Author: Dr. Rohini R
What can Doctors Do to Prevent Violence?
Healthcare is a service industry. Patients expect a certain level of attention and care, whether they are paying or not. If these expectations are not met, it can result in agitation of patients and their family members and sometimes violence. There are several reasons why violence against doctors happens, such as poor infrastructure, lack of support from the government, media’s role, increased healthcare costs, mob mentality, poor doctor to patient ratio, and it is typically not the doctor’s fault but the crumbling healthcare system they have no control over. However, doctors are at the forefront and at a high risk of violence.
So, what can doctors do prevent violence? A key factor in preventing agitation of patients or their relatives and violence is communication. Communication between doctor and a patient is something that is considered sacred.
Patient care was founded on the following three principles: Talk (compassionate talking and listening), Touch (compassionate touch involving a good clinical examination) and Treat. In fact, back in the day, talk and touch was the main focus in patient care since many diseases did not have the kind of treatment options available today.
Doctor-patient communication in integral part of medical education and training in many western countries. In India, doctors are generally not given any specific training in communication skills during under-graduation or post-graduation. These skills are not insulted in school either. Some doctors may pick up basic communication skills informally or from their upbringing.
What is Effective Communication?
Effective communication skills have been proven to reduce the risk of agitation and violence against doctors. Yes, Indian doctors are swamped with cases, especially in government hospitals and teaching hospitals. Each doctor may have to consult over 100+ patients in just a coupe of hours. Agreed, you may not have more than 5 minutes with a patient. This is why having effective communication skills is easier said than done. It is not about how much time you have with a patient, it is what you do with that time, how effectively you communicate and what you say in those 5 minutes. This is an acquired skill.
Some Important tips: Avoid being judgmental, avoid yelling or shutting down their questions, no matter how silly they may sound.
Learning how to deliver bad news:
This is another important skill which doctors don’t receive training for. While delivering bad news, here are some ways you can ensure you’re safe:
You should take time to talk to the patient and family, however difficult it may be. If you can, speak to them in their native languages or English if they they are comfortable with it. This gives the patient and their family the confidence that you are on their side and not an outsider. While delivering bad news, it is best to take the patient and family to a separate room along with another person (you may have a security guard wait outside the room), shut the door, ensure the room is quiet room, take a minute or two to modulate your own emotional and physiologic responses, remain calm. Take your time, give the patient and/ pr family time to process and calm down.
Other benefits of effective communication skills:
- Better compliance of treatment and outcomes in patients
- Improved patient satisfaction
- Builds trust
- Successful clinical practice
- Reduce the risk of malpractice
Communication barriers in India:
Very diverse population in India: There is significant variations in spoken language, culture, educational and social background. There are 23 official languages, 99+ non-scheduled languages and more than 19,000 dialects. These are some factors that can make communication difficult for doctors. Hence, It may be be a good idea to seek help from colleagues who are local to the area.
In India, effective communication is easier said than done:
Terrible working conditions for doctors and low wages: These factors make it very difficult for doctors to keep their calm. Working long hours for below minimum wage, no A/C, no time to eat or drink. So yes, effective communication is easier said than done. However, healthcare being a service industry, these things are expected from doctors, unfortunately. These issues have caused burnouts and caused doctors to walk away from the profession.
Read more on violence against doctors