Why doctors feel forced to go on strike

The recent call by the Indian Medical Association for a strike against the National Medical Commission Bill did not receive the expected response. The earlier nationwide medical strike over the violence against doctors, triggered by incidents in Bengal, is still fresh in memory, with its aftermath of broken trust and simmering resentment. Health systems convulsed as doctors took what they believed was the only recourse to highlight their distress. The plight of assaulted doctors and the indifference of the authorities drew empathy from all quarters, and the strike affected every state of the country. Even now, unsettling conditions persist, and society will have to demand solutions in order to effectively pre-empt further strikes.

Medical professionalism eschews civic actions like strikes that are against the ethos of health services. Of the many entrenched problems in our health system, debated after every medical strike, two concerns await urgent attention after the violence at the NRS Hospital in Kolkata.

We should be concerned with the circumstances that push doctors to turn against the tenets of their own profession and strike work, a decision that is almost never taken lightly. It goes against the principles of beneficence and non-maleficence enshrined in medical ethics; also, the Essential Services Maintenance Act preserves continuity of health services in public institutions, so that a citizen’s fundamental right to life is preserved. But clearly, there are other human rights at stake, too. Doctors deserve a safe working environment, free from any form of harassment if reasonable benefit should flow to the patient. Further, critically ill patients have a right to be cared for in a peaceful space, not have their doctors assaulted and hospital rooms thrashed by marauding gangs. When junior doctors feel isolated and abandoned in an imperfect system, they can hardly be blamed for defending their own right to life and safety in the workplace, even as their actions are framed as a dereliction of duty.

For many patients, public hospitals are the only recourse, as they cannot afford other options. These facilities are chronically overwhelmed, with an unceasing flow of patients, stretched resources and overworked personnel. Neglect of these hospitals and inadequate infrastructure is an injustice that cannot be ignored much longer; sub-standard care can never be justified, even if it is provided free of cost. It does not answer the distraught mother with a dying child in her arms. The desperation and helplessness in such situations can lead to a backlash against institutions and doctors, who personify the inadequacies of this sector -- a scenario that has recurred time and again.

In August 2018, a draft ‘Charter of Patient Rights’ was prepared by the National Human Rights Commission and placed for comment in the public domain by the Ministry of Health and Family Welfare. Its objective is to ‘educate citizens regarding what they should expect from their governments and healthcare providers in health settings. Besides the Right to Information and Human Dignity, it assures patients of the ‘Right to safety and quality care according to standards’. Access to timely and efficacious health services is a human and constitutional right of every citizen; an urgent change that is needed if we are to end this injustice that can tip into violence.

Another issue is the training and the preparedness of our doctors in the face of professional demands and stress of the workplace. Interns and junior doctors are often left to manage critical emergency services, a typical flashpoint in incidents of violence so far. The presence of specialists and senior faculty would go a long way in handling complicated cases. The shocking remedy of bouncers and firearms suggested by some sections would deal a deathblow to the already strained doctor-patient relationship. Emphasis on communication skills, breaking bad news and empathy is needed in the formative years.

Until now, ethics and communication did not find a place in a crowded undergraduate curriculum, which was focused instead on knowledge and examinations. In a much-awaited move, the Medical Council of India has finally instituted curriculum reforms after 21 years, mandating training in ethics, attitude and communication through its AETCOM modules from 2019. These and other skill-based competencies will equip young doctors to take on their responsibilities with the right blend of competence and compassion. This foundation in ethics and professionalism will help to handle stressful situations and negotiate complex decision-making, including empathic conversations with distressed families.

In addition to ethics training in medical colleges, upgrading of public hospitals and provision of timely accessible healthcare to every citizen are important measures that will restore dignity and calm to this vitiated sector. Violence against doctors is unacceptable and there should be zero tolerance of this mindless savagery. Introspection and action on systemic problems in healthcare and training, addressing them in a transparent, resolute manner can ensure that doctors never again need to resort to strikes in this country.

(The writer is Adjunct Faculty, Division of Health and Humanities, St Johns Research Institute, Bengaluru)