Commentary

‘Don’t blame doctors, blame the broken healthcare system’: Doctors need a safe working space

Public expectations about treatment cannot be satisfied without overhauling the system

In what highlights the lawlessness, a condemnable incident involving physical assault on doctor allegedly by patients’ families, inside a hospital has brought the focus back on the security arrangement of healthcare facilities and raised questions on our healthcare system.

In the past few years, many instances of violence against medical practitioners have come to light. The state healthcare fraternity and government are finding it hard to search for viable ways to reform a system that, by most accounts, is in the throes of an unprecedented crisis as far as safety of doctors is concerned.

Any act of violence against a hospital staff or any act causing loss or damage to property of a hospital is to be made a non-bailable offence as nineteen states of India have some kind of Medicare Service Persons and Medicare Service Institutions (Prevention of violence or damage or loss of property) Act passed.

This legislation sends a clear message that assaults on doctors, nurses and other health professionals providing care is unacceptable.

A hospital is a place that renders medical service to the public, and attributes of a safe climate in hospitals mandates absences of hindrances. Undoubtedly, every doctor tries to give their best to save the patient with the resources available, and none wishes to see the patient undergoing an undesirable course.

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Medical staff extensively works hard under very odd and difficult circumstances, even at times when stones are pelted on them or ambulances are frisked dangerously, a majority of them strive to keep patient services intact, and majority of care providers are maintaining their professional ethics and good Samaritan behavior.

I wonder how can they still become victims of patient and attendants abuse?

The phrase “a few bad apples who spoil the bunch” is much more relevant now than it was in the past. Instead of dealing strongly with offenders we judge people unfairly through the prism of our own stereotypes.

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In low and middle income states like ours, Doctors continue to bear the brunt of aggression. Arising out of compromised services in medical infrastructure and medicine availability, or simply because the patient can’t afford medications implants or devices, which he or she has to purchase. But if a patient says, “I can’t afford that,” It is not in the hands of the Doctor to solve this problem.

These are uncomfortable moments where dedicated Doctors find it increasingly difficult to meet the expectations of patients from providing the standard care they need, and forsake their traditional commitment to the primacy of patients’ interest.

Such challenges on patient dissatisfaction center on increasing disparities among the legitimate needs of patients and the resources provided to the doctors by the healthcare system and the policy makers to meet those needs.

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Another important issue, is of breaking bad news, which is part of the art of medicine. A properly structured and well-orchestrated communication has a positive therapeutic effect. I strongly agree on our shortcomings in communication skills where individual behaviors matter for reacting more appropriately to specific situations.

Risk, benefits, alternatives to treatment, and particularly progress of patient are not explained well in time to patients or their family with the result the attendants are not mentally prepared for any undesired outcome, and a undesirable behaviour of physical assault, or an avalanche of derogatory remarks filled with anger and hostility is often hurled on doctors.

This act of hooliganism against medical staff or hospital while discharging their professional duties is not unacceptable, as there is a system in place to register a complaint of dissatisfaction or dissent.

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The recurrent attacks on doctors and medical establishment not only demoralize the entire medical fraternity but it also ends up weakening the faith in the system, as the erring miscreants usually go scot free without going through any due punishment.

Further inactions on this issue may trigger a brain drain of our talent to the corporate sector, and private hospitals.

As a Healthcare Quality and safety expert with zero tolerance to negligence I can safely say that Doctors are often made scapegoats, but the problem is the ailing health system.

Adverse events are systematically connected to features of people’s expectations, overpromised healthcare by politicians during electioneering, compromised standards on human resources, lack of clear protocols, sub-standard essentials, defective processes and unsafe operating environment.

Progress on safety comes from understanding and influencing these connections.

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However, the difficulty associated with this recognition remains the “shame and blame” concept of error that continues to persist within medicine, media, and the polity.

Exacerbating this difficulty are mandates and calls for full attention to the underlying gaps in our current healthcare delivery system, but doesn’t mean the staff or building or ambulances have to face the wrath of attendants.

It is more demoralizing when the authorities fail to understand shortcoming’s in the system, learn from past episodes and instead blame doctors. After such unpleasant negative encounters for any dedicated doctor to work effectively and efficiently is a challenge.

Eliminating disruptive behavior is essential for creating a culture of safety in hospitals is a priority.

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The collision of expectations with reality is often explosive, just as the public has to adjust to existing health care delivery system along with its shortcomings, doctors too have to show humane resilience during the vulnerable moments of patients and attendants.

No doubt our hospital staff usually makes every effort to treat everyone, as we would like to be treated. The patients and their attendants should also realize that along with rights, they have responsibilities.

Medical service is high-risk, and problem-prone service, on the one hand, there can be favorable outcome to ongoing treatment next moment unfavorable or unpredicted results or responses of treatment, sudden deterioration which at times may be beyond physician’s control can happen and patient/family is not well educated to understand that it doesn’t mean that a doctor is a killer or negligent.

Most of the hospitals have a policy procedure for initiating inquiry on appeal of aggrieved patient or family. The way to reduce violence against Doctors, is the collective responsibility where community, doctors, media, police, politicians, have to play their role and above all quality of healthcare system is poor and needs to be improved.

We need to resist the siren call of “Blame Someone” or nothing will ever get better.

 

Dr Fiaz Fazili is a Surgeon & Director Hospital Quality, Patient safety and Accreditation program. He also has a Diploma in Islamic studies from Islamic Online University. His work has been published in local and international Journals. 

Views and opinions expressed in this article are those of the author’s and do not necessarily reflect the editorial position and policy of the Free Press Kashmir.

 

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