Most women wear fear as second skin—not out of choice but because of circumstances. If women had a nickel each time they faced any assault, they would give the Elon Musks a run for their money. And, each assault leaves behind a memory that scars them for life, a memory laced with fear, pain and despair.
“I will never forget my medical college days. Someone came to my hostel window one night and it was the scariest experience ever. I informed my superiors but the management suppressed the issue. There was no security at the gate outside the women’s hostel on the college campus,” recounts a doctor who did her postgraduation in Delhi and is now practising community medicine. A few months ago, she revisited her college, and found that little had changed. “I am sure some junior resident may be undergoing the same trauma that I went through,” she says. She wanted to remain anonymous as she didn’t want her parents to know the ordeal she went through. Fear has many in a chokehold, silencing their pain and experience, no matter how rampant and universal. The gruesome rape and murder of a postgraduate trainee doctor at Kolkata’s RG Kar Medical College and Hospital in August sent shockwaves across the nation, igniting widespread protests and bringing to light serious concerns about safety within medical institutions. But has anything changed?
Ready with care: The accident and emergency team of Kokilaben Dhirubhai Ambani Hospital in Mumbai. Most trauma centres across India are vulnerable to attacks | Amey Mansabdar
“One thing I can say for sure is that there might not be a single female resident who was not catcalled while on duty inside a government hospital. The situation is same with interns,” says Dr Prachi Goswami, 25, a second-year resident at the University College of Medical Sciences, a government hospital in East Delhi. “All of us have been cussed and verbally abused at some point or the other. And this does not happen as much with male residents. But then, we are all used to it now. The thing is, we can still bear all of that uncouth attitude, but it gets unbearable if we don’t have basic facilities like clean bathrooms and a clean place to rest during 24-hour duty.” That’s what wearing fear as second skin does to you—you get used to it. Goswami used to live in a hostel, but moved back in with her family in Delhi after she felt she was being stalked on her way to work from the hostel at night.
The thing with fear is that it moves with you. And, it is infectious, even when not shared. Dr Sarla Shah, a family physician in Mumbai’s upmarket Prabhadevi, would know. She constantly worries about her granddaughter, who works in the trauma care centre of a hospital in Mumbai. “This fear is real even though my granddaughter feels I’m overreacting,” says Shah. “I know how frustrated, angry and hot-headed an accident victim’s family can be. They can vent it all out on the doctor, especially if it happens to be young women who have just started out.”
While women doctors and nurses have it worse, men, too, have had their share of attacks. In November, a frustrated family member of a cancer patient stabbed oncologist Dr Balaji Jagannath several times at Kalaignar Centenary hospital in Chennai. A study by medical researchers in Karnataka on the nature of violence against doctors in tertiary care centres reveals that over the previous decades, violence against physicians has risen. Nearly half the physicians surveyed (48.02 per cent) reported facing violence during work hours. The department of obstetrics and gynaecology recorded 43.2 per cent of such instances, while surgery, medicine and other departments reported 23.6 per cent, 22.8 per cent and 10.4 per cent, respectively. While this was specific to Karnataka, the situation is bad across the country. Maharashtra reported 12 attacks on doctors in 18 months. A 2017 study by the Indian Medical Association said over 75 per cent of doctors across India had experienced workplace violence, while nearly 63 per cent were unable to see patients without fearing violence.
Up in arms: Junior doctors protest in Kolkata following the rape and murder of a postgraduate trainee doctor at RG Kar Medical College and Hospital | Salil Bera
One would think one’s workplace would provide a sense of security, that a place of healing would be the last place where violence would come knocking. It is no wonder then that safety tops the wish-list of most doctors, junior or senior and in both public and private sector, that THE WEEK spoke to. These issues, says Lavleena Lagey (name changed), a nurse working at the Nanded hospital where a number of children died in the neonatal intensive care unit in 2023, aren’t limited to doctors alone. “In the NICU in our hospital, the number of babies is always 10 times more than the sanctioned bed capacity, and we have just one staff to cater to all patients,” she says. “Add to that, the meagre wages, no permanent jobs, and no incentive to work well either.” A nurse at the civic body-run Sion hospital in Mumbai recounts how “patients’relatives come in a state of drunken stupor and we have nowhere to go except for becoming their punching bags if their patients don’t do well. But because we have to continue working, we can’t say anything”.
