“Ek baar to maar khana hi padega warna doctor kaise banoge (You have to be beaten up at least once to become a doctor).”
These words are commonly heard at medical colleges and are the very belief on which many aspiring doctors enter the profession. From treating people carrying the gravest of diseases to rushing bodies shredded by accidents, blasts and gunshots to the emergency rooms, healing those with excruciating pain to delivering heartbreaking news to families – doctors have one of the toughest jobs and yet, sometimes their efforts go thankless. With each passing day, the number of headlines about doctors being abused, attacked, stabbed, and killed is growing. To be in such a high-pressure environment where a human’s life depends on their actions, facing harassment certainly takes a toll on their mental well-being. But after working for hours and sometimes days straight, do they even have the time to think of their mental health?
Depression, stress, anxiety, and burnout – these terms may be of common knowledge to doctors but when it comes to their own health, these symptoms are often sidelined so that they can focus on healing people and saving lives.
“There are days when we have had to be on duty for more than 24 hours…once I had to be on duty at a continuous stretch for 56 hours in the labour room,” says Dr Bhaskar Das, a psychiatrist at NRS Medical College and Hospital, Kolkata. In such demanding situations, how does one prioritise their mental health before the health of the patient whose life is in their hands?
The medical fraternity in India is overburdened. According to a survey conducted by the Indian Medical Association (IMA), more than 80 per cent of doctors are overwhelmed and stressed and fear of violence is the primary stressor for 46.3 per cent of them. At least 75 per cent of doctors in India have also faced violence at some level and mostly the patient’s relatives are involved.
“There was one incident when I was studying at RG Kar Medical College. A patient had died due to the non-availability of blood. In a government hospital setup, a patient’s attendant needs to be present for these situations like to get blood from the blood bank, but there was no one there. When the patient died, the patient’s relatives came charging at the doctors, one of them tried to hit me,” he says.
For the families of patients, especially in the rural parts of the country, many of whom are not educated enough, doctors are the only point of contact and their only hope to save their loved ones. But in that, they often forget that the doctor’s only job is to treat the patient, not take care of the administrative and logistical processes that come before treatment.
The issue of violence against doctors and medical professionals arises from various factors including improper management, high costs and poorly funded system, and the increased commercialisation of private hospitals. In such a situation, to deal with verbal and physical abuse, doctors need protection under the law, something that has been denied to them on the central front.
The Trigger Point
“In most cases, there’s a communication gap between the patient’s family or attendant and the medical staff. So in case of a patient death, even if we give an explanation of why they died, they (the families) do not even want to listen to us…most of the time they are in such shock that don’t even have the mental capacity to listen to us. So they attack us,” Dr Bhaskar explains.
To date, he adds, we have not been able to bridge the gap between doctors and patients, wherein lies the core fault of the rise in attacks against doctors.
“These incidents happen because of the way hospital management and administration works and partly because of patient attendants.”
Dr Ashar, a young graduate who recently completed his internship at the North Bengal Medical College (NBMC), shares a similar concern but says that there is no way out of these situations. “We are so short-staffed, especially those of us working at government hospitals, that we end up working extremely long hours and become used to it.” He says that the overwork pushes them to function almost robotically, devoid of empathy even in grim situations like deaths.
“Somewhere the blame is also on us – on the growing apathy among young doctors which has become a major concern everywhere. If I see a patient die in front of me, my reaction will be very different from yours,” Dr Ashar says adding that rarely ever can they follow the proper instructions advised by the World Health Organization to break the bad news to a bereaved family because they have multiple patients to take care of at the same time.
The ruthless nature of the profession often makes doctors devoid of empathy, potentially coming across as rude, which triggers the patient attendant or family.
“All we can say is that we tried, the patient could not be resuscitated, the patient is no more and you can take the body in four hours – this is the memorised line we tell families and we have to do it so often that we become indifferent to their emotions. When that happens, sometimes the relatives feel we are rude and we might not have done enough to save their loved one," he says.
Further, he adds, “A single wrong word can agitate the patient’s family and they’ll come lashing at us."
While male doctors are at the helm of physical violence, female doctors face the struggle of being taken seriously. Dr Sejuti Saha, who practices at Kothari Medical Centre, says her biggest struggle with patients and families is to be considered a doctor. “Although I’m lucky to not have faced any bout of physical violence, I face gender discrimination and harassment on a regular basis.”
Dr Sejuti says that because she is a woman, most patients and families do not even consider her a doctor.
“We are never respected as doctors. Either we are nurses to them or just some group staff. There have been cases where we have dealt with the patient from start to end but when it comes to acknowledgement, they don’t even call us doctors. To them, we are a ‘sister’ or ‘nurse’ etc," she says.
Silence On Mental Health
When asked about whether or not the budding professionals are given the training to deal with such situations, Dr Ashar laughs and says that although the medical curriculum is changing rapidly, he has not heard of any junior who received any kind of training to deal with violence and harassment from patient families even with the rise of such cases.
Dr Ashar also says that seniors remind them of how to prepare for hospitals saying things like, “You have to be beaten up to become a doctor”.
Dr Bhaskar adds to this by saying there is no specific channel for doctors and medical professionals to talk about their mental health and well-being. “There is no arrangement or program created till now for doctors to channel their mental health. It is very important to look into it because the rate of suicide among young doctors is increasing because of burnout and workload. They drastically reduce weight during their internships and get no time to meet their parents or families,” he says.
What all of them agreed was that even though they might be overworked and underpaid, mental health remains the last thing on the list for a doctor in India. According to various studies across the world, healthcare professionals, especially resident doctors and trainees are prone to developing mental health problems such as depression, anxiety, and substance abuse because they often face the brunt of the occupational hazard of overwork. But like any other profession, the medical fraternity is also in dire need of work-life balance.
Burnout, suicides, and mental issues are twice as common in the medical field than elsewhere. Ironically, the existing literature on the psychological problems of doctors and medical practitioners is still limited to a few surveys.
To add to that is the fear of violence steering more and more aspiring doctors away from the field. If this continues, Dr Bhaskar says, “In future years, India will face a shortage of doctors because the younger generations that are just stepping into the profession now want to go abroad and practice somewhere outside India. And many others are also quitting the line entirely,” adding that students in medical colleges have stopped taking specialised subjects where they have to interact with the patient.
“Even the top-ranking students in this year’s AIIMS list did not have any specialised subjects, they were all theoretical, to avoid uncomfortable scenarios,” he says.
For a populous country like India, to have a health system that is responsive to people, it is crucial that it is in conformity with their dignity, that they are not bearing the brunt of being first in line of duty, and that they are not beaten up.