From panic buttons to too many tests, doctors go on the defensive

At 7:30 am on May 15, when there was half an hour left to go before Shubham Mahalle finished his morning shift at the casualty department of the Government Medical College in Nagpur, a patient was wheeled in with a crippling stomach ache, along with an army of relatives and attendants. During the CT scan, the patient began gasping for breath and his condition started to deteriorate. When Mahalle shared this news, his relatives reportedly manhandled and struck him. Two other members of the medical staff also came under attack. “I accompanied this patient through all the tests and then I was assaulted for it. I kept thinking of the chilling incident in Kerala with Dr Vandana Das. If these guys had a sharp object and stabbed us with it, what could we have done,” asks Mahalle. Luckily, he managed to alert securityand avert a potential scenario like the Kerala one he was referring to, where Dr Das was brutally stabbed to death on May 10 by a drug addict brought in by the cops for medical examination.

As attacks on healthcare professionals, especially those in government hospitals, rise, fears about safety have made both hospitals and doctors take measures. Many hospitals have hired bouncers while some have installed emergency helplines. “There is a pathway ‘code purple’ that gets activated with a phone call to 5555 to the central command centre. A team arrives to defuse the situation before it escalates into violence,” says Dr Anupam Sibal, group medical director and senior paediatric gastroenterologist at the Apollo Hospitals Group.

GMC, Nagpur, where Mahalle works, is also planning measures to help the resident doctors feel safer on duty. More recruits from the Maharashtra Security Force are expected to be roped in, installation of additional CCTV cameras has been approved and there is now talk of a panic button inplaces where aggressive behaviour is most likely to unfold such as the casualty department. Doctors also have access to a newly formed ‘red alert’ WhatsApp group meant for emergency situations like death threats or mob violence. Resident doctors also want restricted entry passes only for doctors’ vehicles and that only one relative be allowed to accompany a patient.

In the absence of a central healthcare protection act (both health and law and order are state subjects), many doctors by their own admission are becoming more risk-averse, and prioritising their own safety. Dr Bipin P Mathew from Matha Hospital, Kottayam, Kerala says the recent spate of attacks on doctors has led to the practice of defensive medicine. “This phenomenon, in which doctors order excessive tests and procedures to protect themselves against possible malpractice lawsuits or in the Indian context, assaults, is a growing concern. It not only raises healthcare costs, but also poses potential risks to patients by subjecting them to unnecessary treatments,” says Mathew. He illustrates the ways in which defensive medicine plays out in India, sometimes even without the doctor realising it. “A patient comes to a doctor with mild abdominal pain. About 90% of the time, the pain is caused by something benign, like something they ate. However, there is a small possibility that the pain might be due to a more serious condition. Out of fear, the doctor may order additional tests and procedures, even if they may be unnecessary,” says Mathew. Following the recent attack, the Kerala cabinet has approved changes to the current Hospital Protection Act 2012, ushering in more stringent provisions to ensure safety of health staff, including heavier fines and longer jail terms. Under the amendment, there is also an iron-clad timeframe for completing the investigation in 60 days by no less than an inspector.

In other states too, doctors are demanding action. Dr Vinay Kumar, anaesthetist, and president at the Resident Doctors’ Association of AIIMS in New Delhi, says the one-patient, one-attendant rule is a must. “This time we are not going to back down. We have decided that we will make a strong case for a central medical protection act to the government. We are demanding one patient, one attendant in the act. When there is no mob, doctors don’t act under fear,” he says.

Some doctors are not waiting for laws. Dr Keerthi Varman from Stanley Medical College in Chennai says he has changed his approach. “While there is a need to have a strong law, I obviously cannot take a gun and knife for self-defence until it happens. I genuinely think communication is key. Also, now if my patients say I will consult some other doctor, I don’t get offended. I say, please do,” adds Varman.

“In any scenario now, I make sure I am not alone with the patient,” says C Karishni from Gandhi Medical College in Secunderabad who has faced a lot of verbal abuse. “But if people and patients are not sensitised to how their violent behaviour can affect us, then what will change?”