There is a golden hour after any accident or heart attack, but a lot of hospitals will not take such patients in because then the goons will come in and destroy the hospital and beat up the doctors ― Dr H. Sudarshan Ballal, chairman, Manipal Health Enterprises Pvt Ltd
A safe and stress-free work environment is a fundamental requirement and also a doctor’s fundamental right, says Dr H. Sudarshan Ballal, chairman, Manipal Health Enterprises Pvt Ltd. He recalls an incident after his return to India from the US. The relatives of a patient with trauma beat up a lady doctor and vandalised the emergency room soon after his death. The next day, all the doctors marched to the Raj Bhavan. The governor called the police commissioner and the vandals were arrested immediately. While in the US, Ballal had seen litigation against doctors and hospitals, but never vandalism and assault. Such attacks not only create a sense of fear among doctors and nurses, but also discourage small and mid-sized hospitals from attending to sick patients. “There is a golden hour after any accident or heart attack, but a lot of hospitals will not take such patients in because then the goons will come in and destroy the hospital and beat up the doctors. So this is actually counterproductive,” says Ballal. “And even though the government has laws against this, which I think is criminal behaviour, it is unfortunately not implemented very effectively. I have no problem with the patients and relatives thinking that the best of care was not given, but there is a civil way of dealing with that.”
Trust in doctors and health care professionals is at its lowest. What was once considered a pious profession is now besieged with mistrust and every opinion by the doctor is contested and countered ― Dr Sandeep Agarwala, senior cardiovascular and thoracic surgeon, Zydus Hospitals, Ahmedabad
Dr Rajesh Mistry, an oncologist from Kokilaben Dhirubhai Ambani hospital in Mumbai recounts a case involving a 65-year-old man with oral cavity cancer and an extremely weak heart. “His medical condition and the associated risks of surgery were thoroughly explained to both him and his family,” he says. “After understanding these risks, they consented to proceed. The surgery was uneventful, but tragically, the patient suffered a cardiac arrest in the ICU and could not be revived despite our best efforts. While I could understand the grief of the family, they started abusing our team, including the resident doctors. Thankfully, the situation did not escalate into violence, as we often see in similar cases. Such incidents are deeply disheartening for medical professionals who dedicate themselves to the well-being of their patients. There should be greater empathy for health care providers during difficult times.”
Doctors say they are aware of the frustration that stems from a patient’s slow (or no) recovery and from the burden of out-of-pocket expenditure and how all that frustration is eventually directed at the doctors, who are no longer trusted for their expertise. “Trust in doctors and health care professionals is at its lowest,” says Dr Sandeep Agarwala, senior cardiovascular and thoracic surgeon, Zydus Hospitals, Ahmedabad. “What was once considered a pious profession is now besieged with mistrust and every opinion by the doctor is contested. Misinformation and quick-fix treatments, the presence of social media and superficial interpretation of information available on the internet adds to more confusion rather than clarity in the mind of patients.”
Outcomes may be positive or negative, but they should be effectively conveyed to the relatives of patients in a language that they understand ― Dr Swapnil Khadake, head, critical care, Fortis Hiranandani Hospital, Vashi in Navi Mumbai
A research paper titled ‘Current challenges for doctors in India’, published in Sociology of Health and Illness, says that the public image of doctors in India has become negative; they are seen as greedy people who were in nexus with pharmaceutical companies and device manufacturers. “A few doctors make it impossible to shed this kind of an image,” says Shah. “In India, there are sections of the population who dismiss a doctor as someone who is self-indulgent and profiteering but those same people come to us eventually to get themselves and their loved ones treated and then suddenly we become God.”
Many senior doctors wish their juniors and those entering the profession are taught how to “communicate effectively” as part of their syllabus, so as to be adept at managing difficult relatives. “Treatment wise, everyone is right in their place because everyone has to follow national, international or government guidelines to treat any disease or any particular pathological abnormality, complications or side effects,” says Dr Swapnil Khadake, head, critical care, Fortis Hiranandani Hospital, Vashi, Navi Mumbai. “Outcomes may be positive or negative, but they should be effectively conveyed to the relatives of patients in a language that they understand.”
