Medicosnext
Words by Dr Rajendra Pandey
Loss of a loved one is the most painful experience, but irrespective of the cause of death, violence against doctors is never ever justified. It is barbarism, should never be tolerated and must always be punished.”
“There is an exceptionally high calibre of doctors in Nepal. What is common amongst these doctors apart from being experts in their field is they have excellent communication skills. They deal with their patients with respect irrespective of their status.”
“While there is breath there is hope is an unrealistic expression for patients whose treatment options are exhausted. Doctors can reasonably predict life expectancy (with exceptions) in patients who are seriously unwell, in life support systems, have multi-organ failure or terminal cancers, etc.”
Loss of a loved one is the most painful experience, but irrespective of the cause of death, violence against doctors is never ever justified. It is barbarism, should never be tolerated and must always be punished. If there is no deterrent it will keep on recurring. In an unsafe atmosphere, doctors will practice defensive medicine and who can blame them for doing so.
Dengue can randomly kill anyone in any hospital, anywhere. Why were the two doctors at the Sancho Hospital in Hetauda physically assaulted following the death of a patient with Dengue?
- Was it due to a sense of loss and anger?
- Was it due to perceived medical negligence?
- Was it due to unexpected expectations from the healthcare system?
- Was it due to communication related issues?
Or simply because there is no system to protect doctors who become an easy target. There have been several similar incidents before and after what happened at Hetauda Hospital.
Unlike in western countries, there are no trusted legal pathways to take action against doctors for alleged negligence. Bereaved families vent their anger against doctors on the spot. Doctors are vulnerable due to a lack of protection given by authorities and a misunderstanding of the situation by the bereaved family.
After an incidence of assault, apart from false assurances nothing is ever done to prevent the next one. This cycle of violence against doctors followed by protests from doctors themselves just keeps repeating. Ultimately this harms the people trying to access healthcare which is already limited. For those connected to politics and convicted by the court as criminals, new laws have been passed by parliament to release them from jail without completing their sentences, however there is a reluctance by the government to punish the culprits involved in violence against doctors as per existing rules and laws.
For doctors, when an ill patient recovers it is a matter of immense joy. Unfortunately, illnesses can kill, which comes as an unexpected shock to the family and at times it is not the result doctors were expecting either. Why does the family and friends of the deceased then resort to violence? Why has society lost respect and faith in doctors?
Complication vs Negligence
There is a lack of awareness as to what medical negligence is, and what it is not. In medico legal terms, medical negligence is when there is a breach of care (substandard or negligent care) by a healthcare professional or a hospital, leading to the avoidable harm of a patient (causation). There are a number of ways medical negligence can occur i.e. misdiagnosis, incorrect treatment or surgical error. In a large majority of cases what is perceived as medical negligence is actually a complication of the surgery or illness. In a court of law, complications during treatment are not necessarily recognized as medical negligence.
Clinical practice is largely an art of communication
Medicine is an evidence based science, but how we practice it is largely an art of communication. It is not just about treating illnesses, but also managing anxieties and expectations. It is not enough to treat, it is equally important to counsel and communicate with empathy. It is also vital to share uncertainty and risks involved in the clinical course where appropriate.
Empowering patients with facts and advice helps formulate a management plan agreed upon by the patient which makes the patient an equal stakeholder in his or her treatment. It helps avoid anger and resentment against the doctor, should the future clinical course not go as expected. Patients after making informed choices will therefore not blame doctors, should events not follow an expected course. This modern empowered patient is as much responsible for his treatment, and its success or failure as the doctor. When patients attend hospital, they are vulnerable, anxious and are intimidated by the environment. Any miscommunication or unsympathetic attitude can easily trigger a hostile reaction from the family of the patients. Breaking bad news to patients also requires extra sensitivity, people may forget what was said but will always remember how it was said. Be kind – is the common sense teaching.
There is an exceptionally high calibre of doctors in Nepal. What is common amongst these doctors apart from being experts in their field is they have excellent communication skills. They deal with their patients with respect irrespective of their status. They are empathic, make eye contact, show compassion and reassure where appropriate. They do not get offended when questions are raised by the patients about their illnesses or treatment, instead they explain and address their concerns.
Doctor is not God anymore
Nothing has changed the world we live in more than the internet. It has demolished many myths, doctor is god, is one of them. To an extent ‘Dr Google’ has taken away godly power from the medical profession. Everyone interested is empowered with information from the same source as doctors.
When patients visit their doctors they may already have some idea about their diagnosis, investigations and even their treatment. Doctors can no longer afford to feel offended when patients/families raise questions about their illnesses and treatment. After all, it concerns them and they are the ones suffering from the disease, and on top of it they have paid for the service doctors are providing.
‘Dr God’ who did not have to answer to his believers after giving his blessings in the form of a prescription in the olden days, has now been given retirement by ‘Dr Google’. Counselling, patients’ ideas and expectations, risks of treatments, which were hardly heard of 50 years ago are now the backbone of modern medicine helping both the patients and the medical profession.
Lack of trust and respect
Doctors in years gone by commanded far more respect than in today’s world. There was no Google or the more recent chatGPT to question doctor’s advice. Only doctors knew what they were doing, and there were not enough investigations available to challenge the doctors’ diagnosis. There are so many grey areas in medicine, so often it is not black and white. As a result there are many different ways of managing a patient. It is very unprofessional for any doctor to criticize another doctor’s management plan unnecessarily. Unfortunately, this unprofessional practice is so widespread in Nepal that it has contributed to society as a whole not trusting the majority of doctors they come across. It results in patients seeking second and third opinions unnecessarily. When doctors themselves do not seem to trust each other’s why would the society right?
Unrealistic expectations, while there’s breath there is hope
There are unrealistic expectations from a healthcare system which is working under adverse circumstances due to a lack of doctors, nurses and every other specialty associated with health care. There is a serious lack of investment in the health sector by the state.
Where nothing else seems to be in order, it is unfair to pick on doctors. Politics is dirty, the system is corrupt, traffic is always in disarray, and people lose their lives crossing the road or falling in the potholes, even the ambulances do not get an easy way to the hospital.
While there is breath there is hope is an unrealistic expression for patients whose treatment options are exhausted. Doctors can reasonably predict life expectancy (with exceptions) in patients who are seriously unwell, in life support systems, have multi-organ failure or terminal cancers, etc.
For all of us, our journey on this earth will come to an end one day. Selling one’s last piece of land may only buy another 6-12 months of misery. Doctors can’t treat death, which is the ultimate truth. Rather than fighting the truth and doctors, it is much better to give our loved ones spiritual support and a dignified send off from this world.
Role of media
Surveys across the world have consistently shown the medical profession to be the most respected one. However, after an unexpected death, the media often builds up a narrative against the doctors which is not factual. It is demoralizing to the doctors and encourages abuse against them.
Lack of trusted pathway to investigate alleged negligence
It is not only doctors who need protection against violence but families too need protection against medical malpractice. For those who have lost a loved one they need a transparent mechanism whereby they can understand the cause of death. It will definitely help them cope with their loss. The Medical profession owes this transparency to the people they serve.
Conclusion
In the sphere of healthcare, the violence against doctors persists as a relentless adversary. The assaults that ensue in the wake of tragic deaths not only imperil the safety of medical professionals but also corrode the fundamental fabric of healthcare. To break this vicious cycle, it becomes imperative to forge a robust system—one that not only safeguards doctors from unjustifiable attacks but also provides transparency to bereaved families. Only through nurturing a culture grounded in mutual respect, comprehension, and trust can we authentically mend the wounds inflicted upon the healthcare system.
