The Interview: Why Doctors in India need to stand United

If you know me personally, you know that I tend to be quite laid-back by nature. There are a few things however that do get me riled up (fanaticism & blind beliefs among others) and one of them remains the increase in violence against doctors in India.

The immensely popular doctor-exclusive social media site, DocPlexus approached me last fortnight for an interview in view of the article I had written earlier in May that had ended up in the news. DocPlexus was in fact one of the first websites to share that post and hence spread the word to other doctors, resulting in them sharing it on their social media.
Of the topics they wanted me to talk on, the one that interested me the most was something close to my heart: Why Doctors in India need to stand United.

This was easily one of the hardest interviews to write on because I am used to the much more simpler 'How long have you been blogging?' and 'What is the origin of your blog's name?' type of questions.
Anyhow, I hope I did justice to the topic and I am glad to see many of my colleagues from the medical field were very receptive to it (comments from the original interview can be viewed here), considering I have chosen once more not to sugar coat my answers and call a spade a spade.

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Excerpts:

What issues did you face that made you question the unity of doctors in India and compelled you to voice your opinion? 

I actually have been lucky so far in that I have never had to face an incident till date. It was just a case of the straw breaking the camel's back. We had been witnessing an increasing incidence of violence against doctors over the last year or so. Images and videos were available on all social media but what was really heart-breaking for me personally were the comments from the public. Rather than condemning violence, they were watching videos of elderly doctors being trashed after the death of a patient and actually applauding the act. 

Yes, there are some who bend the law in our field too but to paint all doctors with the same brush and use it as an excuse to condone and commit violence is inexcusable. I believe shortly thereafter the IMA too released their data about 75% of doctors admitting to having faced violence during their career. In all this, the one thing missing was a strong response from the medical community. I'm sure they would have condemned it in the regional IMA meetings but if that indignation stays inside those four walls, how will the rest of the world know how you feel? When I wrote my post, I honestly did not think it would make a difference. 

Three years back, I had written what I still believe was a far better post “Doctors, Defend thyself”, requesting the public to have faith in doctors and give us a chance. That was appreciated by doctors but stayed within our community. I guess it is a sign of the times that this time around, doctors shared it in far greater numbers forcing the media to take note. I was halfway through completing my next post – a movie review - when I started to get the news from doctors across various states that my article was being actively discussed in their departments by heads and juniors alike. I guess what worked this time was the ‘thesis-like’ format – the first 3/4th of the article is undeniable facts and actual events, all with references.  

Why do you think doctors in India need to stand united?

Paraphrasing from the words of Pastor Martin Niemoller,

“First they came for the CMOs, and I did not speak out-

Because I was not a CMO.

Then they came for the intensivists, and I did not speak out-

Because I was not an intensivist.

Then they came for the surgeons, and I did not speak out-

Because I was not a surgeon.

Then they came for me

and I found there was no one left to speak for me.'

This isn’t the same world as a generation ago. The doctor-patient relationship has eroded and it is a fact that we must accept. Just because violence is not occurring in your hospital today, does not mean that it will not happen tomorrow. Every act of violence you ignore emboldens the next one. We are seeing this in every aspect of our social and political life today as well, are we not? Unlike them though, for us, there are no voices – political or otherwise - to speak out simply because we are all caught up in our own busy schedules.

You can’t afford to live in a cocoon within your hospital, thinking that whatever is happening elsewhere will not affect you. Social media links us all today. Don’t underestimate – or worse, ignore – the potential it has to unite or divide. A guy seeing what he believes is medical negligence being committed by a doctor elsewhere will start to wonder about the integrity of doctors in his city too. It is human nature, isn’t it?

What do you think are some of the stressful societal issues doctors face every day?

Be frank. You know we are in a lose-lose situation presently.

When the government funding to healthcare gets slashed by 20% at a time when even an increase by 200% would barely be sufficient, that puts an untenable strain on the 31% of healthcare it caters to. The remaining 69% which forms the private sector of healthcare has to work without the subsidies and so naturally, the burden of paying a heavier price falls on the poor patient. When he has to part with a significant amount of his savings for an ailment (or sadly, a chronic one), that anger falls upon the ‘evil doctor’ who he sees as fleecing him. Since in his eyes, the patient is now paying top dollar, he expects that his diabetes be cured completely; that the single pill of amlodipine must be enough to control his hypertension once and for all; that two shots of nebulization must undo decades of a smoker’s lung.

