail.

Once it is passed and implemented, it will be a milestone for controlling this menace.  The working of all professions is based on the principle of trust and faith among the service giver and the client. But it is most important in the doctor-patient relation, if we don’t have bond of trust and faith between doctor and patient then how can doctors work? Unfortunately the doctors are always under the scanner of suspicion by patients and their relatives.

 Modern medicine is neither cheap nor 100 per cent effective in curing the disease in all cases. Doctors are most of the time working in conditions of many uncertainties because human body is working on dynamic principles not like the other sectors.

The doctors are dealing with the living and loving people. The loss of loved one is more traumatising to any person than the loss of other things like money or material.

 If you analyse the working of the small private hospitals they are not having enough medical and non medical staff proportionate to the types of services hospital renders. The hospital services have many components.

One is the medical component and other is non medical component. Behaviour is first thing which influences the results, irrespective of profession. Most of the problems can be sorted out with the acceptable behaviour itself.

 As I mentioned earlier, behaviour of an individual is a very important to render the service. That means doctors not only needs medical knowledge but also has to maintain the good interpersonal relation. Communication skill is an important tool of the medical care.

The doctor has to deal with the medical and non medical problem. Hence doctor should have good behaviour, knowledge and skill to deal with different kinds of problems.

But unfortunately doctors are also human like patient and their relatives and it should always be kept in mind. As there are certain responsibilities of doctors and other healthcare workers, similarly, responsibilities also have to be borne by patients and their relatives.

(The author is an orthopaedic and spine surgeon, and the founding president of State Chapter of Indian Orthopaedic Association)