[Answered] “The ‘systematic failure’ to address the needs of patients contributes to a higher mortality.” Comment.

The nationwide violence against doctors, is invariably the result of systemic problems in the healthcare sector in the form of expensive and unaffordable treatment, poor infrastructure, overburdened doctors and poor doctor-patient ratio that adversely affects optimal attention to patients which in turn creates trust deficit in doctor patient relationship and paves the way for violence against doctors. The inefficiencies and systematic failure has not only led to poor healthcare and contributed to higher mortalities.

Inadequacies in India’s Healthcare System:

1. Ailing Public health sector: Meagre healthcare budget, overcrowding, long waiting time and the need for multiple visits for investigations and consultations frustrate patients on a daily basis.
2. Paucity of Resources: Doctors work in extreme conditions ranging from overcrowded out-patient departments, inadequate staff, medicines and infrastructure.
3. Expensive Private Medical Education: increasingly high cost of medical education in the private sector is forcing many students in India to look for cheaper destinations abroad. Expensive medical studies are responsible for dearth of doctors in India as after acquiring studies from abroad they do not prefer to practice their profession in India because of the necessity to clear the exam conducted by the Medical Council of India.
4. Overburdened Doctors: Owing to disproportionate Doctor Patient ratio, limited number of doctors, nurses and medical staff have to cater to a large number of patients.
5. Doctor-Patient Ratio: Studies and Survey reveal that in India, there is one government doctor for every 10,189 people (the World Health Organisation recommends a ratio of 1:1,000) implying a deficit of 6,00,000 doctors.
6. Unaffordable Treatments: More than 17% of Indian population spends at least 10% of household budgets for health services.  Catastrophic healthcare related expenditure pushes families into debt, more than 24% households in rural India and 18% of the population in urban areas have met their healthcare expenses through some sort of borrowings. Competition Commission of India report on affordability stated that 50 to 65% of Indians did not have regular access to essential medicines.
7. Doctor Patient Relation: The highlighting of errors by doctors, medical staff, and hospitals, as well as corruption among doctors, has further eroded the trust patients have in the medical facilities.  Trust deficit between doctors and patients is also gradually becoming a concern, with rising violence against doctors.
8. Ineffective Implementation of Laws: Inspite of having the laws that envisage imprisonment besides recovery of compensation from perpetrators for loss or damage to Medical professionals and property, states are lacking in its effective implementation. For example, West Bengal has also enacted a law for protection of doctors but due to its poor implementation it has failed to curb the ongoing doctor-patient crisis.

Thus it is important to create conditions and remove systematic failures in order to prevent mortality especially among poor. It is also important, we should also address the underlying factors such as overcrowding, lack of resources, behaviour of frontline service providers and how they should handle cases sympathetically.