The Stethoscope Versus the Fist: A First-Hand Account

The first time I witnessed a physical attack on a doctor, I was an intern working in a large government hospital in Delhi and was posted in the gynaecology emergency during the night shift.

A woman had been brought in. She was bleeding heavily after giving birth and was already in shock. Her blood pressure was critically low, and she was gasping – a pattern of breathing which heralds imminent death.

I was instructed by my senior to insert an intravenous line so that we could pump fluids and medicines to salvage her collapsing cardiovascular system.

My complete inexperience and ineptitude was what saved me from being thrashed that night. I had a grand total of two weeks practical experience on the job, and could not successfully insert the line into her vein. I was relegated to collecting her blood samples and carrying them to the lab (an ignominious duty), while my seniors worked on the patient.

Upon returning, I found a scene that many doctors are familiar with (especially those who work in government hospitals) – the doctors beaten up, equipment trashed, and security notably absent.

I’ve been fortunate to never have been on the receiving end of the violence that too many healthcare providers experience. However, being in this profession, I am always aware of this omnipresent threat. There have been many close calls where the pendulum could have swung either way. 

I have adopted many behaviours and safety protocols, either consciously or unconsciously, in how I speak to certain patients and their family, how to lighten a tense atmosphere with a joke, how to always keep my tone and body language neutral in an aggressive situation, and how to limit the number of people that accompany a patient.

There was a time I even seriously toyed with the idea of carrying a gun, and contacted a shady policeman I had treated, who assured me that “being a doctor, you can get the license and a legitimate gun in one month through my contacts. In the meantime, I can get you a katta tomorrow if you want.”

I tried learning Krav Maga, fantasising about Steven Seagal-ish situations where I could take on an entire mob single-handedly and leave them a quivering pile of fear. But I gave up after the first day when I nearly broke my wrist trying to do a push up.

Violence against those who can’t defend themselves is not a new phenomenon in India, and if recent trends are anything to go by, it’s steadily increasing.

The perpetrators are nearly always male, between the ages of 20-45, and all commonly afflicted with a sense of outrage, entitlement, willful ignorance and frustration.

People are rarely at their best when they’re at a medical institution. For the patient, their physical and mental suffering, and fear for the condition of their life, pushes all social norms and civil behaviour to the backburner.

For family and friends, fear for their loved one, and ignorance of their condition and prognosis, makes them toss civility out of the window. Selfishness, insecurity, arrogance and entitlement take centre stage.

Over years of medical practice, I have become accustomed to seeing people at their worst, and consequently I’ve become strongly misanthropic.

I imagine that this viewpoint is not uncommon among the medical profession.

There is, of course, a systemic cause to this problem, stemming from the shift of the perception of healthcare towards a capitalistic model, wherein it is viewed as any other trade, i.e. services rendered for money paid.

However, a disease doesn’t care about how much money you throw at it, and there are limits to medical science.

And politically, the way India has been churning these past few years, we have seen condonation – if not outright support – for mob violence. The mainstream shift in consciousness towards justification for violence in retaliation for perceived aggrievements or slights is hardly confined to the hospital wards.

In my experience, doctors, too, have by-and-large drifted to the right – many of them vocally – and only come back smack to the centre when the trickle-down effect impacts them negatively in some way.

In this context, I’m also cynical about the motives of the Indian Medical Association (IMA) on the uproar over the assault of a two doctors in Kolkata. Many similar cases, some even recent, have not gained as much media traction. There was no condemnation from the IMA for them either. 

India’s healthcare apathy

There are also the universally known problems of public healthcare in India – high patient load, poor equipment and sanitation, staffing issues, shortages of medicine, poor funding etc.

These issues are so well-known and thoroughly discussed and dissected that it seems trite to speak about them further. We as a society, it seems, have taken this situation to be unsolvable and as a fixed constant. Nobody seems inclined to speak of how healthcare spending (which was abysmally low at 3.8% of GDP to begin with in 2013) has been cut to 1.5% of the GDP successively since 2014.

A section (including doctors) seem to believe that following the US system of privatised capitalist healthcare with private hospitals delivering world-class medicine (only to those who can afford it), is the solution.

I strongly disagree, the reasons for which can be patently clear to anyone who has even a remote inkling about the profound poverty and income inequality in India, as well as the utter failure of the insurance-funded private healthcare system in the US.

Speaking as a doctor, I also acknowledge that there are deep failings amongst the medical community which has bred a distrust of our profession amongst lay people, and poisoned the doctor-patient relationship.

As medical students, we are taught medicine through rote learning of facts and figures, memorising body parts and functions, studying data and research papers.

But never are we taught science – to question authority, to think laterally, to be intuitive, to develop ethics, integrity and sincerity. None of those topics appear on the curriculum of any medical college in the country.

More importantly, since medicine is the most human of all sciences, never is any aspiring doctor taught how to treat the patient rather than the disease. I have seen that most doctors, and I include myself here, lack empathy and basic communication skills with their patients.

Their relationship is not built on trust between healer and sufferer, but rather a dominant superior instructing, correcting and scolding an ignorant inferior – a relationship built on fear, compliance, authority, submission and other dictatorial overtones. Like all authoritarian relationships, this breeds resentment and anger.

Another cause is, of course, the suspicion of science and intellectuals in our country, which too has been on the rise over the past few years.

A cognitive dissonance occurs in the public thought, wherein alternative medicine – such as ayurveda, homeopathy and other such quackery is considered the drug of choice for treating diseases until the inevitable serious consequence follows.

At that time in the utter extremity, does the family finally resort to scientific medicine, which may be inadequate to deal with the failing health of the patient at such a late stage?

However, the people then expect that institutional medicine will perform miracles – even as they harbour suspicion and mistrust of the doctors practicing it.

Ignorance, fear, insecurity, mistrust and religious beliefs when it comes to medicine make for bad bedfellows.

When the perceived divinity fails in delivering the expected miracle, what is left to do but kill the false god?

Anonymous is no longer a doctor in training, and presently practices medicine while maintaining his love for jazz and Douglas Adams.

Featured image credit: Pariplab Chakraborty