Why a Zero Tolerance Policy against Violence Needs to be Set up in Every Hospital

According to the latest WHO data published in 2018 life expectancy in India is: Male 67.4 years , female 70.3 years and total life expectancy is 68.8 years which gives India a World Life Expectancy ranking of 125.

As doctors, when a patient does well, we experience great satisfaction and don’t expect anything in return, similarly when a patient dies; we grieve as much as the family does. We think, we discuss about it with our colleagues, we talk about it in our meetings, why we could not save that life.

We do this so that it does not happen to others. Sometimes we go beyond our duties and expectations to save lives. We have to remember that we are NOT GODS and thus do not raise the expectations of the family members - no one is immortal, everyone has to die some day.

There are many of us who forgo our food & drink and spend hours caring for someone who we have no relation to. We spend hours without sleep so that the family of the patients can sleep peacefully at home.

In the recent incident in West Bengal, NRS Medicine College, doctors could not save an 85 year old male patient (life expectancy of 67.4 years) and as many as 200 people descended on the campus of the hospital and attacked the treating doctors and interns. Two of these interns suffered bad injures.

One sustained a depressed skull fracture and had to be operated as a life-saving emergency. The images circulated on the social media are very depressing and distressing. There is a lot of anger among the doctor community.

Violence against doctors is on the rise in India and it is time that ZERO TOLERANCE is imposed through legislation and for this whole of the doctor community in the country has to come together.

WHAT IS ZERO TOLERANCE and WHY IS IT SO IMPORTANT?

The Practice of ZERO TOLERANCE needs to be taken very seriously if a member of staff or one of the doctors or nursing team is treated in an abusive or violent way.
This policy states that doctors, nurses and the hospital staff has a right to care for others without fear of being attacked or abused.

How the Hospital Staff Should Behave:
To successfully provide healthcare services, a mutual respect between all the staff and patients has to be in place. This also means that all staff working in the hospitals should

• aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. 
• respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time.  
• understand that ill patients and their relatives do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in them being removed from the hospital premise and, in extreme cases, the local security and the police will be contacted.

In order to maintain good relations with patients and their relatives, they need to be informed what types of behaviour would be considered unacceptable:

1. Using bad language or swearing at practice staff.
2. Any physical violence towards any doctors, nurses or the staff working in the hospital.
3. Verbal abuse towards the staff in any form including insults and threats.
4. Persistent or unrealistic demands that cause stress to staff.
5. Causing damage/stealing from the hospital premises, staff or patients

Posters stating the same need to placed in all the facilities within the hospitals and the premises.

It is important to educate the patients and relatives about this ZERO TOLERANCE and at the same time educate doctors about effective communication. There is a need to understand the expectations of the patients and at the same time ensure that unrealistic expectations are not encouraged.

There is a greater need for doctors to be united to achieve this goal.

Author's note:

The above post was written by Dr Shiv Kumar Singh following the June 11, 2019 heinous attack on young doctors in a medical college in West Bengal but focuses on the larger picture of violence against doctors in India and a key step that needs to be implemented at the earliest by hospitals across the country.

Dr Shiv Kumar Singh is a Consultant Anaesthesiologist at the Royal Liverpool University Hospitals in the United Kingdom. He did his MBBS from JIPMER and MD Anaesthesia from AIIMS and is one of the most popular Indian anaesthesiologists of the modern era for the extra efforts he makes to teach and guide fellow doctors across the world, both in person and via the use of online technology.