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What must Doctors do to avoid mob attack?

What should doctors do to avoid mob attack? What should doctors do to avoid violence against themselves? How doctors can minimize mob attack?

Attacks on doctors and hospitals have become so common, they are no longer news. Why have we reached this state? As you know most of such incidents of violence against doctors happen during night shift. And majority of such incidents happen after death of patient. Sometimes it is not possible to save the patient due to extent of injury, that’s why it may not be a case of negligence. Moreover if there are any negligence, there are legal methods to deal such cases but violence against doctors is never an option.

Let’s first understand the psychology behind such attacks

After death of loved ones, every individual (let’s say relatives) pass through the some stages that are inevitable. Let’s know the stages individual goes through after death of loved ones:

Denial & shock

Anger

Bargain

Depression

Acceptance

One should understand the Anger stage where such incidents of violence against doctors happen. That’s why mob attack doesn’t happen very immediate after the death of the patient but takes time say 20-30 mins.

What must Doctors do to avoid being beaten up by patients/relatives?

There are few things that if you keep in your mind, you can minimize the attack and can save your life. Let’s discuss:

General Instructions

  1. Inform your relatives (let’s say parents, siblings) about your night shift.
  2. Keep your phone charged. This will help you inform about incident.
  3. Keep your Speed dial set up for any emergency call.
  4. Keep proper records.
  5. Do not commit negligence. Be knowledgeable in your subject. Do not venture out of your area of work/expertise.

When an serious patient comes to you

  1. Anticipate the death. By proper examination, one can know the status of patient.
  2. Call for the support if you can anticipate the violence.
  3. Since death of patient to anger stage of relative one takes some time, You should make sure that dead body is handed over to the relatives and release it out of the hospital (to Ambulance) ASAP. Don’t hold the dead body for longer time.
  4. You should handle the condition with ultimate calmness. Don’t argue with angry relatives. Angry arguments with angry relatives will always result in damage.

Whom to call for help or support?

  1. Colleagues are always better than strangers. If you are in medical college attached hospital, first call should be to your colleagues (best to call are Undergraduate MBBS students). They can reach to the incident site at earliest. Long live medico unity!!
  2. Call to local police. It  is best to keep liaison with the local police.
  3. Call the administration.

What should Hospitals and Nursing Homes do to Prevent and Manage Violence by Patients/Relatives?

Courtesy: Indian Journal of Clinical Practice, Vol. 22, No. 9, February 2012

What preventive action by hospitals/nursing homes to be taken?

It needs to be appreciated that violence against hospitals occurs mainly because of lack of information and misunderstanding. It also occurs because of negligence or crudeness or arrogance or greed on the part of nursing homes or hospitals. The hospitals or nursing homes should do the following:

A. They should take steps to minimize the possibility of such attacks. Examples of such steps are:

1. The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, should be strictly complied with by the doctors working in the hospital or nursing home.
2. A notice should be prominently displaced providing information to the public about the actions that an aggrieved patient may take. Such information may include:

  • Name and mobile telephone number of the person/doctor who is officially assigned the duty of attending patient complaints/ emergencies on 24-hour basis.
  • Name of the person in charge and the members of the “Patients Grievance Redressal Committee” of the hospital or nursing home concerned and the time limit (say, 48 hours)  during which the Committee would take initial necessary action.
  • The mechanism for supplying a copy of patients’ medical records on request, including the fees and time limit for the same.
  • Name and address of the local Indian Medical Association (IMA) “Patients Grievance Cell”, if such a cell exists.
  • Name and address of the State Medical Council.
  • Name and address of the District Consumer Forum.
  • Schedule of hospital charges
  • Names, qualifications and medical council registration numbers of all doctors.

B. They should buy a hospital professional indemnity policy through a legal risk cover company. While choosing the legal risk cover company, they should choose that company whose terms and conditions include a written clause that the company will provide legal services in connection with criminal/ police complaints related to violence against the hospital.

