The doctor’s strike in Kolkata’s NRS Medical College that snowballed into a nationwide stir has flagged the faultlines in the doctor-patient relationship. More than three lakh physicians in several parts of the country struck work on Monday in response to a call by the Indian Medical Association (IMA); their counterparts in West Bengal called off a week-long strike late evening after West Bengal Chief Minister Mamata Banerjee agreed to their demands. The IMA has demanded a safe working environment and a “national law against violence in hospitals”. There can be no quarrel against this demand. However, it’s also a fact that 19 states, including West Bengal, have passed the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, which outlaws attacks against physicians. Offenders can be sentenced to jail term of up to three years and levied a fine of Rs 50,000. The failure of such remedies to curb violence against medical personnel points to deeper problems that dog the doctor-patient relationship in the country’s hospitals.
The atmosphere at the emergency, casualty or OPD wards of most government — and private — hospitals is nowhere close to being congenial for those suffering serious illness. Tempers often run high when patients have to contend with overcrowded and unhygienic facilities, the waiting time to meet specialists is painfully long and several visits have to be made to get even basic investigations conducted. At the same time, the debate on medical ethics in India has not progressed much beyond the doctor-patient binary. This has not only prevented the satisfactory resolution of complex systemic problems pertaining to the rights of patients and physicians, but has also resulted in junior doctors becoming the face of the failure of the country’s healthcare system. One such doctor incurred the wrath of a deceased patient’s family at NRS Medical College.
Whatever be the provocation, the violence against doctors is inexcusable. But the episode lays bare an aspect of the country’s healthcare system that hasn’t received adequate attention in the policy discourse: Physicians, especially junior doctors, lack the communication skills to engage with emotionally-charged relatives of patients suffering life-threatening diseases. Such skills hold the key to building trust between doctors and their patients — or their relatives. The doctor’s relationship towards patient is largely paternalistic. This means that very rarely does a doctor convey to a patient, in a jargon-free language, the complexities of his ailment or counsels him about dealing with its symptoms or prepares him mentally for a long-drawn therapy. Young doctors have scarcely any training in being empathetic while conveying bad news to patients’ relatives. These lacunae have much to do with the IMA’s dwindling credibility. Hit by several scams in the past five years, the internal regulator of medical practice in India has failed to be an interlocutor between doctors and patients. The NRS incident underscores the need for institutional interventions to rebuild the doctor-patient relationship.