Recently my clinic routine was disturbed by a "Breaking News". There were reports of a shooting at Brigham and Women's Hospital, a teaching affiliate of the Harvard Medical School. Now, gun violence is not uncommon in America, but the details of this case left me numb. Dr. Michael Davidson, forty-four year old Director of endovascular cardiac surgery at Brigham and Women's Hospital and father of three young children (Aged 9, 7 and 2) was killed in cold blood by gunman Stephen Pasceri. Dr. Davidson had treated Pasceri's seventy-nine-year-old mother and apparently there had been some complication and she had died. Pasceri, blaming her physician walked into the hospital, sought Dr. Davidson out and shot him in cold blood in the very clinic where he used to treat patients. His friends and colleagues rushed him to the operating room, but unfortunately he succumbed to his injuries.
This tragic incident brought back memories of being on call as a young physician in a busy hospital in Delhi more than a decade ago. Physical attacks on doctors are relatively rare in America, but unfortunately commonplace in India. What I'm about to describe now is not an uncommon scenario in the Indian setting: A patient in the casualty/emergency room or Intensive Care Unit (ICU), in a critical state succumbs to their illness. The doctor delivering the bad news is assaulted by the patient's family members. This was India, fifteen years ago. One would hope that things have improved over the last decade or more: but what if I told you that the situation has gone from bad to worse. An ongoing study of the Indian Medical Association (IMA) revealed that over 75% of doctors have faced violence at the work place.
In September 2013, a lady doctor on call at the Lok Nayak Hospital in Delhi was physically assaulted and apparently threatened with rape by a patient's kin. Her crime: two patients had come in at the same time and she had attended to the sicker patient first, which allegedly upset the other patient's relatives. Earlier this year, a doctor was assaulted in Allahabad and the infrastructure in the ICU damaged by relatives of an eighty-year-old patient who apparently came in with multi organ failure and died in the hospital. The tragedy is that the brunt of this senseless violence is often borne by junior doctors who are on call at night, when these attacks are more prone to happen. This is very disheartening and can demoralize the future doctors of our country. Some of the reasons attributed for the violence include misunderstanding between physicians and patients or their families, cost of medical care and a delay in attending to the patient.
Complicating the issue is the fact that medicine is not a smooth road; it is filled with speed breakers and outcomes are not always good. Anger against doctors or health care professionals is justifiable if family members believe that they have been wronged, however, resorting to violence is not the solution. This trend towards increasing violence can result in unintended consequences and may deter physicians from taking up complicated cases that have a high percentage chance of poor outcomes, out of fear of physical harm or threats. Physicians are demanding tougher laws against assault at the workplace and more security in the hospitals. In response, some states have passed Medical Protection Acts, but so far it is not clear if they have made an impact in curbing the attacks. Some have suggested more effective communication between doctors and patients (including incorporating communication skills as a part of the medical curriculum) as a tool to decrease patient dissatisfaction.
This is a very complex issue and the solution involves many stakeholders, however, there remains an urgent need to address this problem in order to stem the tide of violence. Not long ago having a physician in the family was a source of significant pride and this tradition was passed down generations. Now, some physicians are actively discouraging their children from a future in medicine. Hospitals should be places of compassion, caring and healing; not police zones with senseless violence and killings.
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