Do we need a reliable and effective Central Medicare Act or a policy to limit the number of patients a doctor should attend in a given facility and time? Maybe both.
At a recently held national seminar on “Violence against doctors,” hosted by the Indian Medical Association (IMA), a demand was to bring in a reliable and effective Central Medicare Act. Strong legal action against those who indulge in this kind of violence will hopefully deter people. Is it the lack of a competent legislature, the only reason why people indulge in violence at places they primarily come to seek help? Or it is more than that. And are these sporadic incidences or there lies an underlying pattern.
Deficient man power
Those of us who have associations with teaching hospitals can see a definite pattern in most of these. These events mostly happen in those departments which have a high inflow of critical patients presenting as an emergency. Trauma centers, neurosurgery, medicine, pediatrics are most at risk. There are hardly any of these cases from the department not dealing with life-threatening conditions in an emergency. ENT, eye, skin psychiatry are the examples. Secondly, the episodes almost always take place after the prime working hours have passed, it is usually after five pm. In these hours most of the regular strength of doctors and support staff has left, and only the emergency team and support staff is there.
Lack of protocol for crowd management
It’s no secret, in what state of mind the relatives of critical patients is when rushing to the hospital in odd hours? Often a single patient is accompanied by more relatives the waiting room can accommodate. There is the blood relatives, distant relatives, just relatives, neighbors, coworkers, and friends. If the patients patient happens to some association with any religious or political organization, then, of course, their office bearers.
Now every hospital has a crowd management policy. And mostly it is to delegate the responsibility to some private security agency which in turn post few underpaid and untrained but well-dressed guards at the critical point. This crucial point is often the door between waiting room for relatives and the examination room/ward for patients. The guard will stop an educated female relative, argue with a male, plead with someone with authority in the air and step aside if someone is in khaki or khadi.
So very soon, the whole of the examination room/ward is flooded with all the variety of relatives of this last patient presenting in an emergency. Now you do not need to be a doctor to figure out, the first thing they all want. They want immediate attention and answers to their questions. There are sisters and support staff there, but those are too busy with their routine work of other patients on the beds. So they point the finger to the doctor.
lack of experience leadership
Now it is emergency hours, so do not expect the regular faculty to be in the ward. All you have are the resident doctors. Since we have a strict hierarchy system in residency, only the juniors are in the wards — the house officer who is getting oriented and the second year junior resident who has just obtained orientation.
The first struggle is to arrange the bed for the newcomer. Since we have a universal policy not to refuse treatment a patient, so the beds are already full, and the corridor is filling fast. Same is for the availability of other necessary equipment, staff, and nursing support. The resident doctor is desperately trying to provide the thing to patients; however, he can.
Delayed decision making
Now in this scenario, the relative of the newcomer patient want a bed, the attention and the answers and they want it urgently. The request is first ignored, then politely refused. When they insisted, they were shouted at, by the sister that it is obvious, she is busy. Then there is an argument between both the parties on who is right in their situation, and the mercury begins to rise. What ensues is a heated argument, exchange of threats followed by obscenities and sometimes a fight.
Never learn from mistakes!
After this, the system gets up from its slumber. Faculty rushes in, and so are more security guards. But the media person and the police from local chowki arrive first. Police pacify both the parties; media person gets the news for next day. Relatives take their patient to some other facility and residents go to strike. After a few days they come back to the ward for duty, and the routine continues.
Now the question is, do we need a reliable and effective Central Medicare Act or a policy to limit the number of patients a doctor should attend in a given facility and time? Maybe both.