Violence and civilisation have co-existed since times immemorial and healthcare professionals are no exceptions. Violence today can be directly linked to the changing social and economic circumstances. I would like to examine the key stakeholders and how each has contributed to the changing landscape.
Patients
In times gone by, any patient would come to a doctor with a feeling of complete surrender. The doctor would be seen as a manifestation of God — and there was an unsaid understanding that not everything was in the doctor's control. With economic and scientific advances, the mindset of patients and their relatives has undergone a sea change. Rather than considering healthcare as a noble profession, it is being seen as a business. Patients expect to be at the centre of the model — from no long waits, to precise treatment sans side effects, courteous behaviour, and cure at any cost. The nuclear family structure, where every member is precious, renders families unable to handle any unfavourable outcomes.
Doctors
Not so long ago, most doctors were well equipped with the skills required not only to pass exams but also the sensitivity and empathy to understand human emotions and sufferings. The commercialisation of healthcare and health education has led to many changes. The speed with which MBBS seats are being added every year is alarming — and private medical colleges are as numerous as government ones, with hefty fees. Even average students are able to enter MBBS. Faculty standards have seen a precipitous decline. Ghost faculty and those seen once in a blue moon are the reality of many private medical colleges.
An MD or MS graduate today has more or less the same skill set which an MBBS graduate would have had a few years back. Students who attend dummy schools in their 11th and 12th grades while preparing for MBBS entrances carry forward the same habits into MBBS. An average medical student now spends a minimum of 12–13 years only studying. The health administrators with their moorings in the corporate sector advise doctors to adopt all sorts of means to maximise earnings, not all of which are ethically sound.
Society
Indian society and civilisation has historically prioritised family over individual, and tribe over family. The joint families of the era gone by have now shrunk to nuclear ones. The basic etiquettes of social living which a child would naturally pick up at home are no longer being imbibed. Because of living fast-paced lives with little time to spare for others, patients and their relatives have begun expecting instant treatment, quick diagnosis, and rapidly acting medications — all provided with a smile and at affordable rates.
Today's generation treats all professions as equally important, and the privileged position accorded to medical practitioners is increasingly under siege. The end result of these significant societal changes is a vicious cycle of dissatisfaction which, under some circumstances, can spiral into violence.
Policy-making Bureaucrats
Sardar Vallabhbhai Patel once described our bureaucracy as the "steel frame of India." Gradually, this steel frame has rusted — bureaucrats have become yes-men of politicians and are more interested in accruing wealth and power. The tenure of a typical bureaucrat in any particular post is increasingly becoming shorter, making it unrealistic to expect them to develop a thorough understanding of the field. Healthcare is a complicated system, and bureaucrats working in it need the help of domain specialists and considerable time to understand its nuances.
Politicians
The breed of political leaders who led the country in the immediate post-independence era had come out shining like diamonds from the independence movement — grounded, perseverant, honest, intellectual and dedicated. Gradually, things deteriorated to the extent that politics began to be seen as a synonym of corruption. The prospects of making money from the burgeoning private medical college and hospital sector attracted the attention of greedy politicians, who started influencing policy decisions.
The Way Forward
What is needed is a systemic reset — better regulation with simplicity, stronger medical education standards, restored respect for the doctor-patient relationship, and civil society playing an active role in bridging the trust deficit. Healthcare is too important to be left solely to market forces or political whims. Every stakeholder — patient, doctor, administrator, politician and society — has a role to play in rebuilding what has been eroded.