Anger

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?

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6 thoughts on “Anger

  1. Anger management is of importance in police work, but we need it everywhere – wherever there is stress arising from pressures of all kind. Police stations, Railway stations, hospitals, airports and wherever there is public – authority interface. Tempers cool only after the damage is done. Training is the main key and it has to be designed carefully with help from psychiatric experts. Pradnya has shed light on a vital area of our work.

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  2. When a policeman is assaulted action against the culprits is prompt and effective. Not so when a doctor is assaulted. Not a single conviction amongst some 50 odd cases! So please be sensitive when commenting.

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  3. I recall a dinner invitation as a part of home hospitality experience in Reno, Nevada, during my 2007 visit to US, under the International Visitors Leadership Program. Our host’s living room had a wall-mounted large-screen TV, showing a lazily-foraging grizzly bear, amidst rolling grassy slopes and clear streams abounding with fish, with soothing music in the background. I asked the host about the video and the music, and he told me that he and his wife were trained musicians and were running a company, which was in the business of composing and providing calming music tracks to hospitals, to assist recuperating patients. That was 10 years ago. Likewise, if in our country, we were to respect research and knowledge of human psychology and architecture, and introduce such interventions, it will help in reducing stress and restoring calm. Small entrepreneurs could support hospital care with services like providing potted plants and pets (puppies/fishtanks) in casualty and waiting areas.

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    1. Nandkumar’s idea makes a lot of sense. I feel calmed in the waiting areas in US hospitals and clinics, seeing the pictures. They are large, the colours are “cool” and they are selected by, or donated by art experts. But they do not come cheap!

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  4. Respected Mam
    Thanks for the enlightening article. All the points are brilliant and up to the mark. I would like add a few more points in this context. According to me there can be another perspective of looking into this scenario. First of all we should not ignore the point that in many cases, ignorance of the hospital staff results into the deterioration of the health of the patient. We’ve also witnessed such cases where overdose of certain medicines or drugs have worsened the condition of patients. Sometimes, negligence or non-cooperation on the part of hospital staff fuels the anger of patient’s relatives. So basically there are two sides of a coin and we need to find a proper balance between the two. We need to find a peaceful way in which if the patient has lost his health due to heedlessness of the hospital staff; then the hospital also loses something.
    I am strictly against the method of violence adopted by the relatives to express their anger. Losing a loved one is very painful, losing a loved one due to the negligence of hospital can be traumatic but losing a loved one due to negligence and still not be able to do something about it can be gut wrenching and can further evoke violence. We need to alleviate that rage by providing the relatives a diplomatic and an amicable way of expressing their anger.

    Now the question arises as to how we would be able to do that or how to know that it was actually the carelessness of the hospital that cost the life of the patient. For this, we need to have a patient grievance redressal department in every district where the concerned relatives can approach and request the intervention of the department. The department can comprise retired government doctors so that they can immediately contact the hospital and demand a proper report of the treatment given to the patient. The department can also be armed to provide grades and categorize the hospitals on the basis of patient feedback. Too much of negative feedback and cases may account to scrutiny and further penalisation by the department. In this way we can keep a check on the performance of hospitals and also on public’s behaviour. The deployment of security personnel in the hospital can also help in controlling the situation.

    Regards
    Parik Dhamija

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