Currently, 44000 resident and teaching doctors in hospitals of Maharashtra are on strike. The triggering issue was the latest violent attack by patient’s relatives, on the doctor of a patient who had died of chronic renal failure, in a medical college hospital in Mumbai. The medical community, on social media, is expressing their disbelief that even the Hon’ble High Court is not sympathetic to their manner of protest-mass leave-on grounds of poor security at their places of work. The Hon’ble High Court has stated that state doctors cannot resort to strike/mass leave, as a means of protest in the same manner as factory workers.
Incidently, police routinely face mob or individual violence during the course of their duties – like enforcing traffic rules – or during public protests-which may be against deficits of service or against government policies . Many a times, policemen get injured or killed during action on such violent protests. But it is taken for granted that duty of a policeman may involve such risks! It is for another day that we may talk of risk compensation to policemen. But I want to point out the similarity in situations faced by both professions in their dealings with public ire, though the difference is that it is the job of police to face and deal with public violence, while for a doctor, it is not. For both, however, it has become a professional risk.
Doctors practice the most benevolent of professional roles in all humanity – that of dealing with saving and nurturing human life and health. Clearly, it is a basic need that hospitals should have secure workspaces for them. And their demand of better security in hospitals starting with visitor management, is very valid. The administrative response to that demand, that armed security will be deployed in large numbers at hospitals, however, may not be sufficient to ensure peace from violent relatives in hospitals. One must remember that, besides cures, hospitals will continue to deal with death of patients too. Armed security in large numbers, alone as a measure, will not be useful in those circumstances, to deal with affected relatives. Hospitals, like educational institutions, are peopled with a unique psychological profile. A fine tuned, multi pronged approach is required, to put in place a mechanism that will work.
The problem, to my mind, needs to be looked at from two perspectives- 1) immediate work on well trained, sufficient number of security personnel to be deployed for effective visitor management in public hospitals. This, currently, is a visibly deficient area. The police is not the agency for guard duties, but the same should be fulfilled through non-police security agencies of the government – like the Maharashtra Security Corporation or the district guard boards or the Armed Forces retired persons Resettlement Boards. Security in public hospitals needs better resourcing.
The second viewpoint is more important in the long term. What can public hospitals do to reduce anger in its visitors, since this is clearly a problem needing to be tackled? Can the hospital spaces, more so in areas of greater mortality, be designed differently to evoke calmness – with better seating, different lighting, more greenery/ water fountains in open spaces? Can there be better use of the existing para medical manpower, like nurses, by training them for communication with patients’ relatives and even for reducing the work-hours burden of resident doctors? I think equal importance needs to be given to psychological designing as to feet on the ground security, when solving the problem of hospital based violence. I’ve heard of pet dogs and pups being made available in some universities abroad, for students during exam times to reduce their stress. Some out of the box solutions are warranted in India too, for problems like this one.
I am especially impressed with the work culture at Tata Memorial Cancer Hospital-a public hospital in Mumbai. It is amazing how the patient-focus is so visible there. And everyone including a lift operator is so unfailingly polite and considerate- despite the massive patient load. Do they train their manpower differently? How do they achieve that organisational culture of service?