Anything less is failure on the part of the doctor, even if he has explained the long term ramifications of his disease. And well, if the patient were to unfortunately die while in hospital care, it has sadly become opportune to blame the doctor for providing inadequate care or for injecting a wrong drug – the anguish at the loss of a loved one turns into rage at the one who they feel has failed them.

In a nutshell, we are “ONLY” short of functioning doctors, MBBS seats, post-graduation seats, primary hospitals, secondary hospitals, finances, beds, sterile equipment and medication. I can understand if we are talking about a third world country but this is supposed to be one of the most influential developing countries in the world with a foot already in the ‘developed country’ section. How can you hope to progress while leaving behind the healthcare aspect?

There is a rise in the incidence of attack or abuse towards doctors. What do you think are the reasons behind such violence? How should doctors raise this issue fairly to concerned authorities?

I am not a big advocate of the ‘present day doctors are evil & money minded’ theory that many proclaim and I hate that it is immediately brought up whenever an incidence of violence against a doctor occurs. You may differ with me on this but give me a moment to place my argument.

Do a random Google search and look at the cases of violence occurring over the last year against Indian doctors. From the media reports, you and I as doctors can get an idea of what has occurred in most of those cases.

Invariably, it is the death of a patient often brought with multiple co-morbidities or during an epidemic that triggers the assault. The doctor? A casualty medical officer or an intensivist. What money did these people try to steal from the patient that ended up in the patient dying? Were these doctors so evil that they withheld BLS and defibrillation because they did not get paid under the table?

• An elderly doctor getting beaten up after a patient with a stroke and intracranial bleeding dies half an hour after admission. 
• A radiologist murdered because he refused to reveal the sex of the fetus. 
• A casualty officer beaten and having her clothes torn and threatened with rape because she followed triage instead of giving priority to a particular patient. 
• A gynaecologist beaten because she confirmed that a miscarriage had occurred. 
• A surgeon arrested because patients died in a government sponsored camp due to tainted pharmaceutical medicines.

Where are the evil doctors? The money minded ones ‘who need to be beaten up’? Yes, you and I both know they exist but these people getting beaten up – are they being beaten up for a crime they committed? Or for being the bearer of bad news? Stop equating one with the other. Those who are guilty of cheating patients or medical negligence definitely deserve to be punished BY THE LAW but don’t use that as an excuse to defend violence today. 

What can we do about it?

I want more doctors to come forth and express their views. I want the voices of IMAs to be heard. Everyone I used to talk to would ask me what the point was since their one voice couldn't make a difference. I hope I proved that aspect wrong with the one post that ended up being shared over 25,000 times, landed on the front page of newspapers, and in various social media formats extending all the way to BBC.

One voice can indeed be heard; not just within a room or hall but across the world.

And if one nutty anaesthetist like me - after inhaling residual anaesthesia gases of halothane and isoflurane - can get everybody to sit up and finally take note of what ails the medical system in our country, can you imagine what all of us could do if we spoke in unison? The best solutions to what ails the Indian healthcare system and how it can be treated lies with the doctors here, not the politicians...  I believe that sincerely.

Share your experiences. Share your stories. Share your solutions. But be heard.

Regarding a more ‘on the streets’ approach, while it is easy to say the standard ‘explain the condition to the patient’s relatives’ line, the fact is that I would ask you all to ensure your safety as well. Ensure your hospitals provide adequate security measures to handle such situations.   

At the moment, how can doctors protect their decisions as a medical professional? 

Documentation. It is as simple as that. Write your prescriptions legibly, noting the exact duration you have advised for the prescribed medicines and document not just your findings but also your recommendations. Read up well on medico-legal aspects related to our profession. Know your own rights, both as a provider of medicine as well (God forbid) as a victim of hospital violence. In fact, I would really appreciate it if DocPlexus would get the views of a true legal expert on this aspect (or re-share, in case there has been one earlier) so that everyone could save it on to their laptops or mobile devices too. It was fine when we were in a respected doctor- patient relationship. 

