Violence against healthcare professionals – Explained, pointwise

Introduction

Violence against healthcare professionals is a concerning issue that poses significant challenges to the healthcare system and the well-being of those who dedicate their lives to saving others. Recent incidents highlight the urgency of addressing this problem. For instance, the murder of a young doctor in Kerala and the alarming statistics of violence faced by doctors in India emphasize the need for immediate action.

Healthcare professionals, including doctors, nurses, and paramedics, endure physical, verbal, and psychological abuse, impacting their safety, mental health, and ability to provide quality care. It is essential to understand and address the factors contributing to this violence to ensure a safe and secure healthcare environment for all.

What are the various types of Violence against healthcare professionals?

Physical Violence: The doctors are physically attacked by patients or their relatives in hospitals. 

Verbal Abuse: It involves the use of offensive, threatening, or derogatory language towards healthcare professionals. For instance, nurses are subjected to verbal insults and threats by agitated patients or their family members. 

Psychological Intimidation: This form of violence includes psychological tactics to instil fear or distress in healthcare professionals. For example, doctors are subjected to constant harassment or psychological manipulation by colleagues or superiors. 

Sexual Harassment: It involves unwelcome sexual advances, comments, or behaviour directed at healthcare professionals. For instance, female healthcare workers face unwanted sexual advances from patients or colleagues. 

Cyberbullying: This refers to the use of electronic communication to harass or intimidate healthcare professionals. For example, doctors receive online threats or being subjected to online defamation through social media platforms. 

Damage to Property: It involves deliberate destruction or vandalism of healthcare facilities or the personal belongings of healthcare professionals. For instance, equipment or vehicles belonging to medical staff are being vandalized by angry patients or their relatives.

Why do healthcare professionals face violence?

Frustration and Anger: Patients or their family members may experience frustration and anger due to various reasons, such as long wait times, unfavourable treatment outcomes, or dissatisfaction with the healthcare system. This can lead to violent outbursts towards healthcare professionals, as seen in cases where doctors are physically attacked by patients or their relatives. 

Lack of Awareness and Miscommunication: In some instances, patients or their attendants may not fully understand the complexities of medical conditions or treatment plans, leading to miscommunication or unrealistic expectations. This can result in confrontations or verbal abuse towards healthcare professionals who are perceived as not meeting their expectations. 

Inadequate Resources and Infrastructure: Insufficient resources, overcrowded hospitals, and long waiting periods can contribute to patient frustration. When healthcare professionals are unable to provide immediate attention or the desired level of care due to resource limitations, it can escalate tensions and increase the likelihood of violence. 

Emotional Distress and Mental Health Issues: The emotional strain and burnout doctors experience can impact their interactions with patients, potentially triggering confrontations or aggression. 

Lack of Security Measures: Insufficient security personnel, lack of surveillance systems, or easily accessible areas can increase the risk of physical assaults or damage to property. 

What are the impacts of violence against healthcare professionals?

Physical Harm and Injuries: Acts of violence can result in physical harm and injuries to healthcare professionals. For example, doctors being physically assaulted by patients or their attendants may suffer from bruises, fractures, or more severe injuries. 

Psychological Trauma: Healthcare professionals who experience violence may endure long-lasting psychological trauma. Verbal abuse, threats, or witnessing violent incidents can lead to anxiety, depression, post-traumatic stress disorder (PTSD), and other mental health issues. 

Fear and Emotional Distress: Violence creates a pervasive atmosphere of fear and emotional distress among healthcare professionals. The constant threat of violence can lead to heightened stress levels, impacting their job satisfaction, and personal well-being. 

Impaired Quality of Care: When healthcare workers are operating under fear and stress, it may affect their decision-making abilities, concentration, and overall performance, ultimately compromising patient care. 

Retention and Recruitment Challenges: If healthcare professionals do not feel safe and supported in their workplaces, they may choose to leave the profession or avoid working in high-risk areas, resulting in a shortage of skilled healthcare workers. 

Deterioration of Doctor-Patient Relationship: Violence creates a hostile environment, leading to strained doctor-patient relationships and hindering effective communication and collaboration. 

What are legal provisions focused on reducing violence against healthcare professionals?

