I never thought that the face of a broken justice system would be made visible to the nation through a bunch of doctors. As I write, a junior doctor’s strike which initially began in West Bengal, but gradually garnering support enters its second week. Instigated by the assault of two junior doctors by a mob that assembled after a patient admitted to the Government run Nilratan Sarkar Medical College died allegedly due to medical negligence, the action of the doctors quickly garnered widespread support, partly driven by the initially callous and apathetic attitude of the West Bengal Chief Minister. In overcrowded, understaffed and poorly equipped government hospitals, it is usually hard to prove whether intentional negligence took place, or the overburdened system was just not able to cope. But the incident brought to the forefront one thing – poor law enforcement.
Violence against junior doctors, the first responders in any emergency room or casualty before the specialists are called in are the backbone of the health care system. If something goes wrong as is often wont to ( in Government hospitals in particular), the first to take a hit are the junior doctors who are the visible and soft targets. Because this has become something of a phenomenon, the system has at least technically tried to take note. In response to this violence, there are laws in at least 19 states protecting doctors ( typically called the Medical Protection Acts). The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws’ attacks against physicians and damage to their property. Offenders can get a jail term of up to three years and a fine of Rs 50,000. However, there is a twist in the tale. Not one perpetrator of violence has been convicted under this law in any of the 19 states and so there is no deterrence for the mobs.
It is not just the justice system for doctors that is broken though. The Kolkata assaults have thrown up other questions. One question is whether doctors can go on strike, given the nature of their profession. This is more than an ethical or moral question. Although there is a Supreme Court Judgement of 2013 indicating that doctors are “duty bound” to save lives at all costs and not amounting to do so would amount to medical negligence the question has repeatedly been asked as to how one is expected to do so when one’s own life is at stake.
Then there is the matter of the health care system itself, which is crumbling, and I am not talking about the lack of facilities and hard infrastructure and the decreasing amounts of budgetary allocation which are often talked about. There is also the matter of the soft infrastructure – the relationship between a patient and a doctor. The trust deficit between doctors and patients is also gradually becoming a concern. The tainted image of the medical profession is often regarded as the main reason for the increase in attacks on doctors, courtesy conflict of interest, prohibitive private care costs and overstretched public facilities.
At the institutional level, a balance needs to be attained between important but stop-gap measures that may further jeopardise trust (say, increased security at hospitals) and those that further long-term interests. Medical bodies championing doctors’ causes should focus less on tugging at moral heartstrings of the laity and more on highlighting the practical realities that threaten doctor-patient ties. But owing to perceived conflicts of interest, doctors can hardly sound authoritative to the layman in this regard. The media, civil society and alternate medical forums(not the IMA; clearly seen as looking out for itself and nothing more) have an increasing role to play in the days to come. Both patients and doctors need to perceive (and every doctor will be a patient someday too!) that justice is being done to them.
By Shantanu Dutta
Shantanu Dutta, an Ex-Air Force Doctor is now working in the non-profit sector