Why Bereaved Ones Attack Doctors? Psychiatrist Explains The Perceived Neglect

Why Bereaved Ones Attack Doctors? Psychiatrist Explains The Perceived Neglect
It is a common thing to hear in hospital that it can’t happen to my loved one. Denial can make us feel strong emotions, says expert

Doctors can't treat all patients at the same time. There will always be a first and then a second. We don't choose patients, we prioritize, says the expert

Written by Kashish Sharma |Published : November 25, 2022 4:51 PM IST

No doctor, however prepared can predict the day or hour when they might be under attack by a patient's family. Verbal or physical attacks against the healthcare professionals are far more common than reported. Studies show that doctors are four times more likely to be injured or suffer violence in a workplace when compared with other professionals. While a lot has been covered from a legal or ethical point of view, conversations are missing around the psychological causes that might prompt this violence in the first place.

Violence against doctors is not a white and black picture but a multilayered phenomenon that has lot to do with how a healthcare system works. It might be easy to pick sides but the situation is far more complicated than what might seem on the surface. In cases where the bereaved may attack the doctors, the situation is far more psychologically complex.

Multi-faceted problem

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Among the many reasons that have caused an increase in these cases of violence could be a changing trust in the medical system. From enjoying a divine status in olden times, the social image of healthcare providers has seen a downward road. There is a general feeling of wrong doing by the doctors for financial gain. Anxiety, long waiting period before meeting the doctor in emergency ward, not getting enough medical attention, financial constraints, lack of grievance cells in hospitals and other might be few reasons that could build up frustration in the relatives who might engage in verbal or physical violence. Sometimes unhygienic and crowded emergency rooms could also facilitate the violence.

With commercialization of the health sector, the financial divide has never been as wider as it is today. With many patients lacking a health insurance, sometimes a certain diagnosis can come as a financial disaster and sets them off into an emotional turmoil. This might result in the displacement of this anger onto physicians.

Divided violence

Violence is not exerted against all doctors equally. Not all healthcare providers are vulnerable to the same extent. Studies have shown that younger doctors and female doctors are more prone to suffer physical and verbal violence. Also, emergency rooms and department of obstetrics and gynecology are at greater risk than other departments. Studies have also shown that close to 40-50 per cent of psychiatrists will be physically attacked by a patient and this might happen early in their career. In former cases, it is usually not the patients who will attack the doctors.

Perceived neglect

Behind the so many reasons why family members or relatives of the patient might engage in violence is a sense of perceived neglect at the hand of the practitioner. While Indian medical schools might be imparting sound medical training to their students, however empathy is a thing that cannot be taught. Sometimes lack of empathy towards the patient can become the prime cause of the violence.

Expert Eye View

While it is easy to put goon culture (when local politicians might break in hospitals and threaten staff) in ethical boxes of right and wrong but when the bereaved attack the practitioners, the situation becomes all the more complex. In order to understand the situation from horse's mouth, Healthsite spoke to Dr Mantosh Kumar, Senior Consultant, Psychiatry (Fortis National Mental Health and Behavioural Sciences) who provided the psychological insight into the situation and the factors that might facilitate people's behaviour.

To give one patient more time is to steal same from another

Ineffective communication between the doctor and the patient's family can bring them at the brink of an emotional cliff. Miscommunication by physicians can cause the attendants to have unrealistic expectations for patient recovery. In emergency and ICU settings, doctors not very often explain the patient prognosis to attendants who might be having unrealistic expectations.

In response to this, Dr Kumar said: "Patient burden is exceedingly high in our country. There are so many to look after and so little time to give one. The right way is to communicate clearly and each one of us tries our best to do it. However, practically the situation is far more challenging than it might seem. The time window we can give a patient is very short. To give one patient more time is to steal time from another."

There is no class to assault

Talking about the socio-economic differences in the attendants who might engage in violence, Dr Kumar shared that violence has nothing to do with people who might engage in it. He said: "We have been equally attacked by the privileged than by people coming from weaker sections of the society."

Nobody wants to be the second

Dr Kumar explained a scenario where 10 equally critical patients land up in an emergency room and there are limited doctors to attend. He said: "Doctors can't treat all patients at the same time. There will always be a first and a second. Doctors don't choose patients, we prioritize. However, while the treating the first, if the second suffers a little, their families are bound to feel the anger. Everybody wants their own to be saved first. "

A healthy patient who becomes critical in hospital

Dr. Kumar explained that how certain medical conditions like Hyponatremia or low sodium levels in the blood can turn into medical emergencies in no time. As per the expert, such medical situations can be misinterpreted by the society where a seemingly healthy patient suddenly falls critically sick during their stay at hospital.

He said: "It is a common sight to see a patient land in emergency ward with dropping sodium levels. They might seem alright when they come to the hospital. Maybe the condition might not be that bad when they arrive but the levels might be dropping in them rapidly. One cannot judge what's going inside the body just by looking at a person. The attending doctor is now left to consider so many factors that might have caused it. It could be age-related, maybe the person is dehydrated, may be they are on some medication that is interfering with the electrolyte balance and there might be no end to the reasons. So, in a small window of time, we as doctors might have to find the exact cause to provide a targeted treatment. However, the clock might be clicking all this while and it might start showing on the patient. They might start deteriorating."

Grief is complicated

The health expert explained that the journey from denial to acceptance while processing grief is not same for all. For some it might come early, for others denial could stretch to longer periods and can manifest in extreme reactions such as aggression.

He said: "It is a common thing to hear in hospital that it can't happen to my loved one. Denial can make us feel strong emotions."

Participating actively is the way out

To end the discussion, Dr Kumar said that if the attendants participate actively in their loved one's recovery, things can change for the better. As an attendant, Dr Kumar said, one must look up for the condition our loved one might be suffering from. If they cannot understand, they must frankly approach the doctor to understand the direction in which the recovery can go.

"When we say that a patient is in ICU, there are no two meanings to it. The family has to accept that their loved one is critical and anything can happen. The awareness to know what admission to ICU means is important."