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MULTISPECIALITY, MULTIDISCIPLINARY, NATIONAL
PEER REVIEWED, OPEN ACCESS, MLAM (SOCIETY) JOURNAL
Indexed with Scopus (Elsevier) & Index Copernicus (Poland)
January'-'June'2023' ' Volume'32' ' Issue'1'
PRINT'ISSN:'2277-1867'
ONLINE'ISSN:'2277-8853'
JOURNAL OF FORENSIC
MEDICINE SCIENCE AND LAW
Official Publication of Medicolegal Association of Maharashtra
Editor-in-chief
Dr Ravindra Deokar
Associate Editors
Dr Sadanand Bhise
Dr Sachin Patil
Editorial Office Address
Department of Forensic Medicine & Toxicology, Third Floor, Library Building, Seth G S Medical College & KEM Hospital, Parel,
Mumbai, Maharashtra, India. Pin-400 012. Email id: mlameditor@gmail.com Phone: 022-24107620 Mobile No. +91-9423016325.
JFMSL20233201010103
Journal of Forensic Medicine Science and Law 32 (1) (2023) 01-03
!
*Corresponding author: Dr Ravindra B Deokar, Professor (Additional), Department of Forensic Medicine, Seth G S
Medical College & KEM Hospital, Mumbai, Maharashtra, India. Email: ravindradeokar@kem.edu (M)+91-9423016325.!
Article Info: Received on: 07.02.2023; Accepted on: 24.05.2023.!
!
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!
Editorial
Violence Against Doctors: Prevention, Administrative and
Legal Recourse
Ravindra!B!Deokara*,!Sachin!S!Patilb!
aProfessor!(Additional),!Department!of!Forensic!Medicine!&!Toxicology,!Seth!G!S!Medical!college!&!KEM!Hospital,!
Parel,!Mumbai-400012.!!
bAssociate!Professor,!Department!of!Forensic!Medicine!&!Toxicology,!Lokmanya!Tilak!Municipal!Medical!college!&!
LTMG!Hospital,!Sion,!Mumbai-400022.!!
!
1. Introduction
Violence against doctors and healthcare
professionals/ hospitals is a great concerning issue.
Workplace violence (WPV) against general
practitioners, doctors and healthcare providers is an
important global issue.1,2
‘No physician, however conscientious or
careful, can tell what day or hour he may not be the
object of some undeserved attack, malicious
accusation, black mail or suit for damages….’3
It refers to physical, verbal, or psychological
aggression targeted at medical practitioners,
nurses, and other healthcare staff. This violence can
occur in hospitals, clinics, and other healthcare
settings. Recently, reports of violence against
doctors, including grievous hurt or murder, are
making headlines across the world.2
Majority of these violence cases (60-70%)
are violence took in the form of either verbal abuse
or aggressive gesture. Very often, abusers of a
medical person were patients themselves. They
were mostly under the influence of alcohol or drug.
It happened mostly in psychiatry ward or at
casualties. There is increased risk of violence when
a general physician is on call, particularly at
night.2,3,4
There are various important factors that
may be contribute to such incidents. Amongst
these commonest factors are emotional stress, long
wait times and frustration, disagreements over
treatment, lack of communication, cultural and
language barriers, resource limitations, mental
health issues, lack of security measures, lack of
training and de-escalation techniques.5
2. Global Perspectives:
The World Health Organization (WHO) has
recognized violence against doctors and healthcare
providers as a global issue. WHO estimate suggest
that about 8-38% of healthcare providers suffer
from physical violence at some point in their
professional careers. Study of violence against
healthcare providers from the USA in the 1980s
showed that 57% of emergency care workers have
been threatened with a weapon, whereas in the UK,
studies showed that 52% of doctors reported some
kind of violence.2-5
In Asia, violence against medical
professionals has been reported from China,
Pakistan, Israel, and Bangladesh. Prevalence rates
of violence against doctors have been higher in Asia
as compared to those of Western countries.6 Study
by Liu et al in 2019, aimed to quantify the
prevalence rates of workplace violence (WPV) by
patients and relatives against healthcare providers.
