Who will take care of our medicos?

The recent attack on a doctor at the Rajiv Gandhi Government General Hospital has yet again turned the spotlight on the lack of safety and security for doctors on duty. The Tamil Nadu Medical Council says that every month, at least one attack is reported on a doctor or a paramedical staff in the state. While there is a stringent act in place—Tamil Nadu Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act passed in 2008-—which prohibits violence against medicare service persons and damage or loss to property of medicare service institutions, till date there has been no conviction. On the other hand, experts attribute the frequent attacks to the poor infrastructure and doctor to patient ratio that leaves the common man frustrated. 

In 2008, an attack on a doctor at the Ponneri GH triggered a state-wide agitation by doctors. A persistent fight by the members of the Tamil Nadu Medical Council (TNMC) brought into effect the Hospital Protection Act that prohibits violence against medicare service persons and damage or loss to property of medicare service institutions. However, nine years later, despite the existence of a tough Act, not much has changed on the ground. 

Dr K Senthil, President, TNMC says that so far no one has been convicted under the Act. He says that the TNMC had rallied in support of the doctors and ensured that the then government passed the Hospital Protection Act. “But till date, sadly there has been no convictions. The Act is extremely tough and prescribes a sentence of anywhere between three and 10 years. But either doctors don’t want to pursue the case — especially if they continue to practice in the same facility—or the perpetrators threaten them to arrive at a compromise, since the case drags on for years.,” he says. 

He adds that restricting the number of attendants for patients would be an effective solution. “These attacks most often happen in the casualty ward, where more than 10 or more assemble from the patient’s side. While in private hospitals they have been able to restrict the number of attendants, government facilities and smaller hospitals haven’t been able to control the crowd,” he says. 

Earlier this week, a commotion broke out at a Salem government facility. A person who had been admitted died and there was just one nurse on duty to attend to eight wards. Citing the incident, Dr GR Ravindranath, general secretary, Doctors Association for Social Equality (DASE), says that addressing poor infrastructure in the health system should be the primary goal of the state and central governments. “The doctor- patient ratio in our state is 1:750, which is just about average. A meagre 1.15 per cent of the GDP is being spent on health. As a result, the healthcare facilities are inadequate. The desperate common man directs his angst against doctors who are unable to attend to the sea of patients. In the government set up, there is no accountability,” he says. 

Ravindranath adds that the state government’s promise of CCTV cameras and security cannot address the deep rot in the system. 

Dr S Gurushankar, President of Tamil Nadu Chapter of Association of Healthcare Providers of India (AHPI), who met Union Minister of Health and Family Welfare JP Nadda to raise the issue of violent attacks on doctors, reckons that the continuing attacks will affect rural medical services in the long run. “If doctors continue to be assaulted, then taking healthcare to rural parts of the country will not be possible and the entire health infrastructure may be at risk of failure,’ he says. He adds that India’s public health system is overburdened, with only nine hospital beds per 10,000 people, compared to the global average of 29, putting a serious strain on the doctor-patient relationship. 

Dr Vijayakumar Chockkan, Director, Medical Services, SIMS Hospital, says, “No doctor wants the patients under their care to die. The patients and their near and dear ones should understand that the doctors on duty do their best. They put the current knowledge and evidence based approach to heal and treat their patient for the best clinical outcomes.”