Last week, a 50 year old previously healthy man died in our hospital following a massive stroke. The computed tomography scan showed that he had bled deep within his brain, the blood not letting the brain perform its functions.

Death, especially sudden, evokes a medley of emotions- shock, denial, accusation, frustration, anger and grief. Not necessarily in that order.

Soon after the patient died in our ICU, an irate mob of 50 people bypassed the hospital security, got into the stroke unit and began to shout and abuse residents and nurses. The crowd refused to believe that brain hemorrhages are often fatal and there is little that doctors can do to reduce bad outcomes. Tempers rose and verbal spats threatened to turn physical. It took counseling skills of a young lecturer to defuse the violent situation, tranquil the boisterous mob, and send it home.

We learnt that a day before the patient had visited the hospital complaining of giddiness. An emergency resident interviewed him, checked his vital signs, did an ECG and found nothing wrong. She told him to see an ear-nose-throat specialist a day after, and prescribed him medications that reduce vertigo.

A day later, the patientโ€™s face sagged; the arm went limp and the leg lost power. He rapidly became drowsy, his respirations became noisy and he needed emergency hospitalization. Despite being put on a ventilator, and being administered medications that reduce brain swelling, he died within a couple of hours of admission to the hospital.

The crowd returned the night after. Although the doctors had ordered a post-mortem, the crowd kept on shouting, and refused to accept explanations, disrupting the morning activities of the hospital and inviting the attention of a large number of outpatients whose curiosity to know the chain of events made it difficult for doctors to function. Thankfully, the wiser counsels prevailed and the crowd gradually disappeared from the hospital.

Over the last few years, doctors complain, that the patients and relatives are getting increasingly inpatient, hostile, suspicious and boisterous. The traditional doctor patient relationship based on mutual trust and respect seem to be getting eroded and is getting replaced by a provider-client relationship.

Nothing wrong with patients conscious of their rights. Nothing wrong if patients develop a healthy skepticism for the medical science. Doctors should not mind if patients extract detailed explanation from them, and want to know the pluses and minuses of the various diagnostic and therapeutic decisions that the doctors make while caring for the patients. Doctors also need to understand that the patientโ€™s relatives, given sudden death of a loved one, are likely to behave irrationally.

But what do the doctors do when the patients abuse them, try to physically harm them, and start damaging hospital equipment, break glasses, and vandalize hospital furniture? How should the doctors and nurses respond when they run the real risk of being abused, molested and thrashed for no fault? Although such attacks now constitute a non-bailable offence, with the offender facing up to three years in jail, and Rs 50,000 fine on anyone who attacks a doctor or a hospital employee, law alone does not seem to be an effective measure to reduce such incidents. Public hospitals often lack enough security to protect the doctors from the mob, and young doctors- their patience evaporating โ€“ try to outsmart crowd by raising their voices to high decibel levels. We see such incidents recurring with frightening frequency in our accident and emergency departments, intensive care units and even in the wards. Often hordes of relatives and well-wishers enter the hospital and get into wards and ICU, with nobody to check them. Sensitive areas in public hospitals, such as ICUs do not have security guards.

Ethicists argue that while doctors are certainly entitled to protection if they are to perform their duties diligently, there is also an urgent need to make hospitals more accountable to the public. Although administrators believe that a good doctor patient relationship, open and honest communication between the patients and their doctors and keeping the relatives well informed about the happening in the hospital can a go a long way in reducing such incidents, young doctors point out that on several occasions, despite their best efforts they are increasingly facing confrontation, violence or verbal abuse from patients or their relatives.

Patients tend to have unrealistic expectations from the doctors and many violent incidents owe their origin to lack of perceived satisfaction with the medical services or failure to meet their voiced-and unvoiced- demands. Working conditions in public hospitals in our country are often woefully inadequate, with a small number of interns and residents caring for a large numbers of patients. Patients have to wait agonizingly long in the queues and doctors function in a chaotic, malfunctioning and unresponsive system. Little wonder that such scenarios trigger violent outbursts on the part of frustrated patients and their families.

All healthcare professionals, including doctors, have the right to work in an environment that is free from harassment and threat. Hospitals are no longer “Great Place to Work, Great Place to Receive Care and a Great Place to Practice Medicine”. They are also great place to be abused, insulted, kicked, bitten, punched, knifed, hit, stabbed or spat at.