The prevalence is high, especially in Asian and
North American countries. Psychiatric wards and
casualty departments were most common settings.
JOURNAL OF FORENSIC
MEDICINE SCIENCE AND LAW
(Official Publication of Medicolegal Association of Maharashtra)
Email.id: mlameditor@gmail.com
PRINT ISSN:
2277-1867
ONLINE ISSN:
2277-8853
How to cite this article: Deokar RB, Patil SS. Violence Against Doctors: Prevention, Administrative and Legal Recourse.
J For Med Sci Law 2023;32(1):1-3.
Deokar'R,'Patil'S'''''''''''''''''''''''''''''''''''''''''''''''''''''''Journal'of'Forensic'Medicine'Science'and'Law'32'(1)'(2023)'1-3'
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Mostly nurses and on call physicians were
victims of such violence. There is a need of
collaborative efforts by policymakers, governments
and health institutions to take actions to address
issue of violence towards healthcare professionals.2
3. Indian perspective:
According to the study by Indian Medical
Association (IMA) in 2017, over 75% of doctors across
the country had faced some form of violence at their
workplace. The study also reported that over 50% of
doctors had experienced physical violence.7
Violence against doctors in India:
Healthcare professionals, including doctors,
nurses, and other medical staff, have been subjected
to various forms of violence, including physical
assaults, verbal abuse, and intimidation. This
phenomenon has led to protests, strikes, and calls for
better protection and security for medical
practitioners.8 Violence seen in various forms such as
telephonic threats, verbal abuse, intimidation,
physical but non-injurious assault, physical assault
causing simple or grievous injury, murder, vandalism,
and arson. Violence leads to develop psychological
issues in doctors such as depression, fear, and
anxiety, insomnia, posttraumatic stress leading to
absenteeism. Many doctors have injured themselves,
lost lives, lost their clinics, and also tarnished their
reputation as a professional.
Some key factors contributing to violence against
doctors in India
a. Policy factors: India's health-care spending is
close to 2% of the total budget. This is dismal
when compared to other countries.
b. Social factors: Impression of profit making
profession in the mind of general public and
patient, there are unrealistic expectation that
paying more money should save one's life.
c. Professional factors: Ineffective patient–doctor
communication, unempathetic approach by
healthcare providers.
d. Local Factors: Mob mentality, politician’s
interference.
Various Issues:
a. Lack of Communication: Poor communication
between doctors and patients, especially in
cases where there are language or cultural
barriers, can exacerbate misunderstandings and
conflict.
b. Media Influence: Negative portrayals of medical
professionals in the media can contribute to a
negative perception of doctors, which may
indirectly contribute to violence.
c. Legal and Ethical Issues: Legal and ethical
concerns related to medical practices can
sometimes lead to confrontations between
doctors and patients or their families. Even
though there is act passed by the Government of
India to prohibit violence against Medicare
service persons and damage or loss to property
of Medicare service institutions in year 2008 and
in Maharashtra, there is similar act “The
Maharashtra Medicare Service Persons and
Medicare Service Institutions (Prevention of
Violence and Damage or Loss to Property) Act,
2010” was Implemented in year 2010 but there
is improper implementation of these laws have
made them ineffective in curbing the violence
against the healthcare professionals. Other
sections like sec 425,427 IPC were not properly
implemented against the accused person.9
4. Prevention:
It is need of the hour. In general necessary
things are as follows-
a. Communication Improvement and improved
Doctor-Patient Relationship: Efforts to improve
the doctor-patient relationship, promote
transparency, and enhance patient education
have been made to reduce misunderstandings and
distrust.
b. Training Programs: Training programs for doctors
and healthcare staff in communication skills,
conflict resolution, and de-escalation techniques
have been introduced to better handle challenging
situations.
c. Mental Health Support.
d. Public Awareness Campaigns and increased
Public Engagement: Engaging with the public and
addressing concerns through open dialogue can
help build trust and improve relationships
between healthcare professionals and patients.