Amendments to Existing Acts: The government have introduced amendments to existing acts to enhance legal protection for healthcare professionals. For example, the Epidemic Diseases (Amendment) Ordinance in India made violence against doctors during the COVID-19 pandemic a cognizable and non-bailable offence, imposing fines and jail terms on offenders. 

State-Level Laws: Several states have enacted their own laws to address violence against healthcare professionals. These laws provide specific provisions to deter and punish perpetrators. For instance, Kerala introduced the Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act, 2012, which aims to protect healthcare workers and impose stricter penalties on those committing violence. 

Proposed Central Legislation: Efforts have been made to introduce comprehensive central legislation to combat violence against healthcare professionals. In 2019, the Indian government proposed the Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, which aimed to make violence against doctors a non-bailable offence with stringent penalties. However, the bill was later withdrawn. 

Inclusion of Healthcare Workers: Legal provisions have been expanded to include a broader range of healthcare workers for protection against violence. The Kerala government’s ordinance, for example, extended protection to paramedical students, security guards, managerial staff, and other health workers, in addition to registered medical practitioners and nurses. 

Fast-Track Courts: To ensure timely justice and expedite the trial process, the establishment of fast-track courts dedicated to handling cases of violence against healthcare professionals has been proposed. These courts aim to prioritize and speed up the legal proceedings, providing swift justice to victims. 

What are the challenges in reducing violence against healthcare professionals? 

Lack of Awareness and Reporting: One of the significant challenges is the underreporting of incidents of violence. Healthcare professionals may hesitate to report violence due to fear of repercussions or a belief that it will not lead to any substantial action. This lack of reporting hinders the accurate assessment of the problem and limits the implementation of effective measures. 

Inadequate Legal Framework: Despite efforts to introduce laws and amendments, the legal framework may still be insufficient to address the complex nature of violence against healthcare professionals. Existing laws may lack clarity, have weak enforcement mechanisms, or fail to cover all types of violence and their specific contexts.  

Variations in State Laws: The presence of different laws across states can create inconsistencies and challenges in effectively combating violence. In states without specific laws or with weaker provisions, healthcare professionals may face greater vulnerability to violence.  

Delayed Justice and Low Conviction Rates: The slow judicial process and low conviction rates for perpetrators of violence against healthcare professionals pose significant challenges. Delays in legal proceedings can discourage victims and undermine the deterrence effect of legal provisions. 

Inadequate Security Measures: Healthcare settings may lack adequate security measures to protect healthcare professionals from potential violence. Insufficient security personnel, lack of training, and ineffective security infrastructure can contribute to an unsafe environment. 

What should be done?

Enact Comprehensive Legislation: This legislation should include strict penalties for offenders and provide comprehensive protection for healthcare workers. For example, Congress MP urged the Indian government to reintroduce a comprehensive central law to check violence against healthcare professionals. 

Strengthen Implementation of Existing Laws: This includes ensuring prompt and effective investigation of reported incidents, holding perpetrators accountable, and providing support to victims. The legal provisions should be actively enforced to create a deterrent effect 

Improve Reporting Mechanisms: This can involve creating confidential reporting systems, whistleblower protections, and channels for reporting to law enforcement agencies. Encouraging reporting helps in generating accurate data and taking appropriate action against perpetrators. 

Enhance Security Measures: This may include deploying trained security personnel, installing surveillance systems, and adopting access control measures. Creating a safe working environment is essential to prevent and deter acts of violence. 

Promote Awareness and Education: It should be launched to address the underlying causes of violence against healthcare professionals. This includes promoting understanding of the vital role healthcare workers play, debunking misconceptions, and fostering respect for healthcare providers. Such initiatives can be conducted through media campaigns, community engagement, and educational programs. 

Provide Support Services: This can include counselling services, helplines, and access to mental health support. Additionally, providing training on conflict resolution, de-escalation techniques and self-defence can empower healthcare professionals to handle challenging situations effectively. 

Collaboration and Stakeholder Engagement: It requires collaboration between various stakeholders, including government bodies, healthcare organizations, professional associations, and law enforcement agencies. Working together, these stakeholders can develop comprehensive strategies, share best practices, and advocate for the safety and well-being of healthcare professionals. 

Sources: The Hindu, NLM, Lancet, Forbes, The Wire, Indian Express, Deccan Herald, Herald Goa and Indian Express

Syllabus: GS 2: Social Justice: Issues relating to development and management of Social Sector/Services relating to Health