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Violence Against Doctors: Prevention, Administrative and Legal Recourse

Authors:
  • King Edward Memorial Hospital and Seth G S Medical College Mumbai Maharashtra India

Abstract

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. ‘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….’ 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. 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
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
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*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.
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.
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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 patientdoctor
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;
374:16619.
4. Wyatt R, Anderson-Drevs K, Van Male LM. Workplace
violence in health care: a critical issue with a
promising solution. JAMA. 2016; 316:10378.
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: 92737.
7. Ambesh P. Violence against doctors in the Indian
subcontinent: A rising bane. Indian Heart J. 2016;
68:74950.
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;
29:3448.
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.
ResearchGate has not been able to resolve any citations for this publication.
Article
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Incidents of violence against doctors in the Indian subcontinent have increased in the last few years. Most doctors in India, China, Pakistan, Nepal and Sri Lanka are concerned about their safety at work. The problem is worse in government hospitals, which characteristically lack appropriate security protocols. In order to tackle the issue, doctors need to accept the problem, discuss the various causative factors, understand the public sentiment and collaborate with the government to find a solution. Formulation of legal provisions and standards to ensure the safety of health workers is the need of the hour.
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Violence against health care professionals in the workplace is underreported and understudied. Additional data are needed to understand steps that might be taken to reduce the risk.
Article
Global Conference on Primary Health Care identified that promoting the primary healthcare system has become an important work. Workplace violence (WPV) against GPs is an important global problem. This study aimed to summarise the evidence on the prevalence of WPV against GPs. We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles to identify studies on reporting the prevalence of WPV against GPs. We included 15 eligible studies in this meta-analysis. 63.1% (95% confidence interval (CI): 55.6%–70.6%) experienced any form of WPV, 33.8% (95% CI: 25.3%–42.3%) encountered non-physical violence, and 8.5% (95% CI: 5.7%–11.4%) reported experiencing physical violence. The proportion of physical violence differed across study location, sex, and practice setting, and the prevalence of physical violence increased with study period. No significant differences in the prevalence of non-physical violence in sex and study location were found. The prevalence of WPV against GPs is high. A higher prevalence of physical violence was found in some Asian countries (such as China), male GPs, and primary care.
Article
We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I 2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.
Article
Violence against doctors is on the rise all over the world. However, India has a unique problem. Meagre government spending on healthcare has resulted in poor infrastructure and human resource crunch in government hospitals. Hence, people are forced to seek private healthcare. Small and medium private healthcare establishments, which provide the bulk of healthcare services, are isolated, disorganized and vulnerable to violence. Violence against health service providers is only a manifestation of this malady. The Prevention of Violence Against Medicare Persons and Institutions Acts, which have been notified in 19 states in the past 10 years, have failed to address the issue. To prevent violence against doctors, government spending on healthcare must be increased and the Indian Penal Code should be changed to provide for a tougher penalty that could act as a deterrent to violence against doctors.
Article
Background: Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. Methods: This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. Results: Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. Conclusions: A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.
Article
Workplace safety is a critical issue in health care. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed towards persons at work or on duty.”¹ This Viewpoint discusses the scope and characteristics of workplace violence in health care settings, relevant government regulations, the responsibility of health care leaders in addressing workplace violence, a model program for violence prevention in health care settings, and a comprehensive environmental risk analysis.
Assaults upon medical men
Assaults upon medical men. JAMA. 1892; 18:399-400.