A Doctor’s Perspective On Hostility Towards Critical Care Physicians From Patients’ Attendants

When Vandana Das, a young medical practitioner, was stabbed to death by an intoxicated patient in a Kerala hospital on May 10, it simply added to the long list of attacks on doctors and healthcare workers in India. The attacks on healthcare professionals have become so common that during the Covid-19 pandemic, there were hardly any protests against the everyday humiliation and attacks on doctors in their rented houses, colonies, and other places. 

If one goes by the global data, 62 per cent healthcare workers have faced attacks in their workplace among which 25 per cent suffered physical assault and 57 per cent experienced verbal abuse. A study conducted by Gayatri Kuppuswami and Uma Warrier, in the backdrop of attacks on doctors during Covid-19 pandemic found that 75 per cent of Indian doctors witnessed some form of violence during their career. Moreover, 63 per cent of the doctors don’t even want to visit the patient due to fear of violence. However, most such cases could be found in stress situations either in the psychiatric wards or intensive care units (ICUs).  

In the fast-paced and high-stakes world of critical care medicine, where life and death decisions are made daily, critical care physicians take centre stage. These highly skilled medical professionals work tirelessly to save lives, particularly those of patients admitted to the ICU in corporate hospitals. However, it is unfortunate that they often face hostility from patient attendants, who may not fully grasp the critical role these physicians play in the challenging Indian healthcare scenario. 

Corporate hospitals in India often cater to a large volume of patients, including those with severe illnesses requiring ICU admission. In India, as per the data from 2020, there are 43,486 private hospitals with 1.18 million beds, 59,264 ICUs, and 29,631 ventilators. This is in contrast to 25,778 public hospitals, 7,13,986 beds, 35,700 ICUs, and 17,850 ventilators. The health budget of India grew only by 0.39 per cent from 2011 to 2020. Against this backdrop, these private hospitals provide advanced medical facilities and technology, attracting patients seeking the best possible care. However, this influx of patients can strain resources, leading to longer waiting times, limited access to physicians, and heightened tensions among patient attendants. 

One of the primary reasons for hostility towards critical care physicians is the lack of understanding about their role. Patient attendants, already stressed by their loved one's critical condition, may harbour misconceptions or hold unrealistic expectations. They may perceive delays or perceived lack of attention as negligence, leading to frustration and anger. A few thoughtful actions may change perceptions.  

Firstly, effective communication is crucial in critical care, but it can be challenging given the high patient load and the complexity of medical conditions. Attendees often feel left in the dark about the patient's progress, treatment plans, or expected outcomes. This lack of communication fuels their anxiety and exacerbates their negative perceptions. 

A patient’s critical condition induces profound emotional stress in patient attendants. Fear, uncertainty, and grief can manifest as anger or hostility when directed towards healthcare professionals. This emotional strain, coupled with the pressure to make life-altering decisions, may contribute to their antagonistic behaviour. 

In the Indian healthcare landscape, familial involvement in patient care is highly prevalent. Patient attendants often expect a more active role and decision-making authority in critical care management. When confronted with a healthcare system that may not align with their cultural expectations, tension can arise. Besides, in the Indian healthcare system, financial constraints are a significant factor contributing to the hostility faced by critical care doctors, even though most of them are salaried employees in corporate hospitals. These financial challenges can arise from several sources.

Critical care services in corporate hospitals often come with substantial financial burdens. Patients and their attendants may face exorbitant expenses for diagnostic tests, medications, procedures, and ICU stays. Only during the height of the Covid-19 pandemic, the private hospitals charged Rs. 20-25,000 a day without ventilator support. In a few cases, a 10-day stay in a private hospital reached a staggering Rs. 4 lakhs. In this scenario, attendants may direct their frustration towards the physicians, wrongly perceiving them as solely responsible for the financial burden. 

Health insurance coverage in India may have limitations, including high deductibles, co-payments, or exclusions for certain procedures or medications. Attendees may encounter unexpected out-of-pocket expenses, leading to heightened financial stress. Unfortunately, this can result in hostility towards critical care doctors, who may be seen as part of a system that exacerbates their financial strain. Besides, only 37mper cent of the Indian population have access to health insurance as per the data of 2021. Almost 400 million people in the country are still living out of its ambit.  

Critical care physicians in corporate hospitals are considered the backbone of life-saving interventions. They are trained to make split-second decisions, navigate complex medical cases, and coordinate multidisciplinary care teams. Their expertise, dedication, and round-the-clock availability are pivotal in saving lives. Acknowledging their immense contribution can bridge the gap between patient attendants and these unsung heroes. 

Building Trust and Collaboration: To address the hostility faced by critical care physicians, hospitals can implement measures to foster trust, enhance communication, and promote collaboration: 

1. Effective communication channels: Establishing clear lines of communication between healthcare providers and patient attendants is crucial. Regular updates, setting realistic expectations, and addressing concerns promptly can significantly reduce hostility. 

2. Empathy and patient education: Healthcare professionals should demonstrate empathy and take the time to educate patient attendants about the critical care process, treatment plans, and potential complications. This knowledge empowers them to make informed decisions and eases their anxieties. 

3. Increased family engagement: Encouraging family engagement, where appropriate, in decision-making processes can help alleviate concerns and ensure that patient attendants feel involved in the care of their loved ones. 

4. Supportive counselling services: Providing emotional support through dedicated counselling services can help patient attendants cope with the stress and grief associated with critical illnesses. 

To mitigate the hostility arising from financial constraints, healthcare institutions and critical care physicians can take certain measures: 

1. Financial counselling: Hospitals can provide dedicated financial counselling services to help patients and their attendants understand the costs associated with critical care. This can include providing information on insurance coverage, financial assistance programs, and potential avenues for reducing expenses. 

2. Enhanced transparency: Ensuring transparency in healthcare costs is essential. Hospitals can make efforts to clearly communicate the financial implications of critical care services upfront, enabling patients and their attendants to make informed decisions. 

3. Social support services: Establishing support services to assist patients and their families in navigating the financial aspects of critical care can help alleviate stress and hostility. This can involve connecting them with resources, such as government schemes, charitable organisations, or crowdfunding platforms. 

4. Advocacy and policy changes: Healthcare providers and professional organisations can advocate for policy changes that address the financial challenges faced by patients. This may involve lobbying for improved insurance coverage, regulatory measures to control healthcare costs, and increased accessibility to affordable critical care services. 

Financial constraints, although unrelated to the direct actions of critical care doctors, can significantly contribute to the hostility faced by these healthcare professionals. By implementing strategies that enhance transparency, offer financial counselling, and advocate for policy changes, hospitals and physicians can help address these concerns. Ultimately, alleviating the financial burdens on patients and their attendants can contribute to a more supportive and collaborative environment in critical care settings. 

(Dr. Ajit K Thakur is Associate Director and Head of the Department of Critical Care, Asian Institute of Medical Sciences. Dr Nitin Saluja is a Consultant of Critical Care at the Asian Institute of Medical Sciences. Views expressed are personal.)