Awareness Campaigns helps to educate the public
about the importance of respecting healthcare
professionals and the consequences of violence.
e. Security Measures: Such as installing surveillance
cameras, increasing the presence of security
personnel, and improving access control.
f. Police Protection at hospitals: It is needed
especially in situations where there was a risk of
violence.
Deokar'R,'Patil'S'''''''''''''''''''''''''''''''''''''''''''''''''''''''Journal'of'Forensic'Medicine'Science'and'Law'32'(1)'(2023)'1-3'
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g. Legal Measures: Stringent law and strict
implementation.
h. Fast-Track Courts: It will help to expedite the legal
proceedings for cases related to violence against
doctors.
i. Collaborative efforts: between healthcare
institutions, government bodies, law
enforcement, medical associations, and the
general public. A multifaceted approach involving
healthcare institutions, governments,
communities, and the public to address the issues.
Doctor’s role:
1. Effective doctor-patient communication:
a. Improve relationship, use anxiety alleviation
techniques,
b. Better training to tackle these situations
c. Optimize and reduce the long waiting periods
for the needy patients.
2. Security Measures:
a. Installing surveillance cameras,
b. Increasing the presence of security
personnel, and
c. Improving access control.
Hospital administration Role:
a. Improvement of services in a global fashion.
b. Employ sufficient number of doctors.
c. Undertake steps to tackle the patients rush
and address long waiting hours issue.
d. Use of computer and internet technology,
e. Strengthen hospital security and easy
interlocking with the local police.
f. Arms/ammunition should not allowed to
patient or their relatives in the hospital.
g. Bring transparency on rates of different
consultation charges, investigations rate,
rents and other hospital related expenses.
h. Install proper complaint redressal system in
the healthcare instituion.
i. Indian Penal Code (IPC) contains several
provisions that can be invoked in cases of
violence against doctors and healthcare
professionals.
5. Conclusion:
Although violence against health care
providers is common, the incidence of severe forms
of violence in India is increasing. Many remedies have
been used to tackle this situation. There is need of
collaborative efforts between healthcare institutions,
government bodies, law enforcement agencies,
doctors associations, and the general public.
A multifaceted collaborative approach
involving governments, healthcare institutions,
medical associations, media, communities, and the
public is needed to address the issues. It result to
improve health care delivery to needy and minimise
violence against doctors.
References:
1. Assaults upon medical men. JAMA. 1892; 18:399–
400.
2. Tian K, Xiao X, Zeng R, Xia W, Feng J, Gan Y et al.
Prevalence of workplace violence against general
practitioners: A systematic review and meta-analysis.
Int J Health Plann Manage. 2022;37(3):1238-51.
3. Phillips JP. Workplace violence against health care
workers in the United States. N Engl J Med. 2016;
374:1661–9.
4. Wyatt R, Anderson-Drevs K, Van Male LM. Workplace
violence in health care: a critical issue with a
promising solution. JAMA. 2016; 316:1037–8.
5. WHO. Violence against health workers. Geneva:
WHO; 2019.
6. Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, et al.
Prevalence of workplace violence against healthcare
workers: a systematic review and meta-analysis.
Occup Environ Med. 2019;76: 927–37.
7. Ambesh P. Violence against doctors in the Indian
subcontinent: A rising bane. Indian Heart J. 2016;
68:749–50.
8. Anand T, Grover S, Kumar R, Kumar M, Ingle GK.
Workplace violence against resident doctors in a
tertiary care hospital in Delhi. Natl Med J India. 2016;
29:344–8.
9. Nagpal N. Incidents of violence against doctors in
India: Can these be prevented? The National Medical
Journal of India. 2017;30(2): 97-100.