But unfortunately, today it is a scary ménage-e-trois with the doctor-patient-lawyer relationship ensuring your acts of goodwill get scrutinized by people whose job it is to twist your every move to prove you were wrong. Hearing someone claim in court that a doctor was incompetent because he gave ondansetron to a retching patient when the textbooks ‘clearly show’ that ondansetron was an anti-cancer drug (I know it is historically but its primary use remains elsewhere) may sound silly to you and me. But it becomes hard to digest when you hear the judge agree with the lawyer on that! 

According to you, how can the cooperation between doctors be increased?

Enough with this verbal jousting. We do no favours to our profession by stealing a few patients from others by bad-mouthing someone else. Save the debates on treatment options for a friendly conversation over the phone after the patient has left or better yet, informally at IMA meetings.

At any rate, I am a big advocate of camaraderie between doctors. And I don’t mean necessarily sector specific (orthopedicians only/ surgeons only etc). Informal get-togethers with the families; learning to be more than just colleagues but instead friends outside the hospital gates as well.

In my other persona as a blogger, over the years I have developed valuable friendships with like-minded friends from all across India. We don’t differentiate based on categories of blog or state, professional disparities, gender, age or any such silly boundaries. Most importantly, it feels like being with an extended family and we know we have each other to fall back on whenever we need help (ranging from online assistance, accommodation in a new city and yes, even getting medical assistance and ambulance services available from a different state altogether.)

If hundreds of total strangers – across all castes, religions and political affiliations - can form such strong bonds, why can’t we (who have gone through the same experiences as students for the best years of our lives) not know each other better? You don’t have to like everyone in your town but don’t be an island too. 

How can IMA, MCI help bring medical community together? Should medical professionals create pressure groups?

I realise that the MCI needs to toe the line of the government but you need to realize you are primarily the voice of 8 lakh Indian doctors. You represent us. And if you remain silent or give standard catchphrases and walk away, then obviously the medical community is going to feel disillusioned.

When the government says that they are reducing the healthcare budget, you should not be accepting it gracefully. You should have been making a lot more noise (earning our respect thus) and saying, “Hell No! This won’t do. I want my countrymen to be healthier than they were last year and you have a responsibility to ensure that happens.”

I thought the IMA was supposed to be our local pressure group! Jokes aside, I've seen this concept being passed around on social media a few months ago wherein doctors of a city form a local whatsapp group. In the event of a potential situation starting to turn violent, a message is sent and doctors in the group converge there to even the numbers.

My mind is conflicted - on the one hand, the initial episodes depicted there have all been successful and averted further violence. But I'm also sad - this should not have been our job. We should have been concentrating on differential diagnoses and ligating bleeders rather than postponing OPDs and cases. That protection should have been the responsibility of law makers and the police.

If you want me to take a stand, I would say yes, make pressure groups within your localities. Until that mythical date arrives when there are adequate steps taken to curb violence against doctors, I fear we need to look out for ourselves.

In this digital age, how can Docplexus aid in uniting medical professionals in India? 

Docplexus has a much bigger role than it is possibly aware of. In this digital world where everything is available at the click of a button, it is lovely to see that this includes our fellow brethren. You connect us all – dare I say it – better than certain actual medical associations. For starters, finally doctors from all across India are directly in contact with each other instead of the 50 odd staff in their hospital alone. I see tough cases being discussed and information imparted which helps us all learn. I also get to interact directly with doctors much more senior to me and seek their point of view and advice. More importantly, it helps us get to know each other long before we actually meet. When we get to know each other and respect each other’s opinions, we stop seeing them as ‘just’ colleagues and start to see them as friends we can rely on. 

You can read My Entire Interview Here on DocPlexus as well.

Related links to this topic include:
1. The viral post itself.
2. A earlier post from 2012 (published three weeks before actor Aamir Khan's infamous 'doctors' episode on Satyameva Jayate. Sadly, things would only deteriorate further for the Indian medical system from then till now.) - Doctors, Defend Thyself.
3. My stern pointers on how to end this cycle of violence against doctors (which would go on to be published in The Huffington Post)


Do let me know (here at the blog) what you think of it. More importantly, tell me about your own doctor-patient interactions. What impression did it leave you with - good or bad, great or unimpressive, crook or angel. I want to hear from you on this.