C. They should organize a collective hospital or nursing home defence mechanism through the local IMA. If this is not possible, a few hospital or nursing homes should come together on their own to form such a joint mechanism. Such joint defense mechanism, Joint Defense Academy (JDM), would do the following:

1. It would collect fees from members and keep proper accounts of the funds collected and spent.
2. It would provide the following services to the members:

  • Liaising with the police.
  • Organizing joint seminars on the issues related to hospital or nursing home protection. The local police officers; CMO; DM; media and some persons from the legal field, if possible the magistrate or sessions judge, should be invited on these occasions and they should be requested to express their views.
  • Engaging the services of an advocate on the criminal side to act as a standing counsel for the member hospital or nursing homes for any legal help at times of violence.
  • Engaging the services of a security agency to provide security cover in normal times as well, additionally, in emergencies, to the member hospital or nursing homes.

D. The cost of the JDM incurred by the member hospital or nursing homes should be recovered, in part or full, as appropriate, from the patients by adding an item in the bill, such as, “Protection against violence charges”. Such charges should be levied in a transparent manner and should be supported by proper accounting procedures. The consent form signed by the patient at the time of admission should clearly state that the signatory consents to pay the “hospital patients protection charges”.

E. They should take the following miscellaneous actions/precautions:

  • Only MBBS doctors should be employed in the hospital. Paramedical staff should be adequately qualified/trained.
  • A written undertaking should be taken from the patient and two relatives that they would not indulge in violence and that any loss to hospital property as a result of violence caused by them would be recoverable from them by various means, including but not restricted to adjustment against the advance deposit and any bank guarantee or any other guarantee provided on behalf of the patient at the time of admission.
  • Hospital records in respect of patients (case sheets) should be properly kept.
  • Treating doctors should spend sufficient time with the patients and relatives to answer their doubts and queries.
  • The consent form should not be got signed in a cursory manner. It should be an informed consent in the true sense.
  • No false assurances, even verbal, should be given to patients.
  • Patients should be clearly and documentedly told
    that they are free to shift their patient to any other hospital at any time.
  • Prompt police complaints should be made against those who commit violence. Video cameras should be installed at a few places to record the photographs and voice of any bad elements who commit violence. This would greatly help in making a police complaint and pursuing it.
  • Patient records should be properly maintained. They should be kept in proper custody of the hospital and should not be loosely displayed. However, proper and detailed referral letters and discharge summaries, containing necessary details, should be given to patients under signature when they leave the hospital.

Note: Some hospital or nursing homes may be small nursing homes with only a few beds. However, all the above measures need to be taken for every hospital or nursing home, big or small. The smaller the hospital, the more the chances of violence against it.

What action to be taken when Violence occurs?

A. Depute someone (preferably beforehand) to take photographs and, even, audio records of the violence.
B. Depute someone to immediately get the medical record of the patient photocopied, preparing at least three copies. These will be useful for giving to the patient’s relatives and the police and to the court. If the mob carries away the original record, the photocopies will be useful.
C. Inform your advocate.
D. Inform the police immediately by phone, etc. and keep a record of such phone call, etc.
E. Identify the troublemakers/leaders in the mob and talk to them and try to pacify them, even though you may have to go out of the way to a certain extent.
F. Get written, signed statements from the persons present (doctors, staff, patients, relatives, others) regarding the occurrence of violence. An advocate’s help in this would be specially useful. (Note: Such statements are crucial as regards the legal course of the incident and may not be easily available later).
G. Lodge an FIR with the police. It is better to let the advocate prepare the FIR.
H. Issue a press statement about the incident.
I. The aggrieved doctor should not be left alone. The local IMA should provide him all support in the interest of the profession. The support should be on the following lines:

  • It should immediately constitute a high powered committee including, amongst others, its counsel and also, preferably, a retired judge (and may be also a police officer), to probe into the incident and submit its report along with the plan of action.
  • It should get published in the newspapers a balanced and correct version of the incident so that the public understands the facts of the situation. This may be by way of a press release or an advertisement.
  • It should take direct action within law against the culprits. It should circulate amongst the members the names of those involved in the incident with a request that members may, at their discretion, decline to provide services to them except in emergency unless they submit apology to the concerned doctor and to the state IMA in writing.
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