Effective and long-term health insurance is another key issue for doctors, especially those working in the private sector. “This issue is not very easy to address, but it has to be done,” says Ballal. “In the west, even when the patient in the emergency room is sick or has died, the hospital takes care of the patient and they don’t have to really worry about the payment, as the insurance company takes care of it. Whereas in India, because a lot of this payment may have to be out of one’s own pocket, people react violently, especially if the outcome is poor or bad, and they take it out on the doctors and the hospitals.”
That a patient needs to “have faith in the doctor’s instinct and knowledge” is a priority on the doctor’s wish-list. Many doctors say that no matter how educated the patient, they “tend to trust Google” more than their doctor. Dr Arun Bal, director, diabetic foot surgery, S.L. Raheja hospital, Mahim, Mumbai, once had a foreign-returned, highly educated college professor for a patient. “She saw on social media that if you soak a bel leaf in water and tie it to your right toe for seven days, your diabetes will be under control,” he recounts. “After seven days, she reported to the hospital with fever and vomiting. We found that all her toes had become gangrenous because of infection. We had to remove all her toes and she had to undergo dialysis. So a major problem that I face in my practice is how do I educate an educated person about such problems. It is extremely challenging. My wish is that people take us doctors seriously and do not give in to quackery.”
Increasing awareness about various ailments among people and the willingness to abide by prescriptions tops the wish-list of Dr Akanksha Parikh, paediatric endocrinologist at Kokilaben Dhirubhai Ambani hospital. And, that wish of hers comes from a recent “heartbreaking” case. She had a five-year-old patient come to her with short stature and development delays. Her parents told Parikh that she was gaining weight but her height remained the same, and that she was quiet and preferred to play on her own. On examination, it was found that the little girl had thyroid hormone deficiency since birth. “Thyroid hormone is an essential hormone for brain growth in an infant, especially in the first three years of life,” explains Parikh. “And during this period if it is deficient, it can lead to permanent neurological delay. We started this child on levothyroxine therapy and she started gaining milestones—her height improved, her speech improved and she began to be more active and started mixing with her peers. But the truth is that there is a high possibility that she still has some residual neurological delay because we started treatment late. Had this child been diagnosed at birth using a simple newborn thyroid screening, which can be performed by either sending a cord blood sample or through the newborn blood spot test, formerly called the heel prick test, we could have started treatment on time, which is ideally in the first two weeks since birth.” Parikh says that, like in the west, India, too, should make newborn thyroid screening mandatory in all hospitals. She also hopes to see a permanent cure for Type 1 diabetes, which affects about two and a half lakh children in our country.
Catch ‘em young: Dr Akanksha Parikh, paediatric endocrinologist at Kokilaben Dhirubhai Ambani Hospital, wants India to make newborn thyroid screening mandatory in all hospitals
For doctors practising in Delhi hospitals, pollution has become a major health concern, and so they wish for the authorities to tackle it on a priority basis. “The most important issue that must be addressed at present is the level of pollution we have in Delhi,” says Dr P.N. Renjen, senior consultant, neurology, Indraprastha Apollo hospitals, Delhi. “We all know that there was a large study by the WHO, which stated that pollution seems to be a very important modifiable risk factor for stroke and which is an absolutely preventable factor. And that is what we are seeing—the risk of stroke is higher because of the increase in pollution levels.”
Most of the doctors THE WEEK spoke to also listed better working conditions and hygienic work environments like clean toilets and resting rooms as part of their wish-list. These were followed by competitive salaries and timely and regular payment of salaries and reduced workload, given that many doctors endure increasing patient load and long work hours. Many junior doctors told THE WEEK that they would want to be free from performing administrative tasks and non-clinical work and be able to concentrate on patient care. Respect and recognition for the junior staff in the department, adequate health insurance and adequate indemnity were also a significant part of their wish-list.
Sounds more like an essentials list than a wish-list, doesn’t it?