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Last week, as I studied communication theories and patient-centred communication frameworks for shared decision-making in healthcare in a classroom in Harvard University on a rainy Boston afternoon, doctors in Maharashtra went on strike over alleged assaults in emergency rooms. Based on reports I read from here, the attacks were said to be particularly violent, and the strike and protests from doctors that followed were also longer and more momentous. But apart from that, it was a story that plays out repeatedly in India, and one that I worked on at some length in Delhi as a reporter.
When politicians or the judiciary insinuate, or articulate directly, as they did this time, that doctors should not strike like other professionals, basing their argument on some higher moral obligation, the blame for triggering these reactions is put on news reports. I saw this repeatedly in my interactions with doctors as a journalist and now I see it in the classroom.
Communication is linked with public health, and doctors, programme managers and researchers involved in the myriad sectors of the field across the world, often find their paths crossing those of journalists. As someone who covered public health in India for a while, and now donning the student hat on the statistics, epidemiology and implementation science of it all, I find myself torn, trying to be “fair” in my reactions and assessments in these classroom debates.
It is hard to explain to anyone outside of journalism, the sheer doggedness it takes for journalists to go out every day in fields we learn about almost entirely just through telling stories about them, how we navigate systems and forces in specialised and super specialised fields, with no learning tools, making our own mistakes. Identifying stories that are worth telling, and the multiple stakeholders involved in each story, and chasing them to get that utopian “balance” is no mean feat. As an academic, a practitioner, a “source” of news, it is equally painful to see one’s narrative, one’s years of blood and sweat, being “twisted” for what has come to be everyone’s pet peeve about journalism — “sensational headlines”.
An argument that was brought up time and again in class discussions had to do with news stories on hospital-based deaths shooting up after the strike, with no effort to collate the average mortality or morbidity rates in the weeks or months prior to the strike. And even if the deaths did go up, the doctors in my class(es) argued, what was the evidence to relate them to the strike? Co-relation, as they teach you in any introductory statistics course, does not imply causation.
But what does a journalist reporting a story do when the counsel for a state agency (in this case, the Brihanmumbai Municipal Corporation) makes this argument in court? Taking state agencies at their word is not journalism, but not reporting an official statement made in court is also arguably not journalism either. Ideally, such a story should be followed with data analysis on mortality over, say, the last six months in the same hospitals.
Though this would still not establish whether or not the deaths over the last week were due to the strike, without eliminating confounders and a dozen other statistical nuances, it would demonstrate some effort at fact checking. But in a developing story, how many newsrooms would allow a journalist that freedom of time and space? And even if they did, how many journalists have the skill set to do that kind of analysis? Is this even the mandate of journalists or something academics must do and share their results with journalists? Before making official statements about these figures, should state agencies be engaging in this fact-checking themselves?
But antagonising those who are trying to tell their stories may not be very sound strategy for doctors. This is especially so at a time when public opinion seems crucial to achieving their rightful demands to workplace security. Patients’ kin engaging in violence in ERs is not a problem unique to India. Learning from communication strategies in other countries across the developing world, might be a good starting point. Doctors, particularly resident doctors, are the frontline face of public hospitals in India. As unfair as it may seem, the truth is that patients’ kin in public hospital emergencies do not understand who makes decisions on purchases of ventilators or medicines. To achieve that level of health literacy in patients in government hospitals will take some time.
Till then, the choice to not communicate and stay restricted in the silos of surgery rooms and research laboratories does not really exist for medical practitioners. As this strike underlined, physicians, administrators and public health professionals need to recognise communication as a skill that needs learning as any other.
As the world debates best practices for shared decision-making in healthcare, the images of doctors wearing helmets in workplaces, as creative as they may be as token protests, are not those that India’s public healthcare system should be associated with. There has to be a middle ground somewhere, for doctors and patients to communicate better, despite the resource constraints.